Deep Brain Stimulation in 18 patients with severe Gilles de la Tourette Syndrome refractory to treatment: The surgery and stimulation
- Domenico Servello (servello{at}libero.it)
- Marco Sassi (marco_sassi{at}hotmail.com)
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.
