Article

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

University of Queensland, Brisbane, Queensland, Australia
American Journal of Psychiatry (Impact Factor: 13.56). 07/2012; 169(8):860-6. DOI: 10.1176/appi.ajp.2012.11101583
Source: PubMed

ABSTRACT 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.
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).
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.
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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    • "Today the field of application of DBS is expanding. For instance, DBS has recently been evaluated in clinical trials in patients suffering from treatment-resistant depression, and first-in-man studies have been conducted for the treatment of Tourette's syndrome (Anderson et al., 2012; Cannon et al., 2012). Despite positive clinical results, the understanding of the mechanisms of action underlying the therapeutic effects of DBS is still a matter of debate (Grill and McIntyre, 2001; Volkmann, 2004; Anderson et al., 2012). "
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