Deep Brain Stimulation of the internal globus pallidus in refractory Tourette Syndrome

• Deep Brain Stimulation in psychiatric disorders like Tourette Syndrome is becoming an increasingly performed surgery.
• The anterior internal globus pallidus is a promising target.
• A significant group effect on tic reduction is observed.
• Comorbid behavioral disorders, mood and cognition show no significant group effect.
• No serious adverse events or side-effects are observed.

ObjectiveDeep Brain Stimulation in psychiatric disorders is becoming an increasingly performed surgery. At present, seven different targets have been stimulated in Tourette Syndrome, including the internal globus pallidus. We describe the effects on tics and comorbid behavioral disorders of Deep Brain Stimulation of the anterior internal globus pallidus in five patients with refractory Tourette Syndrome.MethodsThis study was performed as an open label study with follow-up assessment between 12 and 38 months. Patients were evaluated twice, one month before surgery and at long-term follow-up. Primary outcome was tic severity, assessed by several scales. Secondary outcomes were comorbid behavioral disorders, mood and cognition. The final position of the active contacts of the implanted electrodes was investigated and side effects were reported.ResultsThree males and two females were included with a mean age of 41.6 years (SD 9.7). The total post-operative score on the Yale Global Tic Severity Scale was significantly lower than the pre-operative score (42.2 ± 4.8 versus 12.8 ± 3.8, P = 0.043). There was also a significant reduction on the modified Rush Video-Based Tic Rating Scale (13.0 ± 2.0 versus 7.0 ± 1.6, P = 0.041) and in the total number of video-rated tics (259.6 ± 107.3 versus 49.6 ± 24.8, P = 0.043). No significant difference on the secondary outcomes was found, however, there was an improvement on an individual level for obsessive-compulsive behavior. The final position of the active contacts was variable in our sample and no relationship between position and stimulation effects could be established.ConclusionOur study suggests that Deep Brain Stimulation of the anterior internal globus pallidus is effective in reducing tic severity, and possibly also obsessive–compulsive behavior, in refractory Tourette patients without serious adverse events or side-effects.