Subthalamic deep brain stimulation for refractory Gilles de la Tourette's syndrome: clinical outcome and functional connectivity

被引:9
|
作者
Dai, Lulin [1 ]
Xu, Wenying [1 ]
Song, Yunhai [1 ,2 ]
Huang, Peng [1 ]
Li, Ningfei [3 ]
Hollunder, Barbara [3 ,4 ,5 ]
Horn, Andreas [3 ,4 ,6 ,7 ,8 ]
Wu, Yiwen [9 ]
Zhang, Chencheng [1 ,10 ]
Sun, Bomin [1 ]
Li, Dianyou [1 ]
机构
[1] Shanghai Jiao Tong Univ, Ruijin Hosp, Ctr Funct Neurosurg, Dept Neurosurg,Sch Med, Shanghai, Peoples R China
[2] Shanghai Jiao Tong Univ, Shanghai Childrens Med Ctr, Dept Neurosurg, Med Sch, Shanghai, Peoples R China
[3] Charite Univ Med Berlin, Dept Neurol, Movement Disorders & Neuromodulat Unit, Berlin, Germany
[4] Charite Univ Med Berlin, Einstein Ctr Neurosci Berlin, Berlin, Germany
[5] Humboldt Univ, Berlin Sch Mind & Brain, Berlin, Germany
[6] Brigham & Womens Hosp, Ctr Brain Circuit Therapeut, Dept Neurol, 75 Francis St, Boston, MA 02115 USA
[7] Massachusetts Gen Hosp, MGH Neurosurg, Boston, MA 02114 USA
[8] Massachusetts Gen Hosp, Ctr Neurotechnol & Neurorecovery CNTR MGH Neurol, Boston, MA 02114 USA
[9] Shanghai Jiao Tong Univ, Ruijin Hosp, Ctr Funct Neurosurg, Dept Neurol,Sch Med, Shanghai, Peoples R China
[10] Shanghai Res Ctr Brain Sci & Brain Inspired Techn, Shanghai, Peoples R China
关键词
Subthalamic nucleus; Deep brain stimulation; Gilles de la Tourette's syndrome; Psychiatric comorbidity; Clinical outcome; Functional connectivity; OBSESSIVE-COMPULSIVE DISORDER; WEIGHT-GAIN; PARKINSONS-DISEASE; TIC SEVERITY; DOUBLE-BLIND; FOLLOW-UP; NUCLEUS; MODULATION; CORTEX; DBS;
D O I
10.1007/s00415-022-11266-w
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background Deep brain stimulation (DBS) is a promising novel approach for managing refractory Gilles de la Tourette's syndrome (GTS). The subthalamic nucleus (STN) is the most common DBS target for treating movement disorders, and smaller case studies have reported the efficacy of bilateral STN-DBS treatment for relieving tic symptoms. However, management of GTS and treatment mechanism of STN-DBS in GTS remain to be elucidated. Methods Ten patients undergoing STN-DBS were included. Tics severity was evaluated using the Yale Global Tic Severity Scale. The severities of comorbid psychiatric symptoms of obsessive-compulsive behavior (OCB), attention-deficit/hyperactivity disorder, anxiety, and depression; social and occupational functioning; and quality of life were assessed. Volumes of tissue activated were used as seed points for functional connectivity analysis performed using a control dataset. Results The overall tics severity significantly reduced, with 62.9% +/- 26.2% and 58.8% +/- 27.2% improvements at the 6- and 12-months follow-up, respectively. All three patients with comorbid OCB showed improvement in their OCB symptoms at both the follow-ups. STN-DBS treatment was reasonably well tolerated by the patients with GTS. The most commonly reported side effect was light dysarthria. The stimulation effect of STN-DBS might regulate these symptoms through functional connectivity with the thalamus, pallidum, substantia nigra pars reticulata, putamen, insula, and anterior cingulate cortices. Conclusions STN-DBS was associated with symptomatic improvement in severe and refractory GTS without significant adverse events. The STN is a promising DBS target by stimulating both sensorimotor and limbic subregions, and specific brain area doses affect treatment outcomes.
引用
收藏
页码:6116 / 6126
页数:11
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