Deep Brain Stimulation for Refractory Tourette Syndrome: Electrode Position and Clinical Outcome

Abstract

The efficacy of deep brain stimulation (DBS) for refractory Tourette syndrome (TS) is accepted, but whether the efficacy of DBS treatment in the Japanese population is equivalent to those reported internationally and whether adverse effects are comparable are not yet known. This study evaluated the clinical practice and outcome of DBS for TS in a Japanese institution. This study included 25 consecutive patients with refractory TS treated with thalamic centromedian-parafascicular nucleus DBS. The severity of tics was evaluated with the Yale Global Tic Severity Scale (YGTSS) before surgery, at 1 year after surgery, and at the last follow-up of 3 years or more after surgery. The occurrence of adverse events, active contact locations, and stimulation conditions were also evaluated. YGTSS tic severity score decreased by average 45.2% at 1 year, and by 56.6% at the last follow-up. The reduction was significant for all aspects of the scores including motor tics, phonic tics, and impairment. The mean coordinates of active contacts were 7.62 mm lateral to the midline, 3.28 mm posterior to the midcommissural point, and 3.41 mm above anterior commissure-posterior commissure plane. Efficacy and stimulation conditions were equivalent to international reports. The stimulation-induced side effects included dysarthria (32.0%) and paresthesia (12.0%). Device infection occurred in three patients (12.0%) as a surgical complication. The DBS device was removed because of infection in two patients. DBS is an effective treatment for refractory TS, although careful indication is necessary because of the surgical risks and unknown long-term outcome.

European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part IV: deep brain stimulation

“…However, no significant differences were found between different brain targets ( p > 0.05). Just recently, Kimura et al [ 96 ] reported about findings from clinical practice and outcome of DBS in TS in Japan. They included 25 patients with refractory TS treated with thalamic CM-Pf DBS.…”

Tic Status in Tourette Syndrome Due to Depletion of the Deep Brain Stimulation Battery

“…The most common precipitating factors reported are febrile infection and discontinuation of regular medication . To our knowledge, this report is the first description of a tic status due to DBS IPG depletion …”

“…2 To our knowledge, this report is the first description of a tic status due to DBS IPG depletion. 3 No well-established guideline for tic status management is available, but it is recommended to readminister the previously suspended drug or administer an antipsychotic in increasing dosages. In the absence of improvement, benzodiazepines can be added, and sedation may be needed in severe cases.…”

Evidence for Thalamic Responsive Neurostimulation in Treatment of Adult and Pediatric Epilepsy

“…Lastly, preoperative MRI was analyzed for appropriate position within the hyperintense CMT, a small nucleus measuring about 10 mm in diameter. Specific MRI sequences for stereotactic planning include the magnetization-prepared 2 rapid gradient echo [12] and fast gray matter acquisition T1 inversion recovery [13,14]. The CMT belongs to the posterior intralaminar nuclei group (including the parafascicular and central lateral nuclei), lying posterior to the hypointense mediodorsal nuclei and anterior to the hypointense pulvinar.…”