苍白球内侧部电刺激联合内囊前肢毁损术治疗伴有强迫症的抽动秽语综合征疗效初探  

Efficacy of deep brain stimulation of the globus pallidus pars interna combined with anterior capsulotomy in the treatment of Tourette′s syndrome with obsessive-compulsive disorder: a preliminary study

作　　者：孟凡刚[1,2,3] 范世莹 高冬梅 王慧敏 高源 韩春雷 朱冠宇 刘焕光[2] 石林[2] 张华[2] 杨岸超[2] 张建国[2] Meng Fangang;Fan Shiying;Gao Dongmei;Wang Huimin;Gao Yuan;Han Chunlei;Zhu Guanyu;Liu Huanguang;Shi Lin;Zhang Hua;Yang Anchao;Zhang Jianguo(Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Beijing Tiantan Hospital,Capital Medical University,Beijing Key Laboratory of Neurostimulation,Beijing 100070,China;Chinese Institute for Brain Research,Beijing 102206,China)

机构地区：[1]首都医科大学,北京市神经外科研究所,北京100070 [2]首都医科大学附属北京天坛医院神经外科,神经电刺激研究与治疗北京市重点实验室,北京100070 [3]北京脑科学与类脑研究中心,北京102206

出　　处：《中华神经外科杂志》2022年第11期1093-1097,共5页Chinese Journal of Neurosurgery

摘　　要：目的初步探讨双侧苍白球内侧部(GPi)脑深部电刺激术(DBS)联合内囊前肢(ALIC)毁损术治疗伴有强迫症的抽动秽语综合征(TS)的短期疗效。方法2021年3—9月首都医科大学附属北京天坛医院神经外科行双侧GPi-DBS联合ALIC毁损术治疗5例伴有强迫症的TS患者。对其安全性及短期疗效进行回顾性分析。采用耶鲁综合抽动严重程度量表评分(YGTSS)评估抽动症状的改善情况,采用耶鲁-布朗强迫症严重程度量表评分(Y-BOCS)评估强迫症状改善情况。结果5例患者均成功植入GPi颅内电极并完成ALIC毁损手术,无围手术期不良反应。5例患者术后刺激器测试期间YGTSS和Y-BOCS的改善率分别为(49.1±26.2)%(16.0%~91.2%)、(68.9±29.4)%(38.2%~100.0%);开启刺激器后2~6个月,分别为(48.6±26.7)%(18.7%~91.2%)、(61.6±38.1)%(11.8%~100.0%)。术后无一例患者发生永久性并发症。结论初步观察显示,双侧GPi-DBS联合ALIC毁损术短期内可以改善伴有强迫症的TS患者的抽动和强迫症状,长期疗效有待进一步随访。Objective To investigate the short-term efficacy of bilateral deep brain stimulation(DBS)of the globus pallidus interna(GPi)combined with capsulotomy of the anterior limb of the internal capsule(ALIC)in the treatment of Tourette syndrome(TS)with comorbid obsessive-compulsive disorder(OCD).Methods Five TS patients with OCD were treated with GPi-DBS combined with ALIC capsulotomy at the Department of neurosurgery,Beijing Tiantan Hospital,Capital Medical University from March 2021 to September 2021.The short-term safety and clinical efficacy were analyzed retrospectively.The scores of Yale Global Tic Severity Scale(YGTSS)and Yale Brown Obsessive-Compulsive Scale(Y-BOCS)were used to evaluate the improvement of tic symptoms and OCD respectively.Results The implantation of electrodes into the GPi and the ALIC capsulotomy were successfully completed without perioperative adverse events.During the postoperative test period,the improvement rates of YGTSS and Y-BOCS score were(49.1±26.2)%(16.0%-91.2%)and(68.9±29.4)%(38.2%-100.0%)respectively.At 2-6 months after the impulse generator was turned on,the improvement rates of YGTSS and Y-BOCS scores were(48.6±26.7)%(18.7%-91.2%)and(61.6±38.1)%(11.8%-100.0%)respectively.None of the patients developed permanent complications after GPi-DBS combined with ALIC capsulotomy.Conclusions Preliminary observation has shown that GPi-DBS combined with ALIC capsulotomy can improve the tic symptoms and OCD of TS patients in a short time.The long-term efficacy still needs further follow-up.

关 键 词：多动秽语综合征 强迫性障碍 深部脑刺激法 苍白球内侧部 内囊前肢毁损术 

分 类 号：R651.1[医药卫生—外科学]