感觉性抽动的立体定向苍白球射频毁损术

Stereotactic Pallidotomy with Radiofrequency for Sensory Tics in Tourette Syndrome

目的研究分析22例Tourette综合征(TS)的感觉性抽动特点及实施单侧苍白球腹后部毁损术的治疗作用。方法对22例经过系统的精神科药物及心理行为治疗失败的TS患者实施立体定向苍白球射频毁损术,应用YGTSS评分量表和感觉性先兆问卷对运动性抽动和感觉性抽动进行评估。结果22例患者中18例(81.8%)有各种类型的感觉性抽动,位于头/面部者最多(72.2%),术后感觉性抽动发作频率较术前均有所下降,YGTSS各项评分均显著下降(P<0.01),其中运动抽动的改善率最高。结论感觉性抽动是TS的常见症状,单侧苍白球腹后部毁损术能全面减轻TS各种症状,但远期疗效有待进一步观察。

Objective To observe the curative effect of stereotactic pallidotomy with radiofrequency on sensory tics in Tourette syndrome. Methods The stereotactic lesioning of unilateral posteroventral globus pallidus with radiofrequency was performed under the guidance of microerectrode recording in 22 patients with refractory Tourette syndrome. And tic severty and sensory tics were accessed by Yale global tic severity scale （YGTSS） and premonitory sensory phenomenon questionnaire. Results There were various types of sensory tics in 18 of 22 patients with Tourette syndrome （81.8%）. The sensory tics occurred in the heads and faces in 13 of 18 patients with various types of sensory tics （72.2%）. The frequency of sensory tics was significantly reduced after the pallidotomy as compared to that before pallidotomy. There was significant improvement in the Tourette symptom severity scale of th side opposite to the lesioning after the pallidotomy as compared to that before the pallidotomy （P〈0.01）. The improvement in motor tic scale was more signigicant. Conclusions Sensory tics is a common symptom in the patients with Tourette syndrome. Pallidotomy produces a significant and short term reduction of tic severity in the patients with refractory Tourette syndrome. The long-term effect of pallidotomy on sensory tics should be further studied in the patients with refractory Tourette syndrome.