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Deep brain stimulation for Gilles de la Tourette syndrome: A case series targeting subregions of the globus pallidus internus§

Authors

  • Raul Martínez-Fernández MD,

    1. Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
    2. Department of Neurology, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
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  • Ludvic Zrinzo MD, FRSC,

    1. Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
    2. Victor Horsley Department of Neurosurgery, National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
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  • Iciar Aviles-Olmos MD,

    1. Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
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  • Marwan Hariz MD, PhD,

    1. Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
    2. Department of Neurosurgery, University Hospital, Umea, Sweden
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  • Irene Martinez-Torres MD,

    1. Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
    2. Department of Neurology, Hospital La Fe, Valencia, Spain
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  • Eileen Joyce MD, PhD,

    1. Department of Neuropsychiatry, National Hospital for Neurology & Neurosurgery, Queen Square, London, United Kingdom
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  • Marjan Jahanshahi PhD,

    1. Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
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  • Patricia Limousin MD, PhD,

    1. Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
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  • Thomas Foltynie MRCP, PhD

    Corresponding author
    1. Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
    • Box 146, National Hospital for Neurology & Neurosurgery, Queen Square, London WC1N 3BG
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  • 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.

  • 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.

Abstract

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

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