Article2012

Deep Brain Stimulation of Anteromedial Globus Pallidus Interna for Severe Tourette's Syndrome

Elisabeth Cannon · Peter A. Silburn · Terrence Coyne · Karen A O’Maley · John D. Crawford · Perminder Singh Sachdev

97 citations0/0 files storedAmerican Journal of Psychiatry

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

Abstract

OBJECTIVE: Multiple anatomical targets for deep brain stimulation (DBS) have been proposed for the treatment of severe Tourette's syndrome. In this open study, the authors evaluated the effectiveness of DBS of the anteromedial globus pallidus interna on tic severity and common comorbidities. METHOD: Eleven patients (eight of them men, mean age=39 years) with severe and medically intractable Tourette's syndrome underwent implantation of Medtronic quadripolar electrodes in the globus pallidus interna bilaterally. The primary outcome measure was the Yale Global Tic Severity Scale. Secondary outcome measures included the Yale-Brown Obsessive Compulsive Scale, the Hamilton Depression Rating Scale, the Gilles de la Tourette Syndrome-Quality of Life Scale, and the Global Assessment of Functioning Scale. Follow-up occurred at 1 month and then at a mean of 14 months after surgery (range=4-30 months). RESULTS: Ten patients (91%) reported improvement in tic severity soon after DBS. Overall, there was a 48% reduction in motor tics and a 56.5% reduction in phonic tics at final follow-up. Six patients (54.5%) had a more than 50% reduction, sustained for at least 3 months, in Yale Global Tic Severity Scale score. Only two patients required ongoing pharmacotherapy for tics after surgery, and patients improved significantly on all secondary measures. One patient did not tolerate DBS and discontinued treatment after 3 months. Greater anxiety in two patients and hardware malfunction in three patients were noteworthy adverse outcomes. CONCLUSIONS: The results suggest anteromedial globus pallidus interna DBS for Tourette's syndrome is an effective and well-tolerated treatment for a subgroup of patients with severe Tourette's syndrome.

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References

1960A RATING SCALE FOR DEPRESSION 1989The Yale-Brown Obsessive Compulsive Scale 1989The Yale Global Tic Severity Scale: Initial Testing of a Clinician-Rated Scale of Tic Severity 2005Tourette's syndrome and deep brain stimulation 2011Double-blind clinical trial of thalamic stimulation in patients 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)2006Deep brain stimulation in Tourette's syndrome: Two targets?

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2020Deep brain stimulation for Tourette’s syndrome 2015Tourette syndrome, co-morbidities and quality of life 2013Deep brain electrophysiological recordings provide clues to the pathophysiology of Tourette syndrome 2014Deep Brain Stimulation of the Antero-Medial Globus Pallidus Interna for Tourette Syndrome 2016Treatment-refractory Tourette Syndrome 2013The anteromedial GPi as a new target for deep brain stimulation in obsessive compulsive disorder

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