Abstract
Gilles de la Tourette syndrome (GTS) is a complex neurodevelopmental disorder characterized by tics and, frequently, psychiatric and behavioral comorbidities. Above all, obsessive compulsive disorder/behavior (OCD/OCB) influences the clinical picture and has a severe impact on quality of life, eventually more than the tics themselves. Deep brain stimulation (DBS) is an effective therapy in selected, refractory cases. Clinical response to DBS may vary according to the clinical picture, comorbidities, and to the anatomical target. This retrospective study compares the results obtained from DBS in the ventralis oralis/centromedian-parascicular nucleus of the thalamus (Voi-Cm/Pf) (41 patients) and antero-medial Globus Pallidus internus (am-GPi) (14 patients), evaluating clinical response over time by means of Yale Global Tic Severity Scale (YGTSS) and Yale–Brown Obsessive-Compulsive Scale (YBOCS) scores over a period of 48 months. A significant and stable improvement in the YGTSS and YBOCS has been obtained in both groups (p < 0.001). There was a significant difference in YBOCS improvement over time between the am-GPi group and the Voi-Cm/Pf group, indicating a better and faster control of OCD/OCB symptoms in the former group. The ratio of hardware removal was 23% and limited to 13 patients in the Voi-Cm/Pf group. These results confirm that DBS is an effective therapy in treating GTS and suggest that the am-GPi might be superior to Voi-Cm/Pf in alleviating comorbid OCD/OCB.
Highlights
Gilles de la Tourette syndrome is a complex, relatively common neurodevelopmental disorder characterized by tics, which are defined as sudden tonic, clonic, or dystonic involuntary movement and sounds [1]
There was no significant difference in the mean age at surgery (31 years old in the thalamus group, 28 in the antero-medial Globus Pallidus internus (am-Globus Pallidus internus (GPi)) group) (p = 0.20)
The first target for Deep brain stimulation (DBS) used in Gilles de la Tourette syndrome (GTS) has been, more than 20 years ago, the ventralis oralis internus nucleus of the thalamus and the medial part of the centromedian/(Voi/Cm) nucleus of the thalamus [15]; the selection of this target was initially driven by the positive outcome obtained with thalamotomy in treating GTS reported by Hassler and Dieckmann [16]
Summary
Gilles de la Tourette syndrome is a complex, relatively common neurodevelopmental disorder characterized by tics, which are defined as sudden tonic, clonic, or dystonic involuntary movement and sounds [1]. Brain Sci. 2020, 10, 301 characterized by self-injurious behaviors that can result in hospitalizations and temporary (or even permanent) disabilities [6]. Comorbidities, especially psychiatric ones, are an integral part of the clinical picture and contribute to its complexity: GTS is frequently associated with psychopathologies and behavioral aspects, such as obsessive compulsive disorder/behavior (OCD/OCB), attention deficit hyperactivity disorder (ADHD), self-injurious behaviors (SIBs), depression, anxiety, and personality disorders; less common aspects are conduct disorder, oppositional defiant disorder, learning difficulties, and aggressiveness [7]. Obsessive-compulsive tic disorder (OCTD) is a GTS subtype characterized by OCD/OCB as principal feature, together with tics.
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