Neurology®
The most widely read and highly cited peer-reviewed Neurology journal
Quick Search
Advanced Search
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Google Scholar
Right arrow Articles by Porta, M.
Right arrow Articles by Robertson, M. M.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Porta, M.
Right arrow Articles by Robertson, M. M.
Related Collections
Right arrow Tourette syndrome
Right arrow Tics
Right arrow Neuropsychological assessment
Right arrow All Psychiatric disorders
Right arrow Class IV
NEUROLOGY 2009;73:1375-1380
© 2009 American Academy of Neurology

Thalamic deep brain stimulation for treatment-refractory Tourette syndrome

Two-year outcome M. Porta, MD, A. Brambilla, PhD, A. E. Cavanna, MD, D. Servello, MD, M. Sassi, MD, H. Rickards, MD, FRCPsych and M. M. Robertson, MD, DSc(Med), FRCP(UK), FRCPCH, FRCPsych

From the Movement Disorders and Tourette Centre (M.P., A.B.) and Department of Functional Neurosurgery (D.S., M.S.), IRCCS Galeazzi, Milan, Italy; Department of Neuropsychiatry (A.E.C., H.R.), BSMHFT and University of Birmingham, UK; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology (A.E.C.), and Department of Mental Health Sciences (M.M.R.), UCL, London, UK; and St George’s Hospital and Medical School (M.M.R.), University of London, UK.

Address correspondence and reprint requests to Prof. Mary M. Robertson, Department of Mental Health Sciences, University College London, Charles Bell House, 67–73 Riding House St., London W1W 7EJ, UK profmmr{at}aol.com

Background: Eighteen patients with severe and refractory Tourette syndrome (TS) underwent bilateral thalamic deep brain stimulation (DBS).

Objective: To assess the long-term outcome on tics, behavioral symptoms, and cognitive functions in the largest case series of thalamic DBS for TS to date.

Methods: In this prospective cohort study, 15 of the original 18 patients were evaluated before and after surgery according to a standardized protocol that included both neuropsychiatric and neuropsychological assessments.

Results: In addition to marked reduction in tic severity (p = 0.001), 24-month follow-up ratings showed improvement in obsessive-compulsive symptoms (p = 0.009), anxiety symptoms (p = 0.001), depressive symptoms (p = 0.001), and subjective perception of social functioning/quality of life (p = 0.002) in 15 of 18 patients. There were no substantial differences on measures of cognitive functions before and after DBS.

Conclusions: At 24-month follow-up, tic severity was improved in patients with intractable Tourette syndrome (TS) who underwent bilateral thalamic deep brain stimulation. Available data from 15 of 18 patients also showed that neuropsychiatric symptoms were improved and cognitive performances were not disadvantaged. Controlled studies on larger cohorts with blinded protocols are needed to verify that this procedure is effective and safe for selected patients with TS.

Level of evidence: This study provides class IV evidence that bilateral thalamic deep brain stimulation reduces global tic severity measured 24 months after implantation in patients with severe intractable Tourette syndrome.

Abbreviations: ADHD = attention-deficit/hyperactivity disorder; Cm-Pf = centromedian-parafascicular; DBS = deep brain stimulation; DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; GPi = internal pallidum; OCB = obsessive-compulsive behaviors; OCD = obsessive-compulsive disorder; PD = Parkinson disease; QOL = quality of life; STAI = Spielberger State-Trait Anxiety Inventory; TMT = Trail Making Test; TS = Tourette syndrome; VAS = visual analog scale; Voa = ventralis oralis complex; YGTSS = Yale Global Tic Severity Scale.

M.M.R. was supported by the National Hospital Research Development Fund. A.E.C. was supported by Tourettes Action-UK.

Disclosure: Author disclosures are provided at the end of the article.

Received January 30, 2009. Accepted in final form July 17, 2009.




This article has been cited by other articles:


Home page
 NeurologyHome page
K. J. Black
Deep brain stimulation for Tourette syndrome
Neurology, October 27, 2009; 73(17): e87 - e90.
[Full Text] [PDF]