脑深部电刺激治疗药物难治性抽动秽语综合征的疗效观察  

Observation on the efficacy of deep brain stimulation in the treatment of refractory Tourette syndrome

作　　者：高源 范世莹 高冬梅 王慧敏[2,3] 葛燕 韩春雷 朱冠宇 刘焕光[2] 石林[2] 张华[2] 杨岸超[2] 张建国[2] 孟凡刚[1,2] Gao Yuan;Fan Shiying;Gao Dongmei;Wang Huimin;Ge Yan;Han Chunlei;Zhu Guanyu;Liu Huanguang;Shi Lin;Zhang Hua;Yang Anchao;Zhang Jianguo;Meng Fangang(Bejing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Centerof Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery of Bejing Fengtai Hospital,Beijing 100070,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学中心,北京100070 [3]北京丰台医院神经外科,北京100070

出　　处：《中华神经外科杂志》2024年第1期17-21,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨脑深部电刺激(DBS)治疗药物难治性抽动秽语综合征(TS)的临床疗效,初步观察以苍白球内侧部(GPi)与以中央中核-束旁核复合体(CM-Pf)为靶点的DBS在改善抽动症状方面的差异。方法回顾性分析2006年10月至2023年1月于首都医科大学附属北京天坛医院神经外科学中心接受DBS治疗且随访时间≥12个月的40例TS患者的临床资料。其中33例为GPi-DBS组,7例为CM-Pf-DBS组。随访术后6、12个月患者临床症状的改善情况。临床症状的主要评估指标为耶鲁综合抽动严重程度量表(YGTSS)评分,次要评估指标为贝克抑郁量表(BDI)、汉密尔顿抑郁量表(HRDS)、医院焦虑和抑郁量表(HADS)、耶鲁布朗强迫症严重程度量表(YBOSC)评分。对比分析两组YGTSS评分的改善情况。结果40例患者术前,术后6、12个月的YGTSS评分分别为(63.6±14.2)分、(42.0±15.0)分、(36.1±16.9)分,差异有统计学意义(P<0.001);术后6、12个月YGTSS评分的改善率分别为(33.7±19.0)%、(43.1±23.3)%。BDI(24例)、HDRS(24例)、HADS(25例)、YBOCS(14例)评分在术后6、12个月随访时也均较术前有显著改善(均P<0.05)。与术前比较,GPi-DBS组和CM-Pf-DBS组术后6、12个月YGTSS评分的差异均有统计学意义(均P<0.001),但GPi-DBS组与CM-Pf-DBS组比较,术后6、12个月YGTSS评分的差异均无统计学意义(均P>0.05)。GPi-DBS组有5例患者开机后出现恶心、呕吐或异动症状。结论DBS对药物难治性TS患者的抽动症状、焦虑情绪和抑郁情绪均有改善作用,且随着手术时间的延长,改善率有逐渐增加的趋势。初步观察显示,GPi-DBS与CM-Pf-DBS在改善抽动症状方面的差异不明显。Objective To explore the clinical efficacy of deep brain stimulation(DBS)in the treatment of Tourette syndrome(TS),and to preliminarily observe the difference in the effects of targeting the globus pallidus interna(GPi)and the centromedian-parafascicular complex(CM-Pf)on the symptom improvement of TS.Methods The clinical data of 40 TS patients who received DBS at the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University from October 2006 to January 2023 were retrospectively analyzed.Among them,33 cases were in the GPi-DBS group and 7 cases were in the CM-Pf-DBS group.The improvement of clinical symptoms of the patients was followed up 6 and 12 months after surgery.The main evaluation index of clinical symptoms was the Yale Global Tic Severity Scale(YGTSS)score,and the secondary evaluation indexes were the Beck Depression Inventory(BDI),Hamilton Depression Rating Scale(HRDS),Hospital Anxiety and Depression Scale(HADS)and Yale-Brown Obsessive Compulsive Scale(YBOSC).Comparative analysis of the improvement of YGTSS scores were conducted between the two groups.ResultsThe YCTSS scores of 40 patients before surgery,6 months after surgery,and 12 months after surgery were 63.6±14.2 points,42.0±15.0 points,and 36.1±16.9 points respectively,and the differences were statistically significant(P<0.001).The improvement rates of YCTSS scores 6 and 12 months after surgery were(33.7±19.0)%and(43.1±23.3)%respectively.BDI(24 cases),HDRS(24 cases),HADS(25 cases),and YBOCS(14 cases)scores also showed a decreasing trend at 6 months and 12 months post surgery(all P<0.05).Compared with the CM-Pf-DBS group,there was no statistical significance in the improvement of YGTSS scores at 6 or 12 months after operation in the GPi-DBS group or the CM-Pf-DBS group(both P>O.05).In addition,5 patients in the GPi-DBS group developed symptoms of nausea,vomiting or dyskinesia after turning on the device.Conclusions DBS can improve tic symptoms,anxiety and depression in TS patients,and the improvement rate tends to increase wit

关 键 词：抽动秽语综合征 深部脑刺激法 治疗结果 苍白球内侧部 中央中核-束旁核复合体 

分 类 号：R651.11[医药卫生—外科学]