Deep brain stimulation for Tourette syndrome: a single-center series

Abstract

OBJECTIVE Tourette syndrome (TS) is a complex neuropsychiatric disorder characterized by multiple motor and phonic tics. While pharmacological and behavioral therapy can be effective in most patients, a subset of patients remains refractory to treatment. Increasing clinical evidence from multiple centers suggests that deep brain stimulation (DBS) of the medial thalamus can be effective in many cases of refractory TS. METHODS The authors retrospectively reviewed outcomes in 13 patients with refractory TS who underwent medial thalamic DBS performed by their team over a 7-year period. Patients were evaluated by a multidisciplinary team, and preoperative objective assessments were performed using the Yale Global Tic Severity Scale (YGTSS) and Yale-Brown Obsessive Compulsive Scale. YGTSS scores were calculated at visits immediately postoperatively and at the most recent follow-up in patients with a minimum of 6 months of postoperative follow-up. Coordinates of the active DBS contacts were calculated and projected onto each patient's pre- and postoperative images. RESULTS Patients showed an average decrease of 37% (p = 0.0063) in the total tic severity at their first postoperative visit. At their latest visit, their scores achieved significance, decreasing from preoperative scores by an average of 50% (p = 0.0014). The average position of the active contact was noted to be at the junction of the posterior ventralis oralis internus/centromedian-parafascicular nuclei. Device-related complications occurred in 2 patients, necessitating additional surgeries. All patients continued to use the system at last follow-up. CONCLUSIONS The authors' data are consistent with the small but growing body of literature supporting DBS of the ventralis oralis internus/centromedian-parafascicular thalamus as an effective and relatively safe treatment for severe, refractory TS.

Deep brain stimulation for Tourette’s syndrome

“…In contrast to its effect on tic severity, DBS of the medial thalamus did not produce an overall, group mean improvement in the patients' Y-BOCS scores [37]. However at the individual level, about 63% of the patients with TS achieved a greater than 50% reduction in their Y-BOCS scores and one patient experienced an increase in OCD symptoms [37]..…”

“…Several other case reports and case series have reported that DBS of the CM-Pf region can alleviate motor tic severity as well as comorbid psychiatric symptoms in patients with TS [37,38]. In addition, one study reported that DBS of the medial thalamic region produced a mean 50% improvement in overall tic severity (YGTSS total score) at 6-month follow-up [37]. Interestingly, the active lead location was in the region of the posterior ventralis oralis internus/ CM-Pf complex [37], suggesting that the CM-Pf complex may have partially mediated the beneficial effects of the medial thalamus DBS on TS symptoms.…”

“…Furthermore, [35,36]. Several other case reports and case series have reported that DBS of the CM-Pf region can alleviate motor tic severity as well as comorbid psychiatric symptoms in patients with TS [37,38]. In addition, one study reported that DBS of the medial thalamic region produced a mean 50% improvement in overall tic severity (YGTSS total score) at 6-month follow-up [37].…”

“…This effect on TS symptom severity could stem from the modulation of excitatory fibers of the CM-Pf projecting to the striatum and subthalamic nucleus, although this hypothesis remains speculative [60]. In contrast to its effect on tic severity, DBS of the medial thalamus did not produce an overall, group mean improvement in the patients' Y-BOCS scores [37]. However at the individual level, about 63% of the patients with TS achieved a greater than 50% reduction in their Y-BOCS scores and one patient experienced an increase in OCD symptoms [37]..…”

“…In addition, one study reported that DBS of the medial thalamic region produced a mean 50% improvement in overall tic severity (YGTSS total score) at 6-month follow-up [37]. Interestingly, the active lead location was in the region of the posterior ventralis oralis internus/ CM-Pf complex [37], suggesting that the CM-Pf complex may have partially mediated the beneficial effects of the medial thalamus DBS on TS symptoms. This effect on TS symptom severity could stem from the modulation of excitatory fibers of the CM-Pf projecting to the striatum and subthalamic nucleus, although this hypothesis remains speculative [60].…”