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术中磁共振引导下脑深部刺激治疗难治性抽动-秽语综合征

术中磁共振引导下脑深部刺激治疗难治性抽动-秽语综合征
解放军总医院神经外科(北京,100853)潘隆盛 凌至培 李翀 王芙昱 崔志强   梁艳华 许百男

摘 要
目的 脑深部刺激治疗难治性抽动-秽语综合征,至今仍处于尝试性治疗阶段。实施双侧苍白球腹后部(GPi -globus pallidus pars internal)脑深部刺激(Deep Brain Stimulation,DBS);观察GPi-DBS手术对治疗难治性抽动-秽语综合征的疗效和安全性。

方法 我科从2009年3月至2012年2月期间,共收治10例抽动-秽语综合征患者,其中男性9例,女性1例,平均年龄18.3(14-21)岁,平均病程10.1(3-16)年。术前经过系统的精神科药物及心理行为治疗,仍不能控制症状,均为难治性。所有患者均在术中MRI和微电极导向下行立体定向苍白球脑深部刺激器电极植入术。在手术前、术后1周、术后6个月应用耶鲁综合抽动严重程度量表(Yale global tic severity scale,YGTSS)进行评分。

结果 手术后YGTSS的发声抽动评分、运动抽动评分以及总的严重程度均较术前明显减少,具有统计学意义(P<0.O1)。结论 双侧苍白球腹后部脑深部刺激是治疗难治性抽动-秽语综合征安全有效的治疗方法之一,其远期疗效有待进一步观察。
[关键词] 抽动-秽语综合征;立体定向手术;脑深部刺激


Intraoperative Magnetic Resonance Imaging Guided to Deep Brain Stimulation for Treatment-Refractory Tourette’s Syndrome
 Pan long-sheng, Ling zhi-pei, lichong, Wang Fu-yu, Cui zhi-qiang, Liang yan-hua, Xu bai-nan .Department of Neurosurgery, General Hospital of PLA, Beijing 100853, China
【Abstract】 Objective Deep brain stimulation (DBS) has been used in a small number of patients with Tourette’s syndrome and results on tics
and comorbidities have been promising. To evaluate the efficacy and safety of treatment for intractable Tourette’s syndrome with DBS. Methods 10 patients were retrospective1y studied,male 9cases and female1case,median age was 18.3 years(range 14~21)at the time of surgery.Median duration of illness was 10.1 years(range 7~22).All patients referred to surgery were previously failed with multiple nonsurgical methods (psychophar -macological and behavioral therapy),Intraoperative Magnetic Resonance Imaging and stereotactic microelectrode-guided DBS were performed.
 Patients were rated for tic severity by the Yale global tic severity scale (YGTSS) before and after operation. Results There Was statistically significant improvement of tics with respect to the Tourette’s symptom severity scale.The reduced proportion of vocal tic scale was less than motor tic scale. Conclusions DBS provide a significant immediate
 and short term reduction of tic severity in intractable Tourette’s syndrome.The long term effect of DBS need to further studied.
[Key words] Tourette’s syndrome;Stereotactic surgery;Deep brain stimulation