title: Deep brain stimulation for Gilles de la Tourette syndrome: a case series targeting subregions of the globus pallidus internus.
abstract: Deep brain stimulation remains an experimental treatment for patients with Gilles de la Tourette syndrome. Currently, a major controversial issue is the choice of brain target that leads to optimal patient outcomes within a presumed network of basal ganglia and cortical pathways involved in tic pathogenesis. This report describes our experience with patients with severe refractory Gilles de la Tourette syndrome treated with globus pallidus internus deep brain stimulation. Five patients were selected for surgery, 2 targeting the posteroventral globus pallidus internus and 2 targeting the anteromedial region. The remaining patient was first targeted on the posterolateral region, but after 18 months the electrodes were relocated in the anteromedial area. Tics were clinically assessed in all patients pre- and postoperatively using the Modified Rush Video protocol and the Yale Global Tic Severity Scale. Obsessive-compulsive behaviors were quantified with the Yale-Brown Obsessive Compulsive Scale. The Gilles de la Tourette Syndrome-Quality of Life Scale was also completed. All patients experienced improvements in tic severity but to variable extents. More convincing improvements were seen in patients with electrodes sited in the anteromedial region of the globus pallidus internus than in those with posterolateral implants. Mean reduction in the Modified Rush Video Rating scale for each group was 54% and 37%, respectively. Our open-label limited experience supports the use of the anteromedial globus pallidus internus as a promising target for future planned randomized double-blind trials of deep brain stimulation for patients with Gilles de la Tourette syndrome.
authors.affiliation: Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom.
authors.forename: Raul
authors.initials: R
authors.lastname: Martínez-Fernández
authors.forename: Ludvic
authors.initials: L
authors.lastname: Zrinzo
authors.forename: Iciar
authors.initials: I
authors.lastname: Aviles-Olmos
authors.forename: Marwan
authors.initials: M
authors.lastname: Hariz
authors.forename: Irene
authors.initials: I
authors.lastname: Martinez-Torres
authors.forename: Eileen
authors.initials: E
authors.lastname: Joyce
authors.forename: Marjan
authors.initials: M
authors.lastname: Jahanshahi
authors.forename: Patricia
authors.initials: P
authors.lastname: Limousin
authors.forename: Thomas
authors.initials: T
authors.lastname: Foltynie
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D004185:Disability Evaluation; D015259:Dopamine Agents / Q000627:therapeutic use; D005260:Female; D005917:Globus Pallidus / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D005879:Tourette Syndrome / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D015259:Dopamine Agents