目的:评价脑深部电刺激(DBS)联合囊切开术治疗多发性抽动症(TS)合并运动和精神症状的疗效和安全性。
方法:这项回顾性队列研究连续招募了在我们中心接受DBS和前囊切开术联合治疗的运动和精神症状并存的TS患者。纵向马达,精神病学,评估认知结局和生活质量.此外,我们进行了系统评价和荟萃分析,以现有证据总结当前的经验.
结果:总计,纳入我们队列中的5名合格患者和6个队列中的26名汇总患者。经过平均18个月的随访,我们的队列报告运动症状显着改善了62.4%(P=0.005);强迫症(OCD)和焦虑的精神症状显着改善了87.7%(P<0.001)和78.4%(P=0.009);生活质量显着改善了61.9%(P=0.011);认知功能无明显差异(均P>0.05)。与单独进行DBS相比,联合手术可改善精神病预后和生活质量。综合研究结果表明,抽搐有显著改善(MD:57.92,95%CI:41.28-74.56,P<0.001)。强迫症(MD:21.91,95%CI:18.67-25.15,P<0.001),抑郁症(MD:18.32,95%CI:13.26-23.38,P<0.001),焦虑(MD:13.83,95%CI:11.90-15.76,P<0.001),和生活质量(MD:48.22,95%CI:43.68-52.77,P<0.001)。个体分析显示,综合治疗对运动症状的影响,精神症状,生活质量为78.6%,84.5-87.9%,83.0%,分别。不良事件的总体汇总率为50.0%,所有这些不良事件均得到解决或缓解,结局良好.
结论:DBS联合囊切开术可有效缓解TS患者的运动和精神症状,它的安全性是可以接受的。然而,应该考虑最佳候选人,和额外的经验仍然是必要的。
OBJECTIVE: To evaluate the efficacy and safety of combined deep brain stimulation (DBS) with capsulotomy for comorbid motor and psychiatric symptoms in patients with Tourette\'s syndrome (TS).
METHODS: This retrospective cohort study consecutively enrolled TS patients with comorbid motor and psychiatric symptoms who were treated with combined DBS and anterior capsulotomy at our center. Longitudinal motor, psychiatric, and cognitive outcomes and quality of life were assessed. In addition, a systematic review and meta-analysis were performed to summarize the current experience with the available evidence.
RESULTS: In total, 5 eligible patients in our cohort and 26 summarized patients in 6 cohorts were included. After a mean 18-month follow-up, our cohort reported that motor symptoms significantly improved by 62.4 % (P = 0.005); psychiatric symptoms of obsessive-compulsive disorder (OCD) and anxiety significantly improved by 87.7 % (P < 0.001) and 78.4 % (P = 0.009); quality of life significantly improved by 61.9 % (P = 0.011); and no significant difference was found in cognitive function (all P > 0.05). Combined surgery resulted in greater improvements in psychiatric outcomes and quality of life than DBS alone. The synthesized findings suggested significant improvements in tics (MD: 57.92, 95 % CI: 41.28-74.56, P < 0.001), OCD (MD: 21.91, 95 % CI: 18.67-25.15, P < 0.001), depression (MD: 18.32, 95 % CI: 13.26-23.38, P < 0.001), anxiety (MD: 13.83, 95 % CI: 11.90-15.76, P < 0.001), and quality of life (MD: 48.22, 95 % CI: 43.68-52.77, P < 0.001). Individual analysis revealed that the pooled treatment effects on motor symptoms, psychiatric symptoms, and quality of life were 78.6 %, 84.5-87.9 %, and 83.0 %, respectively. The overall pooled rate of adverse events was 50.0 %, and all of these adverse events were resolved or alleviated with favorable outcomes.
CONCLUSIONS: Combined DBS with capsulotomy is effective for relieving motor and psychiatric symptoms in TS patients, and its safety is acceptable. However, the optimal candidate should be considered, and additional experience is still necessary.