Funding agencies: This work was undertaken at UCL/UCLH and was partly funded by the Department of Health NIHR Biomedical Research Centres funding scheme. The Unit of Functional Neurosurgery, Queen Square, London, is supported by the Parkinson's Appeal.
Article first published online: 29 APR 2011
Copyright © 2011 Movement Disorder Society
Volume 26, Issue 10, pages 1922–1930, 15 August 2011
How to Cite
Martínez-Fernández, R., Zrinzo, L., Aviles-Olmos, I., Hariz, M., Martinez-Torres, I., Joyce, E., Jahanshahi, M., Limousin, P. and Foltynie, T. (2011), Deep brain stimulation for Gilles de la Tourette syndrome: A case series targeting subregions of the globus pallidus internus. Mov. Disord., 26: 1922–1930. doi: 10.1002/mds.23734
Relevant conflicts of interest/financial disclosures: Marwan Hariz, Patricia Limousin, and Ludvic Zrinzo have received honoraria for speaking at academic meetings sponsored by Medtronic.
Full financial disclosures and author roles may be found in the online version of this article.
- Issue published online: 26 AUG 2011
- Article first published online: 29 APR 2011
- Manuscript Accepted: 8 MAR 2011
- Manuscript Revised: 7 FEB 2011
- Manuscript Received: 21 DEC 2010
- Gilles de la Tourette syndrome;
- deep brain stimulation;
- globus pallidus internus;
- Modified Rush Video Rating scale
Deep brain stimulation remains an experimental treatment for patients with Gilles de la Tourette syndrome. Currently, a major controversial issue is the choice of brain target that leads to optimal patient outcomes within a presumed network of basal ganglia and cortical pathways involved in tic pathogenesis. This report describes our experience with patients with severe refractory Gilles de la Tourette syndrome treated with globus pallidus internus deep brain stimulation. Five patients were selected for surgery, 2 targeting the posteroventral globus pallidus internus and 2 targeting the anteromedial region. The remaining patient was first targeted on the posterolateral region, but after 18 months the electrodes were relocated in the anteromedial area. Tics were clinically assessed in all patients pre- and postoperatively using the Modified Rush Video protocol and the Yale Global Tic Severity Scale. Obsessive-compulsive behaviors were quantified with the Yale–Brown Obsessive Compulsive Scale. The Gilles de la Tourette Syndrome–Quality of Life Scale was also completed. All patients experienced improvements in tic severity but to variable extents. More convincing improvements were seen in patients with electrodes sited in the anteromedial region of the globus pallidus internus than in those with posterolateral implants. Mean reduction in the Modified Rush Video Rating scale for each group was 54% and 37%, respectively. Our open-label limited experience supports the use of the anteromedial globus pallidus internus as a promising target for future planned randomized double-blind trials of deep brain stimulation for patients with Gilles de la Tourette syndrome. © 2011 Movement Disorder Society