Deep brain stimulation in refractary Gilles de la Tourette syndrome

Abstract

Introduction: Tourette’s syndrome (TS) is a neuro-psychiatric disorder characterized by motor and phonic tics. In severe and refractory cases surgical treatment becomes a rational option.
Materials and Methods: We present two patients diagnosed with TS based on the TS Study Group Criteria and DSM IV. Pre-surgical evaluation included neuropsychological, neurological, and psychiatric evaluations utilizing YGTSS, YBOCS, HDRS, HARS and GAF. Tetrapolar electrodes were implanted bilaterally in the globus pallidus externus (GPe) and connected to the pulse generator in the same procedure. To determine the clinical response to deep brain stimulation (DBS) the scores obtained preoperatively were compared to those obtained postoperatively.
Results: The patients experienced a marked improvement of their symptoms subjectively reported by themselves, their families and the medical team, and objectively appreciated by the clinical scales. Discussion: Vilela Filho was a pioneer in postulating that TS is the clinical expression of hyperactivity in the GPe and evaluated the effectiveness of bilateral GPe-DBS in refractory patients obtaining very good results. The cases presented here further strengthen Vilela Filho’s hypothesis and the importance of GPe as a target in patients with severe and refractory TS.
Conclusions: These cases are part of a series of patients reported by VilelaFilho with similar results, which further strengthen the efficacy of GPe bilateral DBS for the treatment for refractory TS. Although, more experiences and control studies are needed to additionally validate the effectiveness of this technique.