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Deep Brain Stimulation in 18 patients with severe Gilles de la Tourette Syndrome refractory to treatment: The surgery and stimulation
  1. Domenico Servello (servello{at}libero.it)
  1. Department of Functional Neurosurgery, Istituto Galeazzi, Milan, Italy
    1. Mauro Porta
    1. Department of Neurology, Tourette Center, Policlinico San Marco, Bergamo, Italy
      1. Marco Sassi (marco_sassi{at}hotmail.com)
      1. Department of Functional Neurosurgery, Istituto Galeazzi, Milan, Italy
        1. Arianna Brambilla
        1. Department of Neurology, Tourette Centre and Psychology, Policlinico San Marco, Milan, Italy
          1. Mary M Robertson (profmmr{at}aol.com)
          1. Department of Mental Health Sciences, UCL, London, United Kingdom

            Abstract

            Background: Several reports of successful deep brain stimulation (DBS) for the treatment of severe Gilles de la Tourette Syndrome (GTS) have been communicated.

            Method: Eighteen cases with GTS who were resistant to at least six months of standard and innovative treatments, as well as psycho-behavioural techniques, were submitted to DBS. DBS was placed bilaterally in centro-median parafascicular (CM-Pfc) and ventralis oralis (Vo) complex of the thalamus. Patients were evaluated after surgery with immediate and formal assessments at least every three months, including “on-off” and “sham-off” in the first 9 patients.

            Results: All patients responded well to DBS, although to differing degrees. The duration of the follow-up assessments ranged from 3 – 18 months. The comorbid symptoms of obsessive-compulsive behaviour, obsessive-compulsive disorder, Self-Injurious Behaviours, anxiety and premonitory sensations decreased after treatment with DBS. There were no serious permanent adverse effects.

            Conclusions: DBS is a useful and safe treatment for severe GTS. The results of ours and of previous DBS reports suggests that the CM-Pfc and ventralis oralis complex of the thalamus may be a good DBS target for GTS.

            • Gilles de la Tourette syndrome
            • deep brain stimulation
            • neuroimaging
            • treatment

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