Long-Term, Post-Deep Brain Stimulation Management of a Series of 36 Patients Affected With Refractory Gilles de la Tourette Syndrome

Abstract

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. 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 Tourette Clinic. 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 procedure was chosen on the basis of clinical manifestations expressed by the single patient. Six out of the ten procedures centered 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). All the patients were treated bilaterally except one, treated at the right Vo/CM-Pf because of vascular physiologic abnormalities at the left hemisphere. Two patients refused further treatments after DBS intervention (one of them requiring and obtaining 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 Compulsive Scale, and a 10-point visual analog scale for self-evaluation of the impact of TS on social integration of the patient). 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 treatment modality for those patients who fail to respond to conservative treatment modalities. A multidisciplinary team is nevertheless necessary to properly handle this complex therapeutic option.