Internal pallidal and thalamic stimulation in patients with Tourette syndrome.
BACKGROUND
Tourette syndrome (TS) is thought to result from dysfunction of the associative-limbic territories of the basal ganglia, and patients with severe symptoms of TS respond poorly to medication. High-frequency stimulation has recently been applied to patients with TS in open studies using the centromedian-parafascicular complex (CM-Pf) of the thalamus, the internal globus pallidus (GPi), or the anterior limb of the internal capsule as the principal target.


OBJECTIVE
To report the effect of high-frequency stimulation of the CM-Pf and/or the GPi, 2 associative-limbic relays of the basal ganglia, in patients with TS.


METHODS
Controlled, double-blind, randomized crossover study.


METHODS
Medical research.


METHODS
Three patients with severe and medically refractory TS.


METHODS
Bilateral placement of stimulating electrodes in the CM-Pf (associative-limbic part of the thalamus) and the GPi (ventromedial part).


METHODS
Effects of thalamic, pallidal, simultaneous thalamic and pallidal, and sham stimulation on neurologic, neuropsychological, and psychiatric symptoms.


RESULTS
A dramatic improvement on the Yale Global Tic Severity Scale was obtained with bilateral stimulation of the GPi (reduction in tic severity of 65%, 96%, and 74% in patients 1, 2, and 3, respectively). Bilateral stimulation of the CM-Pf produced a 64%, 30%, and 40% reduction in tic severity, respectively. The association of thalamic and pallidal stimulation showed no further reduction in tic severity (60%, 43%, and 76%), whereas motor symptoms recurred during the sham condition. No neuropsychological, psychiatric, or other long-term adverse effect was observed.


CONCLUSIONS
High-frequency stimulation of the associative-limbic relay within the basal ganglia circuitry may be an effective treatment of patients with TS, thus heightening the hypothesis of a dysfunction in these structures in the pathophysiologic mechanism of the disorder.
Welter
Marie-Laure
ML
National Institute of Health and Medical Research (INSERM), Unit 679, Pierre et Marie Curie University-Paris 6, France. marie-laure.welter@psl.aphp.fr
Mallet
Luc
L
Houeto
Jean-Luc
JL
Karachi
Carine
C
Czernecki
Virginie
V
Cornu
Philippe
P
Navarro
Soledad
S
Pidoux
Bernard
B
Dormont
Didier
D
Bardinet
Eric
E
Yelnik
Jérôme
J
Damier
Philippe
P
Agid
Yves
Y
D000328:Adult; D018592:Cross-Over Studies; D046690:Deep Brain Stimulation / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008297:Male; D013788:Thalamus / Q000502:physiology*; D005879:Tourette Syndrome / Q000503:physiopathology* / Q000628:therapy*