title: Five-months-postoperative neuropsychological outcome from a pilot prospective randomized clinical trial of thalamic deep brain stimulation for Tourette syndrome.
abstract: OBJECTIVE
  Tourette syndrome (TS) is a neuropsychiatric disorder presenting with motor and/or sonic tics associated with frontostriatal dysfunction. This study provided pilot data of the neuropsychological safety of bilateral thalamic deep brain stimulation (DBS) to treat medication-refractory TS in adults.
  
  
  METHODS
  This study used a repeated-measures design with pretest and 3-month follow-up from start of continuous bilateral DBS. Five male patients underwent DBS surgery for medically refractory TS. Repeated-measures ANOVA was used to evaluate for any change in neuropsychological test scores, employing a false discovery rate. Outcome measures included 14 neuropsychological tests assessing psychomotor speed, attention, memory, language, visuoconstructional, and executive functions, as well as subjective mood ratings of depression and anxiety.
  
  
  RESULTS
  Average age was 28.2 years (SD = 7.5) with 12-17 years of education. Participants were disabled by tics, with a tic frequency of 50-80 per minute before surgery. At baseline, subjects' cognitive function was generally average, although mild deficits in sequencing and verbal fluency were present, as were clinically mild obsessive-compulsive symptoms. At 3 months of continuous DBS (5 months after implantation), 3 of 5 participants had clinical reductions in motor and sonic tics. Cognitive scores generally remained stable, but declines of moderate to large effect size (Cohen's d > 0.6) in verbal fluency, visual immediate memory, and reaction time were observed. Fewer symptoms of depression and anxiety, as well as fewer obsessions and compulsions, were reported after 3 months of continuous high-frequency DBS.
  
  
  CONCLUSIONS
  Bilateral centromedian-parafascicular thalamic DBS for medically refractory TS shows promise for treatment of medically refractory TS without marked neuropsychological morbidity. Symptoms of depression and anxiety improved.
authors.affiliation: Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Mike R
authors.initials: MR
authors.lastname: Schoenberg
authors.forename: Brian N
authors.initials: BN
authors.lastname: Maddux
authors.forename: David E
authors.initials: DE
authors.lastname: Riley
authors.forename: Christina M
authors.initials: CM
authors.lastname: Whitney
authors.forename: Paula K
authors.initials: PK
authors.lastname: Ogrocki
authors.forename: Deborah
authors.initials: D
authors.lastname: Gould
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Maciunas
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003072:Cognition Disorders / Q000209:etiology* / Q000628:therapy; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D010555:Personality Inventory; D010865:Pilot Projects; D011788:Quality of Life; D013788:Thalamus / Q000502:physiology*; D005879:Tourette Syndrome / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome; D064232:Visual Analog Scale; D055815:Young Adult
keywords: Tourette syndrome; cognitive; complications; deep brain stimulation; neuropsychology; outcome; psychological