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

Richard S. Dowd Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts; and

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Michael Pourfar Department of Neurosurgery, New York University Langone Medical Center, New York, New York

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Alon Y. Mogilner Department of Neurosurgery, New York University Langone Medical Center, New York, New York

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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.

ABBREVIATIONS

CM-PF = centromedian-parafascicular; DBS = deep brain stimulation; GPI = globus pallidus internus; OCD = obsessive-compulsive disorder; TS = Tourette syndrome; VOI = ventralis oralis internus; YBOCS = Yale-Brown Obsessive Compulsive Scale; YGTSS = Yale Global Tic Severity Scale.
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  • 1

    Ackermans L, Duits A, van der Linden C, Tijssen M, Schruers K, Temel Y, et al.: Double-blind clinical trial of thalamic stimulation in patients with Tourette syndrome. Brain 134:832844, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Ackermans L, Neuner I, Temel Y, Duits A, Kuhn J, Visser-Vandewalle V: Thalamic deep brain stimulation for Tourette syndrome. Behav Neurol 27:133138, 2013

  • 3

    Anderson D, Kartha N: Deep brain stimulation in nonparkinsonian movement disorders and emerging technologies, targets, and therapeutic promises in deep brain stimulation. Neurol Clin 31:809826, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Asazuma T, Toyama Y, Watanabe M, Suzuki N, Fujimura Y, Hirabayashi K: Clinical features associated with recurrence of tumours of the spinal cord and cauda equina. Spinal Cord 41:8589, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Babel TB, Warnke PC, Ostertag CB: Immediate and long term outcome after infrathalamic and thalamic lesioning for intractable Tourette's syndrome. J Neurol Neurosurg Psychiatry 70:666671, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Bajwa RJ, de Lotbinière AJ, King RA, Jabbari B, Quatrano S, Kunze K, et al.: Deep brain stimulation in Tourette's syndrome. Mov Disord 22:13461350, 2007

  • 7

    Burd L, Kerbeshian PJ, Barth A, Klug MG, Avery PK, Benz B: Long-term follow-up of an epidemiologically defined cohort of patients with Tourette syndrome. J Child Neurol 16:431437, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Cannon E, Silburn P, Coyne T, O'Maley K, Crawford JD, Sachdev PS: Deep brain stimulation of anteromedial globus pallidus interna for severe Tourette's syndrome. Am J Psychiatry 169:860866, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Dehning S, Leitner B, Schennach R, Müller N, Bötzel K, Obermeier M, et al.: Functional outcome and quality of life in Tourette's syndrome after deep brain stimulation of the posteroventrolateral globus pallidus internus: long-term followup. World J Biol Psychiatry 15:6675, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    DeLong M, Wichmann T: Deep brain stimulation for movement and other neurologic disorders. Ann N Y Acad Sci 1265:18, 2012

  • 11

    Dueck A, Wolters A, Wunsch K, Bohne-Suraj S, Mueller JU, Haessler F, et al.: Deep brain stimulation of globus pallidus internus in a 16-year-old boy with severe Tourette syndrome and mental retardation. Neuropediatrics 40:239242, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Flaherty AW, Williams ZM, Amirnovin R, Kasper E, Rauch SL, Cosgrove GR, et al.: Deep brain stimulation of the anterior internal capsule for the treatment of Tourette syndrome: technical case report. Neurosurgery 57:4 Suppl E403, 2005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Ganos C, Roessner V, Münchau A: The functional anatomy of Gilles de la Tourette syndrome. Neurosci Biobehav Rev 37:10501062, 2013

  • 14

    Goodman WK, Price LH, Rasmussen SA, et al.: The Yale–Brown Obsessive–Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 46:10061011, 1989

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Guy W: Clinical global impressions. ECDEU Assessment Manual for Psychopharmacology—Revised Rockville, MD, U.S. Department of Health, Education, and Welfare,

  • 16

    Hariz MI, Robertson MM: Gilles de la Tourette syndrome and deep brain stimulation. Eur J Neurosci 32:11281134, 2010

  • 17

    Jankovic J: Neurologic Clinics Tourette Syndrome Philadelphia, W.B. Saunders, 1997. 15:

  • 18

    Kaido T, Otsuki T, Kaneko Y, Takahashi A, Omori M, Okamoto T: Deep brain stimulation for Tourette syndrome: a prospective pilot study in Japan. Neuromodulation 14:123129, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Katlowitz K, Pourfar MH, Israel Z, Mogilner AY: Intraparenchymal cysts following deep brain stimulation: variable presentations and clinical courses. Oper Neurosurg [in press], 2016

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Kefalopoulou Z, Zrinzo L, Jahanshahi M, Candelario J, Milabo C, Beigi M, et al.: Bilateral globus pallidus stimulation for severe Tourette's syndrome: a double-blind, randomised crossover trial. Lancet Neurol 14:595605, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Kuhn J, Bartsch C, Lenartz D, Huys D, Daumann J, Woopen C, et al.: Clinical effectiveness of unilateral deep brain stimulation in Tourette syndrome. Transl Psychiatry 1:e52, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Leckman JF, Peterson BS, Anderson GM, Arnsten AFT, Pauls DL, Cohen DJ: Pathogenesis of Tourette's syndrome. J Child Psychol Psychiatry 38:119142, 1997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Leckman JF, Riddle MA, Hardin MT, Ort SI, Swartz KL, Stevenson J, Cohen DJ: The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 28:566573, 1989

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Lee MWY, Au-Yeung MM, Hung KN, Wong CK: Deep brain stimulation in a Chinese Tourette's syndrome patient. Hong Kong Med J 17:147150, 2011

  • 25

    Martínez-Fernández R, Zrinzo L, Aviles-Olmos I, Hariz M, Martinez-Torres I, Joyce E, et al.: Deep brain stimulation for Gilles de la Tourette syndrome: a case series targeting subregions of the globus pallidus internus. Mov Disord 26:19221930, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Mink JW, Walkup J, Frey KA, Como P, Cath D, Delong MR, et al.: Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome. Mov Disord 21:18311838, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Mogilner AY, Pourfar M, Deeb W, Rizer K, Rossi J, Dowd R, et al.: International Tourette's syndrome deep brain stimulation registry and database. Stereotact Funct Neurosurg 94:Suppl 2 50, 2017. (Abstract)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Porta M, Saleh C, Zekaj E, Zanaboni Dina C, Bona AR, Servello D: Why so many deep brain stimulation targets in Tourette's syndrome? Toward a broadening of the definition of the syndrome. J Neural Transm (Vienna) 123:785790, 2016. [Erratum in J Neural Transm (Vienna) 123: 1355, 2016]

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Porta M, Servello D, Zanaboni C, Anasetti F, Menghetti C, Sassi M, et al.: Deep brain stimulation for treatment of refractory Tourette syndrome: long-term follow-up. Acta Neurochir (Wien) 154:20292041, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Pourfar M, Budman C, Mogilner A: A case of deep brain stimulation in Tourette's complicated by twiddler's syndrome. Mov Disord Clin Pract 2:192193, 2015

  • 31

    Pourfar M, Feigin A, Tang CC, Carbon-Correll M, Bussa M, Budman C, et al.: Abnormal metabolic brain networks in Tourette syndrome. Neurology 76:944952, 2011

  • 32

    Rickards H, Wood C, Cavanna AE: Hassler and Dieckmann's seminal paper on stereotactic thalamotomy for Gilles de la Tourette syndrome: translation and critical reappraisal. Mov Disord 23:19661972, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Sachdev PS, Mohan A, Cannon E, Crawford JD, Silberstein P, Cook R, et al.: Deep brain stimulation of the antero-medial globus pallidus interna for Tourette syndrome. PLoS One 9:e104926, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Schoenberg MR, Maddux BN, Riley DE, Whitney CM, Ogrocki PK, Gould D, et al.: Five-months-postoperative neuropsychological outcome from a pilot prospective randomized clinical trial of thalamic deep brain stimulation for Tourette syndrome. Neuromodulation 18:97104, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Schrock LE, Mink JW, Woods DW, Porta M, Servello D, Visser-Vandewalle V, et al.: Tourette syndrome deep brain stimulation: a review and updated recommendations. Mov Disord 30:448471, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Servello D, Sassi M, Brambilla A, Defendi S, Porta M: Long-term, post-deep brain stimulation management of a series of 36 patients affected with refractory Gilles de la Tourette syndrome. Neuromodulation 13:187194, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Servello D, Zekaj E, Saleh C, Lange N, Porta M: Deep brain stimulation in Tourette syndrome: what does the future hold? A cohort of 48 patients. Neurosurgery 78:91100, 2016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Servello D, Zekaj E, Saleh C, Zanaboni Dina C, Porta M: Sixteen years of deep brain stimulation in Tourette's syndrome: a critical review. J Neurosurg Sci 60:218229, 2016

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Servello D, Zekaj E, Sassi M, Menghetti C, Porta M: Submuscular submammarian internal pulse generator implantation in a patient with Tourette's syndrome and obsessive compulsive behavior. Neuromodulation 17:9697, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Smeets AY, Duits AA, Plantinga BR, Leentjens AF, Oosterloo M, Visser-Vandewalle V, et al.: Deep brain stimulation of the internal globus pallidus in refractory Tourette syndrome. Clin Neurol Neurosurg 142:5459, 2016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Tanner CM, Goldman SM: Epidemiology of Tourette syndrome. Neurol Clin 15:395402, 1997

  • 42

    Zabek M, Sobstyl M, Koziara H, Dzierzecki S: Deep brain stimulation of the right nucleus accumbens in a patient with Tourette syndrome. Case report. Neurol Neurochir Pol 42:554559, 2008

    • PubMed
    • Search Google Scholar
    • Export Citation

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