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Thread: Severe Tourette's May Benefit From Deep Brain Stimulation

  1. #1
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    Default Severe Tourette's May Benefit From Deep Brain Stimulation

    Deep brain stimulation for Tourette syndrome: a single-center series
    Richard S. Dowd, MD1, Michael Pourfar, MD2, and Alon Y. Mogilner, MD, PhD2
    Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts; and 2Department of Neurosurgery, New York University Langone Medical Center, New York, New York

    Published online April 7, 2017; DOI: 10.3171/2016.10.JNS161573.


    Abstract

    OBJECTIVE
    Tourette syndrome (TS) is a complex neuropsychiatric disorder characterized by multiple motor and phonic tics. While pharmacological and behavioral therapy can be effective in most patients, a subset of patients remains refractory to treatment. Increasing clinical evidence from multiple centers suggests that deep brain stimulation (DBS) of the medial thalamus can be effective in many cases of refractory TS.

    METHODS
    The authors retrospectively reviewed outcomes in 13 patients with refractory TS who underwent medial thalamic DBS performed by their team over a 7-year period. Patients were evaluated by a multidisciplinary team, and preoperative objective assessments were performed using the Yale Global Tic Severity Scale (YGTSS) and Yale-Brown Obsessive Compulsive Scale. YGTSS scores were calculated at visits immediately postoperatively and at the most recent follow-up in patients with a minimum of 6 months of postoperative follow-up. Coordinates of the active DBS contacts were calculated and projected onto each patient's pre- and postoperative images.

    RESULTS
    Patients showed an average decrease of 37% (p = 0.0063) in the total tic severity at their first postoperative visit. At their latest visit, their scores achieved significance, decreasing from preoperative scores by an average of 50% (p = 0.0014). The average position of the active contact was noted to be at the junction of the posterior ventralis oralis internus/centromedian-parafascicular nuclei. Device-related complications occurred in 2 patients, necessitating additional surgeries. All patients continued to use the system at last follow-up.

    CONCLUSIONS
    The authors' data are consistent with the small but growing body of literature supporting DBS of the ventralis oralis internus/centromedian-parafascicular thalamus as an effective and relatively safe treatment for severe, refractory TS.



    ABBREVIATIONS CM-PF = centromedian-parafascicular; DBS = deep brain stimulation; GPI = globus pallidus internus; OCD = obsessive-compulsive disorder; TS = Tourette syndrome; VOI = ventralis oralis internus; YBOCS = Yale-Brown Obsessive Compulsive Scale; YGTSS = Yale Global Tic Severity Scale.

  2. #2
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    Default Re: Severe Tourette's May Benefit From Deep Brain Stimulation

    Severe Tourette's May Benefit From Deep Brain Stimulation
    Neurology Advisor
    May 3, 2017

    HealthDay News Some young patients with severe cases of Tourette's syndrome (TS) may benefit from deep brain stimulation (DBS), according to a study published in the Journal of Neurosurgery.

    Alon Mogilner, MD. PhD, the senior researcher on the study, and his colleagues at the New York University Langone Medical Center in New York City have been able to offer DBS to certain teenage and young adult patients on an investigational basis. A committee of independent specialists reviews each case, to make sure the patient has tried standard therapies and is a good candidate for DBS. The new study reviewed the outcomes of 13 of those patients who were followed for an average of two years after having the surgery.

    On average, the researchers found, the patients were reporting a 50% improvement in tic severity at their most recent follow-up visit. While DBS did not eliminate their symptoms, it made a difference in their quality of life, according to Dr Mogilner. The relief was enough, for instance, to allow some adolescents who'd been home-schooled to go back to school, he told HealthDay. Two patients did experience complications including a scalp infection and a wire breakage that required some of the DBS hardware to be replaced. Still, the procedure was generally safe, Dr Mogilner said.

    "The authors' data are consistent with the small but growing body of literature supporting DBS of the ventralis oralis internus/centromedian-parafascicular thalamus as an effective and relatively safe treatment for severe, refractory TS," the study concludes.

    Reference
    Dowd RS, Pourfar M, Mogilner AY. Deep brain stimulation for Tourette syndrome: a single-center series [published online April 7, 2017]. J Neurosurg. doi:10.3171/2016.10.JNS161573

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