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
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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.