title: Centromedian-Parafascicular Complex Deep Brain Stimulation for Tourette Syndrome: A Retrospective Study.
abstract: Deep brain stimulation (DBS) of the thalamic centromedian/parafascicular (CM-Pf) complex has been reported as a promising treatment for patients with severe, treatment-resistant Tourette syndrome (TS). In this study, safety and clinical outcomes of bilateral thalamic CM-Pf DBS were reviewed in a series of 12 consecutive patients with medically refractory TS, 11 of whom met the criteria of postsurgical follow-up at our institution for at least 2 months. Five patients were followed for a year or longer. Consistent with many patients with TS, all patients had psychiatric comorbidities. Tic severity and frequency were measured by using the Yale Global Tic Severity Scale (YGTSS) over time (average, 26 months) in 10 subjects. One patient was tested at 2-week follow-up only and thus was excluded from group YGTSS analysis. Final YGTSS scores differed significantly from the preoperative baseline score. The average (n=10) improvement relative to baseline in the total score was 54% (95% CI, 37-70); average improvement relative to baseline in the YGTSS Motor tic, Phonic tic, and Impairment subtests was 46% (95% CI, 34-64), 52% (95% CI, 34-72), and 59% (95% CI, 39-78), respectively. There were no intraoperative complications. After surgery, 1 subject underwent wound revision because of a scalp erosion and wound infection; the implanted DBS system was successfully salvaged with surgical revision and combined antibiotic therapy. Stimulation-induced adverse effects did not prevent the use of the DBS system, although 1 subject is undergoing a trial period with the stimulator off. This surgical series adds to the literature on CM-Pf DBS and supports its use as an effective and safe therapeutic option for severe refractory TS.
authors: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
authors: Paola
authors: P
authors: Testini
authors: Department of Medicine, University of California San Francisco, Fresno, CA.
authors: Cong Z
authors: CZ
authors: Zhao
authors: Department of Neurology, Mayo Clinic, Rochester, MN.
authors: Matt
authors: M
authors: Stead
authors: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
authors: Penelope S
authors: PS
authors: Duffy
authors: Department of Neurology, Mayo Clinic, Rochester, MN.
authors: Bryan T
authors: BT
authors: Klassen
authors: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN. Electronic address: lee.kendall@mayo.edu.
authors: Kendall H
authors: KH
authors: Lee
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D046690:Deep Brain Stimulation / Q000379:methods*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D012536:Scalp Dermatoses / Q000209:etiology / Q000628:therapy; D012720:Severity of Illness Index; D013788:Thalamus; D020323:Tics / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D005879:Tourette Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome