title: Long-term follow-up of pallidal Deep Brain Stimulation in teenagers with refractory Tourette syndrome and comorbid psychiatric disorders: About three cases.
abstract: OBJECTIVE
  Tourette syndrome (TS) is a complex neuropsychiatric disorder associated with comorbid psychiatric disorders. Peak of tic severity typically occurs in early adolescence and impacts quality of life. Since 1999, promising therapeutic effects of Deep Brain Stimulation (DBS) have been reported in tic reduction for adults with refractory TS. The aim of the study was to assess the long-term risk-benefit ratio of pallidal DBS for young patients with refractory TS and severe comorbid psychiatric disorders.
  
  
  METHODS
  We retrospectively assessed the long-term clinical outcomes of three adolescents who underwent pallidal DBS for the treatment of refractory TS.
  
  
  RESULTS
  The mean duration of follow-up was 52 months in our case series. We observed that motor tics decreased with posteroventral GPi DBS in all patients, without reaching a continuous significance over the long-term follow-up. Self-reported social inclusion was globally improved, despite lack of efficacy of DBS on comorbid conditions.
  
  
  CONCLUSIONS
  These findings suggest a long-term therapeutic benefit of early DBS intervention for highly socially impaired young patients suffering from intractable TS with severe comorbid psychiatric conditions. Further studies are needed to determine the most effective targets of DBS on both tics and comorbid psychiatric profile of TS.
authors.affiliation: University Department of Adult Psychiatry, Hôpital La Colombière, University Hospital of Montpellier, Montpellier, France; University of Montpellier, France. Electronic address: pa-hauseux@chu-montpellier.fr.
authors.forename: P-A
authors.initials: PA
authors.lastname: Hauseux
authors.affiliation: Functional Neurosurgery Unit, Department of Neurosurgery, Hôpital Gui de Chauliac, University Hospital of Montpellier, France; Inserm, Unit 1061, Neuropsychiatry, Epidemiological and Clinical Research, Montpellier, France.
authors.forename: F
authors.initials: F
authors.lastname: Cyprien
authors.affiliation: Functional Neurosurgery Unit, Department of Neurosurgery, Hôpital Gui de Chauliac, University Hospital of Montpellier, France.
authors.forename: L
authors.initials: L
authors.lastname: Cif
authors.affiliation: Functional Neurosurgery Unit, Department of Neurosurgery, Hôpital Gui de Chauliac, University Hospital of Montpellier, France.
authors.forename: V
authors.initials: V
authors.lastname: Gonzalez
authors.affiliation: University Department of Adult Psychiatry, Hôpital La Colombière, University Hospital of Montpellier, Montpellier, France; University of Montpellier, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Boulenger
authors.affiliation: University of Montpellier, France; Functional Neurosurgery Unit, Department of Neurosurgery, Hôpital Gui de Chauliac, University Hospital of Montpellier, France.
authors.forename: P
authors.initials: P
authors.lastname: Coubes
authors.affiliation: University Department of Adult Psychiatry, Hôpital La Colombière, University Hospital of Montpellier, Montpellier, France; University of Montpellier, France; Inserm, Unit 1061, Neuropsychiatry, Epidemiological and Clinical Research, Montpellier, France.
authors.forename: D
authors.initials: D
authors.lastname: Capdevielle
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D046690:Deep Brain Stimulation / Q000379:methods*; D005500:Follow-Up Studies; D005602:France; D005917:Globus Pallidus / Q000503:physiopathology*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D001523:Mental Disorders / Q000503:physiopathology / Q000534:rehabilitation*; D012189:Retrospective Studies; D005879:Tourette Syndrome / Q000503:physiopathology / Q000534:rehabilitation*
keywords: Deep Brain Stimulation; Pallidal; Psychiatric; Teenagers; Tourette syndrome