Long-Term, Post-Deep Brain Stimulation Management of a Series of 36 Patients Af- fected With Refractory Gilles de la Tourette Syndrome
Originally published in Neuromodulation Magazine 2009: 10;13:187-94
DOI:
https://doi.org/10.47924/neurotarget2013272Keywords:
Complications, DBS, follow-up, target, TouretteAbstract
Objectives: This study aimed to assess the long-term results of deep brain stimulation (DBS) for patients affected with Gilles de la Tourette syndrome, documenting refractoriness to conservative treatments.
Material and Methods: Starting from November 2004, 36 patients diagnosed with a Tourette syndrome refractory to conventional and innovative treatments (refractory Tourette syndrome) were operated on for DBS positioning at our dedicated TouretteClinic. A total number of 79 procedures were carried out: 67 at the thalamic intralaminar/ ventralis oralis (Vo/CM-Pf) target, 2 at the posterior Gpi, and 10 at the nucleus accumbens. The target of the DBS procedurewas chosen on the basis of clinical manifestations expressed by the single patient. Six out of the ten procedures cen- tered at the Nucleus Accumbens were undertaken on the basis of a persistent behavioral comorbidity in spite of a good response over tic frequency and severity after a first DBS procedure (two interventions at the Vo/CM-Pf and one at the Gpi, bilaterally).
Results: All the patients were treated bilaterally except one, treated at the right Vo/CM-Pf because of vascular physiologicabnormalities at the left hemisphere. Two patients refused further treatments after DBS intervention (one of them requiring andobtaining complete removal of the DBS implant with no postsurgical complications documented) and were excluded from follow-up evaluation. Statistically significant improvements were reached for all the other patients concerning the evaluation
scales used (Yale Global Tic Severity Scale, Beck Depression Inventory, State-Trait Anxiety Inventory, Yale-Brown Obsessive Compulsi- veScale, and a 10-point visual analog scale for self-evaluation of the impact of TS on social integration of the patient).
Conclusions: Gilles de la Tourette syndrome is a complex neuropsychiatric disorder with a significant prevalence in the general population. More than 50% of the patients with TS present a behavioral comorbidity, and anxiety and depression are, to various degrees, associated to this“waxing and waning” clinical picture. DBS in our experience proved to be a valid treatmentmodality forthose patients who fail to respond to conservative treatment modalities. A multidisciplinary team is nevertheless necessary toproperly handle this complex therapeutic option.
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Copyright (c) 2013 Domenico Servello, Marco Sassi , Arianna Brambilla, Stefano Defendi, Mauro Porta
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