title: Lessons Learned from Open-label Deep Brain Stimulation for Tourette Syndrome: Eight Cases over 7 Years.
abstract: BACKGROUND
  Deep brain stimulation (DBS) remains an experimental but promising treatment for patients with severe refractory Gilles de la Tourette syndrome (TS). Controversial issues include the selection of patients (age and clinical presentation), the choice of brain targets to obtain optimal patient-specific outcomes, and the risk of surgery- and stimulation-related serious adverse events.
  
  
  METHODS
  This report describes our open-label experience with eight patients with severe refractory malignant TS treated with DBS. The electrodes were placed in the midline thalamic nuclei or globus pallidus, pars internus, or both. Tics were clinically assessed in all patients pre- and postoperatively using the Modified Rush Video Protocol and the Yale Global Tic Severity Scale (YGTSS).
  
  
  RESULTS
  Although three patients had marked postoperative improvement in their tics (>50% improvement on the YGTSS), the majority did not reach this level of clinical improvement. Two patients had to have their DBS leads removed (one because of postoperative infection and another because of lack of benefit).
  
  
  CONCLUSIONS
  Our clinical experience supports the urgent need for more data and refinements in interventions and outcome measurements for severe, malignant, and medication-refractory TS. Because TS is not an etiologically homogenous clinical entity, the inclusion criteria for DBS patients and the choice of brain targets will require more refinement.
authors.affiliation: Child Study Center, Yale University, New Haven, Connecticut, United States of America.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Motlagh
authors.forename: Megan E
authors.initials: ME
authors.lastname: Smith
authors.forename: Angeli
authors.initials: A
authors.lastname: Landeros-Weisenberger
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kobets
authors.forename: Robert A
authors.initials: RA
authors.lastname: King
authors.forename: Joan
authors.initials: J
authors.lastname: Miravite
authors.forename: Alain C J
authors.initials: AC
authors.lastname: de Lotbinière
authors.forename: Ron L
authors.initials: RL
authors.lastname: Alterman
authors.forename: Alon Y
authors.initials: AY
authors.lastname: Mogilner
authors.forename: Michael H
authors.initials: MH
authors.lastname: Pourfar
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
authors.forename: James F
authors.initials: JF
authors.lastname: Leckman
keywords: Gilles de la Tourette syndrome; deep brain stimulation; globus pallidus internus; midline thalamic nuclei