背景:脑深部电刺激(DBS)是一种治疗难治性抽动——抽动——综合征(GTS)的有希望的治疗方法。然而,其长期功效,安全,推荐的手术年龄仍然存在争议,需要证据来比较不同的年龄类别。
方法:这项回顾性队列研究招募了2006年10月至2022年4月在两个国家中心接受DBS的102名GTS患者。患者分为两个年龄段:儿童(年龄<18岁;n=34)和成人(年龄≥18岁;n=68)。作为抽动症状的纵向结果由YGTSS评估,还有YBOCS,BDI,和GTS-QOL评估强迫症(OCD)的症状,抑郁症,和生活质量,分别。
结果:总体而言,其中包括完成中位60个月随访的患者,儿童和成人之间没有显着差异(p=0.44)。总的来说,YGTSS总分显示术后明显改善,并随时间进一步改善(改善了45.2%,51.6%,55.5%,55.6%,57.8%,与基线相比,随访6、12、24、36、48和≥60个月后61.4%,分别)在所有纳入的患者中(所有p<0.05)。在YGTSS评分≥60个月的随访中,儿童的改善明显高于成人(70.1%vs55.9%,p=0.043),儿童组达到60%改善的时间明显缩短(中位数为6个月vs12个月,p=0.013)。在最后一次随访中,平均改善为45.4%,48.9%,分别为55.9%和40.3%,45.4%,和YBOCS的47.9%,BDI,儿童和成人的GTS-QOL评分,分别,均较基线显著改善(均p<0.05),但两组间无显著差异(均p>0.05),儿童组GTS-QOL评分的改善明显高于成人(55.9%vs.47.9%,p=0.049)。
结论:DBS对患有GTS的儿童和成人均显示出可接受的长期疗效和安全性。对于年龄小于18岁的患者进行的手术似乎显示出可接受的长期疗效和安全性,并且与手术时年龄大于18岁的患者相比,没有增加获益的风险。然而,儿童手术也应谨慎进行,以确保其难治性和安全性。
BACKGROUND: Deep brain stimulation (DBS) is a promising therapy for refractory Gilles de la Tourette syndrome (GTS). However, its long-term efficacy, safety, and recommended surgical age remain controversial, requiring evidence to compare different age categories.
METHODS: This retrospective cohort study recruited 102 GTS patients who underwent DBS between October 2006 and April 2022 at two national centers. Patients were divided into two age categories: children (aged < 18 years; n = 34) and adults (aged ≥ 18 years; n = 68). The longitudinal outcomes as tic symptoms were assessed by the YGTSS, and the YBOCS, BDI, and GTS-QOL were evaluated for symptoms of obsessive-compulsive disorder (OCD), depression, and quality of life, respectively.
RESULTS: Overall, these included patients who finished a median 60-month follow-up, with no significant difference between children and adults (p = 0.44). Overall, the YGTSS total score showed significant postoperative improvements and further improved with time (improved 45.2%, 51.6%, 55.5%, 55.6%, 57.8%, 61.4% after 6, 12, 24, 36, 48, and ≥ 60 months of follow-up compared to baseline, respectively) in all included patients (all p < 0.05). A significantly higher improvement was revealed in children than adults at ≥ 60 months of follow-up in the YGTSS scores (70.1% vs 55.9%, p = 0.043), and the time to achieve 60% improvement was significantly shorter in the children group (median 6 months vs 12 months, p = 0.013). At the last follow-up, the mean improvements were 45.4%, 48.9%, and 55.9% and 40.3%, 45.4%, and 47.9% in YBOCS, BDI, and GTS-QOL scores for children and adults, respectively, which all significantly improved compared to baseline (all p < 0.05) but without significant differences between these two groups (all p > 0.05), and the children group received significantly higher improvement in GTS-QOL scores than adults (55.9% vs. 47.9%, p = 0.049).
CONCLUSIONS: DBS showed acceptable long-term efficacy and safety for both children and adults with GTS. Surgeries performed for patients younger than 18 years seemed to show acceptable long-term efficacy and safety and were not associated with increased risks of loss of benefit compared to patients older than 18 at the time of surgery. However, surgeries for children should also be performed cautiously to ensure their refractoriness and safety.