Abstract
Deep brain stimulation (DBS) of the thalamic centromedian/parafascicular (CM-Pf) complex
has been reported as a promising treatment for patients with severe, treatment-resistant
Tourette syndrome (TS). In this study, safety and clinical outcomes of bilateral thalamic
CM-Pf DBS were reviewed in a series of 12 consecutive patients with medically refractory
TS, 11 of whom met the criteria of postsurgical follow-up at our institution for at
least 2 months. Five patients were followed for a year or longer. Consistent with
many patients with TS, all patients had psychiatric comorbidities. Tic severity and
frequency were measured by using the Yale Global Tic Severity Scale (YGTSS) over time
(average, 26 months) in 10 subjects. One patient was tested at 2-week follow-up only
and thus was excluded from group YGTSS analysis. Final YGTSS scores differed significantly
from the preoperative baseline score. The average (n=10) improvement relative to baseline
in the total score was 54% (95% CI, 37-70); average improvement relative to baseline
in the YGTSS Motor tic, Phonic tic, and Impairment subtests was 46% (95% CI, 34-64),
52% (95% CI, 34-72), and 59% (95% CI, 39-78), respectively. There were no intraoperative
complications. After surgery, 1 subject underwent wound revision because of a scalp
erosion and wound infection; the implanted DBS system was successfully salvaged with
surgical revision and combined antibiotic therapy. Stimulation-induced adverse effects
did not prevent the use of the DBS system, although 1 subject is undergoing a trial
period with the stimulator off. This surgical series adds to the literature on CM-Pf
DBS and supports its use as an effective and safe therapeutic option for severe refractory
TS.
Abbreviations and Acronyms:
CM-Pf (centromedian-parafascicular), DBS (deep brain stimulation), TS (Tourette syndrome), YGTSS (Yale Global Tic Severity Scale)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Tourette syndrome: the self under siege.J Child Neurol. 2006; 21: 642-649
- Course of tic severity in Tourette syndrome: the first two decades.Pediatrics. 1998; 102: 14-19
- Updates in medical and surgical therapies for Tourette syndrome.Curr Neurol Neurosci Rep. 2014; 14: 458
- The treatment of tics.Curr Neurol Neurosci Rep. 2001; 1: 195-202
- Rev Neurol (Paris). 1970; 123 ([in French]): 89-100
- Stereotactic treatment of Gilles de la Tourette syndrome by high frequency stimulation of thalamus.Lancet. 1999; 353: 724
- Double-blind clinical trial of thalamic stimulation in patients with Tourette syndrome.Brain. 2011; 134: 832-844
- Prospective randomized double-blind trial of bilateral thalamic deep brain stimulation in adults with Tourette syndrome.J Neurosurg. 2007; 107: 1004-1014
- Deep brain stimulation in Tourette's syndrome.Mov Disord. 2007; 22: 1346-1350
- Deep brain stimulation in a Chinese Tourette's syndrome patient.Hong Kong Med J. 2011; 17: 147-150
- A trial of scheduled deep brain stimulation for Tourette syndrome: moving away from continuous deep brain stimulation paradigms.JAMA Neurol. 2013; 70: 85-94
- Deep brain stimulation for treatment of refractory Tourette syndrome: long-term follow-up.Acta Neurochir (Wien). 2012; 154: 2029-2041
- Lessons learned from open-label deep brain stimulation for Tourette syndrome: eight cases over 7 years.Tremor Other Hyperkinet Mov (N Y). 2013; : 3
- Microelectrode-guided deep brain stimulation for Tourette syndrome: within-subject comparison of different stimulation sites.Stereotact Funct Neurosurg. 2008; 86: 87-91
- Deep brain stimulation for Tourette syndrome: a prospective pilot study in Japan.Neuromodulation. 2011; 14 (discussion 129): 123-128
- Deep brain stimulation in Tourette syndrome: a description of 3 patients with excellent outcome.Mayo Clin Proc. 2012; 87: 59-62
- Diagnostic and Statistical Manual of Mental Disorders.Fourth Edition, Text Revision. American Psychiatric Association, Washington, DC2000
- Atlas for Stereotaxy of the Human Brain.2nd ed. George Thieme Verlag, Stuttgart, Germany1977
- Tourette Syndrome Association International Deep Brain Stimulation (DBS) Database and Registry Study Group. Tourette syndrome deep brain stimulation: a review and updated recommendations.Mov Disord. 2015; 30: 448-471
- Centromedian-parafascicular deep brain stimulation induces differential functional inhibition of the motor, associative, and limbic circuits in large animals.Biol Psychiatry. 2013; 74: 917-926
- The thalamostriatal systems: anatomical and functional organization in normal and parkinsonian states.Brain Res Bull. 2009; 78: 60-68
- Preferential networks of the mediodorsal nucleus and centromedian-parafascicular complex of the thalamus–a DTI tractography study.Hum Brain Mapp. 2012; 33: 2627-2637
- The primate centromedian-parafascicular complex: anatomical organization with a note on neuromodulation.Brain Res Bull. 2009; 78: 122-130
- Tourette's syndrome and deep brain stimulation.J Neurol Neurosurg Psychiatry. 2005; 76: 992-995
- Internal pallidal and thalamic stimulation in patients with Tourette syndrome.Arch Neurol. 2008; 65: 952-957
- Long-term, post-deep brain stimulation management of a series of 36 patients affected with refractory Gilles de la Tourette syndrome.Neuromodulation. 2010; 13: 187-194
- Deep brain stimulation for Tourette syndrome.Neurosurg Clin N Am. 2014; 25: 117-135
- Design challenges for stimulation trials of Tourette's syndrome.Lancet Neurol. 2015; 14: 563-565
- Five-months-postoperative neuropsychological outcome from a pilot prospective randomized clinical trial of thalamic deep brain stimulation for Tourette syndrome.Neuromodulation. 2015; 18: 97-104
Article Info
Footnotes
Grant Support: This work was supported by grant R01 NS070872 (K.H.L.) from the National Institutes of Health .
Potential Competing Interests: Dr Klassen receives research support from Medtronic unrelated to this study.
Identification
Copyright
© 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
