Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome
JAMA Neurol. Published online January 16, 2018. doi:10.1001/jamaneurol.2017.4317
January 16, 2018
Question What are the outcomes associated with deep brain stimulation in Tourette syndrome?
Findings In this study including 185 patients from 10 countries in the International Deep Brain Stimulation Database and Registry, the mean Yale Global Tic Severity Scale score improved 45.1% at 1 year after deep brain stimulation implantation. The centromedian thalamic region was the most common target of deep brain stimulation implantation (57.1%), with no differences observed between targets, while the most common adverse events were dysarthria (6.3%) and paresthesias (8.2%), with hemorrhages occurring in 1.3% of patients, infection in 3.2%, and explantation in 0.6%.
Meaning Deep brain stimulation was safe and associated with clinical improvements; a publicly available website has been released that tracks the outcomes among all participating centers.
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 12.97 (5.58) 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.
For a more thorough overview of this article, please download the attached articles below:
JAMA Neurol. Published online January 16, 2018. doi:10.1001/jamaneurol.2017.4317
January 16, 2018
Question What are the outcomes associated with deep brain stimulation in Tourette syndrome?
Findings In this study including 185 patients from 10 countries in the International Deep Brain Stimulation Database and Registry, the mean Yale Global Tic Severity Scale score improved 45.1% at 1 year after deep brain stimulation implantation. The centromedian thalamic region was the most common target of deep brain stimulation implantation (57.1%), with no differences observed between targets, while the most common adverse events were dysarthria (6.3%) and paresthesias (8.2%), with hemorrhages occurring in 1.3% of patients, infection in 3.2%, and explantation in 0.6%.
Meaning Deep brain stimulation was safe and associated with clinical improvements; a publicly available website has been released that tracks the outcomes among all participating centers.
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 12.97 (5.58) 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.
For a more thorough overview of this article, please download the attached articles below:
- Deep-Brain Stimulation Improves Tourette's Tics (DBS 2018 Medscape.pdf)
- DBS Linked to Symptomatic Improvement in Tourette Syndrome (DBS 2018 MD Mag.pdf)
