Article2009

Thalamic deep brain stimulation for treatment-refractory Tourette syndrome

Mauro Porta · Andrea E. Cavanna · Domenico Servello · Marco Sassi · Hugh Edward Rickards · Mary May Robertson

168 citations0/0 files storedNeurology

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Obsessive-Compulsive Spectrum Disorders Neurological disorders and treatments Botulinum Toxin and Related Neurological Disorders

Abstract

BACKGROUND: Eighteen patients with severe and refractory Tourette syndrome (TS) underwent bilateral thalamic deep brain stimulation (DBS). OBJECTIVE: To assess the long-term outcome on tics, behavioral symptoms, and cognitive functions in the largest case series of thalamic DBS for TS to date. METHODS: In this prospective cohort study, 15 of the original 18 patients were evaluated before and after surgery according to a standardized protocol that included both neuropsychiatric and neuropsychological assessments. RESULTS: In addition to marked reduction in tic severity (p = 0.001), 24-month follow-up ratings showed improvement in obsessive-compulsive symptoms (p = 0.009), anxiety symptoms (p = 0.001), depressive symptoms (p = 0.001), and subjective perception of social functioning/quality of life (p = 0.002) in 15 of 18 patients. There were no substantial differences on measures of cognitive functions before and after DBS. CONCLUSIONS: At 24-month follow-up, tic severity was improved in patients with intractable Tourette syndrome (TS) who underwent bilateral thalamic deep brain stimulation. Available data from 15 of 18 patients also showed that neuropsychiatric symptoms were improved and cognitive performances were not disadvantaged. Controlled studies on larger cohorts with blinded protocols are needed to verify that this procedure is effective and safe for selected patients with TS. LEVEL OF EVIDENCE: This study provides class IV evidence that bilateral thalamic deep brain stimulation reduces global tic severity measured 24 months after implantation in patients with severe intractable Tourette syndrome.

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References

2000Tourette syndrome, associated conditions and the complexities of treatment 1999Stereotactic treatment of Gilles de la Tourette syndrome by high frequency stimulation of thalamus 2008The prevalence and epidemiology of Gilles de la Tourette syndrome 2005Tourette's syndrome and deep brain stimulation 2007Deep brain stimulation in 18 patients with severe Gilles de la Tourette syndrome refractory to treatment: the surgery and stimulation 2007Prospective randomized double-blind trial of bilateral thalamic deep brain stimulation in adults with Tourette syndrome 2008Internal Pallidal and Thalamic Stimulation in Patients With Tourette Syndrome 2008The Gilles de la Tourette Syndrome–Quality of Life Scale (GTS-QOL)

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2011European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: deep brain stimulation 2012The psychopathological spectrum of Gilles de la Tourette syndrome 2017Tourette Syndrome and Chronic Tic Disorders: The Clinical Spectrum Beyond Tics 2019Tics and Tourette Syndrome 2014Tics and Tourette Syndrome

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