脑内多靶点射频毁损与脑深部电刺激治疗抽动秽语综合征

Therapeutic approach to Tourette＇s syndrome based on multi-target radiofrequency ablation and deep brain stimulation

目的探讨立体定向下脑内多靶点射频毁损术与脑深部电刺激治疗抽动秽语综合征的疗效。方法选择第四军医大学唐都医院神经外科自2007年1月至2013年1月收治的10例难治性抽动秽语综合征患者，对其中6例患者在局麻加强化或全麻下行脑内多靶点射频毁损术，另4例患者行脑深部电刺激术。术后定期随访与程控．在术前、术后f或开机后）1周、1月（部分患者在术后6月、1年、2-6年1，采用耶鲁综合抽动严重程度量表（YGTSS）对患者抽动症状评分，并用耶鲁布朗强迫症量表（YBOCS）等精神量表评估相应精神症状改善情况。结果10例患者手术均顺利，术后无严重并发症。术后（或开机后11年YGTSS评分中运动抽动评分、发音抽动评分、损害评分、总体评分分别降至（4．6±1．5）分、（5．1±2．2）分、f8．9±6．0）分、（18．6±9．3）分，与术前比较差异均具有统计学意义（P〈0．05）。8例合并强迫症状患者术后1年内YBOCS评分亦明显降低。结论两种立体定向手术方式对难治性抽动秽语综合征均具有良好的治疗效果。

Objective To evaluate the potential effect of multi-target radiofrequency ablation and deep brain stimulation on patients with treatment-refractory Tourette＇ s syndrome （TS）. Methods A total of 10 patients with TS, admitted to our hospital from January 2007 to January 2013, were enrolled into the current study. Six patients received multi-target radiofrequency ablation after general or potentiated local anesthesia. Four patients received the strategy of implanting the electrodes in brain and pulse generator under skin. The severities of ties and obsessive-compulsive disorder （OCD） symptoms were evaluated, respectively, by Yale Global Tic Severity Scale （YGTSS） and Yale-Brown Obsessive Compulsive Scale （YBOCS） in all the patients before operation, one week and one month after operation and during the other follow-up periods （some at 6 months, 1 or 2-6 years after operation）. Results All the patients underwent the operation successfully without any severe complications. Postoperative scores of motor tics, phonic tics, overall impairment rating and global severity in YGTSS were significantly decreased （[4.6±1.5] points, [5.1±2.2] points, [8.9±6.0] points and [18.6±9.3] points） as compared with those before the surgery （P〈0.05）. The severities of OCD evaluated by YBOCS in eight patients were also relieved one year after the operation. Conclusion The tic and mental symptoms of intractable TS could be relieved remarkably by the stereotactic technique of nucleus lesion and deep brain stimulation.