Background: Deep brain stimulation (DBS) of the centromedian (CM) thalamic nucleus has reportedly been used to treat severe Tourette syndrome (TS) with promising outcomes; however, it remains unclear how DBS electrode position and stimulation parameters modulate the specific area and related networks. We aimed to evaluate the relationships between the anatomical location of stimulation fields and clinical responses including therapeutic and side effects. Methods: We collected data from eight TS patients treated with DBS. We evaluated the clinical outcomes using Yale Global Tic Severity Scale (YGTSS), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and Hamilton Depression Rating Scale (HAM-D). The DBS lead location was evaluated in the normalised brain space using a 3-D atlas. The volume of tissue activated (VTA) was determined, and the associated normative connective analyses were performed to link the stimulation field with the therapeutic and side effects. Results: The mean follow-up period was 10.9 ± 3.9 months. All clinical scale showed significant significant improvement. While the VTA associated with therapeutic effects covers the CM and ventrolateral nuclei and showed association with motor networks, those associated with paraesthesia and dizziness were associated with stimulation of the ventralis caudalis and red nucleus, respectively. Depressed mood was associated with the spread of stimulation current to the mediodorsal nucleus and showed association with limbic networks. Conclusion: Our study addresses the importance of accurate implantation of DBS electrodes for obtaining standardised clinical outcomes and suggests that meticulous programming with careful monitoring of clinical symptoms may improve outcomes.

中文翻译：

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在抽动秽语综合征中优化丘脑深脑刺激的神经解剖学考虑。

背景：据报道，着重的丘脑核（CM）丘脑核的深部脑刺激（DBS）已被用于治疗严重的图雷特综合症（TS），并取得了可喜的成果。然而，尚不清楚DBS电极的位置和刺激参数如何调节特定区域和相关网络。我们旨在评估刺激场的解剖位置与临床反应（包括治疗和副作用）之间的关系。方法：我们收集了八名接受DBS治疗的TS患者的数据。我们使用耶鲁全球tic严重度量表（YGTSS），耶鲁-布朗强迫症量表（Y-BOCS）和汉密尔顿抑郁量表（HAM-D）评估了临床结局。使用3-D图集在归一化的大脑空间中评估DBS导联位置。确定激活的组织（VTA）的体积，并进行了相关的规范性结缔分析，以将刺激领域与治疗和副作用联系起来。结果：平均随访时间为10.9±3.9个月。所有临床规模均显示明显改善。与治疗效果相关的VTA覆盖CM和腹外侧核，并显示与运动网络相关，而与感觉异常和头晕相关的VTA分别与尾腹和红色核的刺激相关。情绪低落与刺激电流向中枢神经核的扩散有关，并与边缘网络有关。结论：