pvp治疗抽动秽语综合征的初步探讨

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1、PVP治疗抽动秽语综合征的初步探讨张晓华李勇杰【摘要】目的　探讨苍白球切开术（PVP）治疗抽动秽语综合征（TouretteSyndrome，TS）的疗效、安全性及电生理基础。方法　应用微电极技术对22例TS患者实施单侧PVP术，采用耶鲁综合抽动严重程度评分量表（YGTSS）进行手术疗效评估；分析6例患者内苍白球（GPi）的细胞外放电信号特点。结果　⑴术后YGTSS评分较术前明显降低（P<0.01），12个月随访疗效稳定。5例患者出现嗜睡等一过性并发症，无严重并发症。⑵GPi细胞放电频率为20-156Hz，有多种放电模式；对侧肢体肌电图显示GPi神经元放电与肢体

2、抽动运动有同步性。结论　PVP是治疗TS安全有效的措施，GPi神经元有多种放电模式并存在抽动同步化神经元，可能是抽动症状产生的电生理基础；损毁GPi异常活动神经元，可能是手术治疗的病理生理基础。【关键词】抽动秽语综合征立体定向技术微电极记录苍白球苍白球切开术AstudyonoutcomeandmechanismofsurgicaltreatmentforTourette’ssyndromeZhangXiaohua,LiYongjie.BeijingInstituteofFunctionalNeurosurgery,XuanwuHospital,CapitalU

3、niversityofMedicalSciences,Beijing100053作者单位：100053北京首都医科大学宣武医院北京功能神经外科研究所本课题受北京市科技项目基金资助（基金编号953304001）【Abstract】ObjectiveToevaluatetheefficacyandsafetyofunilateralpallidotomyintreatingTourettesyndrome(TS).Thetherapeuticelectrophysiologicalmechanismofpallidotomywasanalyzedaccording

4、tothepropertiesofGPicellsinTS.Methods22patientsunderwentmicroelectrode-guidedunilateralpallidotomy.Allpatientsreferredtosurgerywerepreviouslyfailedwithmultiplenon-surgicalmethods(psychopharmacologicalandbehaviouraltherapy).Pre-andpostoperativeticseveritieswereratedbytheYaleglobaltic

5、severityscale(YGTSS).Withthemicroelectroderecordingtechnique,thepropertiesofGPicellsin6patientswererecordedandanalyzed.Results⑴Postoperativescoresofmotortics,phonictics,overallimpairmentratingandglobalseverityinYGTSSweresignificantlydecreased(P<0.01).Theameliorationofphonicticswasle

6、ssthanmotortics.Thefollow-updataat12monthsrevealedastableefficacy.5casesexperiencedtransientcomplicationsincludeddrowsiness,intracranialpneumatocele，incontinence,diplopiaandslightlyfacialpalsyafterpallidotomy,therewerenopermanentcomplicationssuchasdeath,intracranial,hematomahemipleg

7、iaandvisualfielddefect.⑵ThedischargeratesofGPineuronsrangedfrom20to156Hz,thedischargepatternsincluderegular,irregularlyburstingandclusteringmode.ThesynchronizationsofneuronaldischargeinGPiwiththeactivitiesofcontralaterallimbswereobservedalsobyelectromyogramrecordedatthesameterm.Conc

8、lusions⑴Pallidotomy