title: Deep brain stimulation of the antero-medial globus pallidus interna for Tourette syndrome.
abstract: BACKGROUND
  We have previously reported the results of Deep Brain Stimulation (DBS) of the antero-medial globus pallidus interna (GPi) for severe Tourette Syndrome (TS) in 11 patients. We extend this case series to 17 patients and a longer follow-up to a maximum of 46 months.
  
  
  METHODS
  17 patients (14 male; mean age 29.1 years, range 17-51 years) with severe and medically intractable TS were implanted with Medtronic quadripolar electrodes bilaterally in the antero-medial GPi. The primary outcome measure was the Yale Global Tic Severity Scale (YGTSS). Secondary outcome measures included the Yale-Brown Obsessive Compulsive Scale, Hamilton Depression Rating Scale, Gilles de la Tourette Quality of Life Scale and Global Assessment of Functioning. Follow up was at one month, three months and finally at a mean 24.1 months (range 8-46 months) following surgery.
  
  
  RESULTS
  Overall, there was a 48.3% reduction in motor tics and a 41.3% reduction in phonic tics at one month, and this improvement was maintained at final follow-up. 12 out of 17 (70.6%) patients had a>50% reduction in YGTSS score at final follow up. Only 8 patients required ongoing pharmacotherapy for tics post-surgery. Patients improved significantly on all secondary measures. Adverse consequences included lead breakage in 4 patients, infection (1), transient anxiety (2), dizziness (1), poor balance (1) and worsening of stuttering (1).
  
  
  CONCLUSIONS
  This case series provides further support that antero-medial GPi DBS is an effective and well tolerated treatment for a subgroup of severe TS, with benefits sustained up to 4 years.
authors.affiliation: Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, The University of New South Wales, Sydney, Australia.
authors.forename: Perminder S
authors.initials: PS
authors.lastname: Sachdev
authors.affiliation: Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, The University of New South Wales, Sydney, Australia.
authors.forename: Adith
authors.initials: A
authors.lastname: Mohan
authors.affiliation: Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cannon
authors.affiliation: Centre for Healthy Brain Ageing, School of Psychiatry, The University of New South Wales, Sydney, Australia.
authors.forename: John D
authors.initials: JD
authors.lastname: Crawford
authors.affiliation: North Shore Private Hospital, St. Leonards, Sydney, NSW, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Silberstein
authors.affiliation: North Shore Private Hospital, St. Leonards, Sydney, NSW, Australia.
authors.forename: Raymond
authors.initials: R
authors.lastname: Cook
authors.affiliation: Centre for Clinical Research, University of Queensland, Herston, QLD, Australia; St. Andrew's War Memorial Hospital, Spring Hill, QLD, Australia.
authors.forename: Terrence
authors.initials: T
authors.lastname: Coyne
authors.affiliation: Centre for Clinical Research, University of Queensland, Herston, QLD, Australia; St. Andrew's War Memorial Hospital, Spring Hill, QLD, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Silburn
mesh_terms: D000293:Adolescent; D000328:Adult; D046690:Deep Brain Stimulation; D005260:Female; D005917:Globus Pallidus / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005879:Tourette Syndrome / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult