Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome

Daniel Martínez-Ramírez(University of Florida), Joohi Jimenez‐Shahed(Baylor College of Medicine), James F. Leckman(Yale University), Mauro Porta, Domenico Servello(Istituto Ortopedico Galeazzi), Fangang Meng(Capital Medical University), Jens Kuhn(University of Cologne), Daniel Huys(University of Cologne), Juan Carlos Baldermann(University of Cologne), Thomas Foltynie(University College London), Marwan Hariz(University College London), Eileen M. Joyce(University College London), Ludvic Zrinzo(University College London), Zinovia Kefalopoulou(University College London), Peter A. Silburn(The University of Queensland), Terry Coyne(The University of Queensland), Alon Y. Mogilner(NYU Langone Health), Michael Pourfar(NYU Langone Health), Suketu M. Khandhar(Kaiser Permanente), Man Auyeung(Pamela Youde Nethersole Eastern Hospital), Jill L. Ostrem(University of California, San Francisco), Veerle Visser‐Vandewalle(University Hospital Cologne), Marie-Laure Welter(Sorbonne Université), Luc Mallet(University of Geneva), Carine Karachi(Université Paris Cité), Jean Luc Houeto(Université de Poitiers), Bryan T. Klassen(Mayo Clinic), Linda Ackermans(Maastricht University Medical Centre), Takanobu Kaido(Osaka Shoin Women's University), Yasin Temel(Maastricht University), Robert E. Gross(Emory University), Harrison C. Walker(University of Alabama at Birmingham), Andrés M. Lozano(University of Toronto), Benjamin L. Walter(United States Department of Veterans Affairs), Zoltán Mari(Johns Hopkins University), William S. Anderson(Johns Hopkins University), Barbara Kelly Changizi(The Ohio State University Wexner Medical Center), Elena Moro(Centre Hospitalier Universitaire de Grenoble), S. Elizabeth Zauber(Indiana University School of Medicine), Lauren E. Schrock(University of Minnesota), Jianguo Zhang(Capital Medical University), Wei Hu(University of Florida), Kyle Rizer(University of Florida), Erin Hastings(University of Florida), Kelly D. Foote(University of Florida), Irene A. Malaty(University of Florida), Wissam Deeb(University of Florida), Aysegul Gunduz(University of Florida), Michael S. Okun(University of Florida)
JAMA Neurology
January 16, 2018
10.1001/jamaneurol.2017.4317
Cited by 237Open Access
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Abstract

Importance: Collective evidence has strongly suggested that deep brain stimulation (DBS) is a promising therapy for Tourette syndrome. Objective: To assess the efficacy and safety of DBS in a multinational cohort of patients with Tourette syndrome. Design, Setting, and Participants: The prospective International Deep Brain Stimulation Database and Registry included 185 patients with medically refractory Tourette syndrome who underwent DBS implantation from January 1, 2012, to December 31, 2016, at 31 institutions in 10 countries worldwide. Exposures: Patients with medically refractory symptoms received DBS implantation in the centromedian thalamic region (93 of 163 [57.1%]), the anterior globus pallidus internus (41 of 163 [25.2%]), the posterior globus pallidus internus (25 of 163 [15.3%]), and the anterior limb of the internal capsule (4 of 163 [2.5%]). Main Outcomes and Measures: Scores on the Yale Global Tic Severity Scale and adverse events. Results: The International Deep Brain Stimulation Database and Registry enrolled 185 patients (of 171 with available data, 37 females and 134 males; mean [SD] age at surgery, 29.1 [10.8] years [range, 13-58 years]). Symptoms of obsessive-compulsive disorder were present in 97 of 151 patients (64.2%) and 32 of 148 (21.6%) had a history of self-injurious behavior. The mean (SD) total Yale Global Tic Severity Scale score improved from 75.01 (18.36) at baseline to 41.19 (20.00) at 1 year after DBS implantation (P < .001). The mean (SD) motor tic subscore improved from 21.00 (3.72) at baseline to 12.91 (5.78) after 1 year (P < .001), and the mean (SD) phonic tic subscore improved from 16.82 (6.56) at baseline to 9.63 (6.99) at 1 year (P < .001). The overall adverse event rate was 35.4% (56 of 158 patients), with intracranial hemorrhage occurring in 2 patients (1.3%), infection in 4 patients with 5 events (3.2%), and lead explantation in 1 patient (0.6%). The most common stimulation-induced adverse effects were dysarthria (10 [6.3%]) and paresthesia (13 [8.2%]). Conclusions and Relevance: Deep brain stimulation was associated with symptomatic improvement in patients with Tourette syndrome but also with important adverse events. A publicly available website on outcomes of DBS in patients with Tourette syndrome has been provided.

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