title: Functional outcome and quality of life in Tourette's syndrome after deep brain stimulation of the posteroventrolateral globus pallidus internus: long-term follow-up.
abstract: OBJECTIVE
  Deep brain stimulation (DBS) for Tourette's syndrome (TS) in various targets has been in the focus for some years. However, there are hardly any data on "psychosocial" outcome after DBS for TS. The aim of the present study therefore was to focus on the functional outcome and "psychosocial changes" in TS patients after DBS.
  
  
  METHODS
  Six patients with treatment-refractory TS underwent GPi-DBS. The Yale Global Tic Severity Scale (YGTSS) was used to evaluate symptomatic outcome. Psychosocial changes were assessed applying the Global Assessment of Functioning Scale (GAF) and the Gilles-de-la-Tourette-Syndrome Quality-of-Life scale (GTS-QOL) with additionally documenting psychosocial changes. Follow-up ranged between 12 and 72 months.
  
  
  RESULTS
  In all symptomatic responders (4 of 6) we found a significant functional improvement (mean GAF increasing from 53.75 (± 7.5) pre-operatively to 83.75 (± 7.5) at last follow-up) along with a positive correlation with the course of GTS-QOL (R(2) = 0.62).
  
  
  CONCLUSIONS
  Treatment success should not only be assessed with the classic "tic-scales", but also with the GAF and GTS-QOL. Although improvement of tics seems to be positively correlated with improved functional outcome, symptomatic improvement may lead to unexpected major psychosocial changes - which both the patient and the clinicians in charge - should be prepared for.
authors.affiliation: Department of Psychiatry and Psychotherapy, Ludwig Maximilian University , Munich , Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Dehning
authors.forename: Bianka
authors.initials: B
authors.lastname: Leitner
authors.forename: Rebecca
authors.initials: R
authors.lastname: Schennach
authors.forename: Norbert
authors.initials: N
authors.lastname: Müller
authors.forename: Kai
authors.initials: K
authors.lastname: Bötzel
authors.forename: Michael
authors.initials: M
authors.lastname: Obermeier
authors.forename: Jan-Hinnerk
authors.initials: JH
authors.lastname: Mehrkens
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000502:physiology* / Q000601:surgery; D006801:Humans; D008297:Male; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D013238:Stereotaxic Techniques / Q000295:instrumentation; D005879:Tourette Syndrome / Q000628:therapy*; D016896:Treatment Outcome