Aktuelle Neurologie 2009; 36 - P762
DOI: 10.1055/s-0029-1238855

Bilateral Globus pallidus internus stimulation for intractable Gilles de la Tourette syndrome

JH Mehrkens 1, S Dehning 1, N Müller 1, A Cerovecki 1, K Bötzel 1
  • 1München

Objective: In recent years the application of deep brain stimulation (DBS) in Gilles de la Tourette syndrome (GTS) has come into focus with the Globus pallidus internus (GPi) being one possible target. We here present the results of four patients with intractable GTS in whom bilateral GPi-DBS was performed.

Methods: Electrode-implantation (DBS 3387, Medtronic) was performed under propofol anaesthesia with MRI-guided stereotaxy followed by implantation of the permanent stimulation system (Soletra (1)/Kinetra (3), Medtronic). Initially, standard settings also used for dystonia were chosen (monopolar stimulation, amplitude 2.5 V, pulse width 120µs, frequency 130 pps). Electrode position was verified by MRI and clinical outcome was assessed using the Yale Global Tic Severity Scale (YGTSS), the Verbal Learning Memory Test (VLMT) and the Stroop-Test. Median follow-up was 10 months (range 8–32 months).

Results: Mean age at surgery was 34 years with a range of 26–44 years (3 female/1 male). There was a significant (p=0.001) clinical improvement in two patients (YGTSS score improvement of 66.3%, 78.3% and 100% at 1, 8 and 24 months follow-up in patient one and of 22%, 28% and 66.7% at 1, 3 and 8 months follow-up, respectively in patient two. Only very moderate or no effect was observed in two patients with predominant OCD-features (12 months follow-up). Neuropsychological testing pre- and post-operatively showed an identical cognitive function. No surgery- or therapy-related morbidity was observed. Stimulation parameters were gradually adjusted to try to optimize effectiveness during regular follow-up.

Conclusion: GPi-DBS seems to offer a valuable effective and safe therapy in otherwise intractable GTS in selected patients. However, there also seem to be “moderate – or non-responders“ with predominant OCD-features being one possible factor. Whether choosing a different target might be effective in these patients is currently subject to further investigation.