Deep Brain Stimulation of the Antero-Medial Globus Pallidus Interna for Tourette Syndrome

Abstract

BackgroundWe have previously reported the results of Deep Brain Stimulation (DBS) of the antero-medial globus pallidus interna (GPi) for severe Tourette Syndrome (TS) in 11 patients. We extend this case series to 17 patients and a longer follow-up to a maximum of 46 months.Methods17 patients (14 male; mean age 29.1 years, range 17–51 years) with severe and medically intractable TS were implanted with Medtronic quadripolar electrodes bilaterally in the antero-medial GPi. The primary outcome measure was the Yale Global Tic Severity Scale (YGTSS). Secondary outcome measures included the Yale-Brown Obsessive Compulsive Scale, Hamilton Depression Rating Scale, Gilles de la Tourette Quality of Life Scale and Global Assessment of Functioning. Follow up was at one month, three months and finally at a mean 24.1 months (range 8–46 months) following surgery.ResultsOverall, there was a 48.3% reduction in motor tics and a 41.3% reduction in phonic tics at one month, and this improvement was maintained at final follow-up. 12 out of 17 (70.6%) patients had a>50% reduction in YGTSS score at final follow up. Only 8 patients required ongoing pharmacotherapy for tics post-surgery. Patients improved significantly on all secondary measures. Adverse consequences included lead breakage in 4 patients, infection (1), transient anxiety (2), dizziness (1), poor balance (1) and worsening of stuttering (1).ConclusionsThis case series provides further support that antero-medial GPi DBS is an effective and well tolerated treatment for a subgroup of severe TS, with benefits sustained up to 4 years.

Refining the Deep Brain Stimulation Target within the Limbic Globus Pallidus Internus for Tourette Syndrome

“…However, we observed that the symptom course over time can vary, with some patients tending to reach a response plateau while others deteriorate in comparison to previous follow-up points, unless stimulation parameters are progressively increased, although in general such patients do not decline to baseline tic severity. These observations are supported by previous long-term studies targeting the pallidum [2,3], though whether other factors also predict long-term tic outcome remains unclear.…”

“…The anteromedial or limbic GPi (amGPi) has yielded promising results as a DBS target for TS patients not only in a number of open label case series [1,2,3,4,5], but also in a recent randomised controlled trial [6]. However, even among patients receiving bilateral amGPi DBS, there is considerable variability in response raising uncertainty regarding the optimal site for electrode placement even within this region.…”

Long‐term effects of anterior pallidal deep brain stimulation for tourette's syndrome

“…Tourette's syndrome (TS) is a disabling chronic neuropsychiatric disorder characterized by motor and vocal tics, associated with behavioral disorders and repercussions on family relationships, social life, and ability to work. Although preliminary findings suggest that deep brain stimulation of the anterior internal pallidum (aGPi‐DBS) may reduce symptoms of severe and refractory forms of TS, long‐term outcomes have not been fully reported . We prospectively followed 16 TS patients treated with aGPi‐DBS for 48 months .…”

WINCS Harmoni: Closed-loop dynamic neurochemical control of therapeutic interventions

“…This is important because different diseases and symptoms respond to different therapies on different timescales, which can vary from seconds to months4849505152. For example, fast therapeutic responses, such as those found in DBS for treatment of tremor, may be mediated by nearly instantaneous and rapidly reversible mechanisms involving immediate modulation of pathological neural activity53.…”