脑深部电刺激治疗抽动秽语综合征伴发强迫症状患者的长期疗效

Long--term efficacy of deep brain stimulation in the treatment of Tourette syndrome with obsessive--compulsive symptoms

目的探讨脑深部电刺激术（DBS）对伴发强迫症状的抽动秽语综合征（TS）患者的长期疗效。方法回顾性分析2010年1月～2013年9月首都医科大学宣武医院功能神经外科采用双侧苍白球腹后内侧部（GPi）DBS术治疗的8例合并强迫症（0CD）的TS患者的临床资料。分别于术前，术后6、12个月及最后一次随访，应用耶鲁综合抽动严重程度评分量表（YGTSS）评估抽动症状的改善情况，应用耶鲁-布朗强迫量表（Y--BOCS）及功能大体评定量表（GAF）评估强迫症状和社会功能的改善情况。结果8例患者的随访时间为21～64个月，平均42．9个月。8例患者在抽动症状明显改善的同时，伴发的OCD症状也明显减轻，社会功能明显提高。术后6、12个月及最后一次随访时抽动症状分别较术前改善59．2％、60．9％和58．4％，强迫症状分别改善34．7％、36．4％和39．2％，GAF评分分别改善51．5％、62．1％和64．4％，与术前比较，差异均有统计学意义（P〈0．01）。相关性分析显示，术后YGTSS评分与Y—BOCS评分呈正相关（r=0．618，P〈0．01），与GAF评分呈负相关（r=-0．917，P〈0．01），无长期的严重不良反应。结论GPiDBS是治疗TS安全有效的方法，在明显缓解抽动症状的同时，能有效地缓解伴发的0CD症状，明显改善社会功能，长期疗效稳定。

Objective To explore the long term efficacy of deep brain stimulation in the treat- ment of Tourette syndrome（TS） with obsessive--compulsive symptoms. Methods Bilateral globus palli- dus interna （GPi） deep brain stimulation （DBS） were performed in 8 cases of intractable TS with obsess- ive- compulsive symptoms. Yale Global Tic Severity Scale （YGTSS） was used to evaluate the symptoms of tics; Yale--Brown Obsessive Compulsive Scale （Y--BOCS） and Global Assessment Function Scale （GAF） were used to evaluate the obsessive--compulsive symptoms and quality of life. All patients were followed up preoperative, 6 and 12 months postoperative and at the final follow--up. Results All pa- tients were followed up for 21-64 months （average of 42. 9 months）. Accompanied with obvious im- provement of tics symptoms, the symptoms of obsessive--compulsive and quality of life were also greatly improved in the 8 patients. Compared with preoperative, the symptoms of tics were improved by 59.2%, 60.9% and 58.4% ; the symptoms of obsessive--compulsive were improved by 34.7%, 64.4% and 39.2% ; the GAF score was improved by 51.5%, 62.1% and 36.4 %, respectively （all P〈 0.01）. Correlation analysis showed that the postoperative YGTSS scores were positively correlated with the Y--BOCS scores （r = 0. 618,P〈 0.01） and negatively correlated with the GAF scores （r =-0. 917,P〈0.01）. There were no long- term severe surgical complications in the follow- up period. Conclusions GPi DBS is an effective and safe treatment for TS, which can comprehensively alleviate the tics symptoms and obsessive--compulsive symptoms, significantly improve the qualities of life. The long --term efficacy is stable.