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Modulation of Fibers to Motor Cortex during Thalamic DBS in Tourette Patients Correlates with Tic Reduction
Open AccessArticle

Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets

1
Neurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, 20100 Milan, Lombardia, Italy
2
Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10100 Torino, Italy
3
Tourette’s Syndrome and Movement Disorders Center, IRCCS Istituto Ortopedico Galeazzi, 20100 Milan, Lombardia, Italy
*
Author to whom correspondence should be addressed.
Brain Sci. 2020, 10(5), 301; https://doi.org/10.3390/brainsci10050301
Received: 6 April 2020 / Revised: 14 May 2020 / Accepted: 14 May 2020 / Published: 15 May 2020
(This article belongs to the Special Issue Deep Brain Stimulation and Tourette Syndrome)
Gilles de la Tourette syndrome (GTS) is a complex neurodevelopmental disorder characterized by tics and, frequently, psychiatric and behavioral comorbidities. Above all, obsessive compulsive disorder/behavior (OCD/OCB) influences the clinical picture and has a severe impact on quality of life, eventually more than the tics themselves. Deep brain stimulation (DBS) is an effective therapy in selected, refractory cases. Clinical response to DBS may vary according to the clinical picture, comorbidities, and to the anatomical target. This retrospective study compares the results obtained from DBS in the ventralis oralis/centromedian-parascicular nucleus of the thalamus (Voi-Cm/Pf) (41 patients) and antero-medial Globus Pallidus internus (am-GPi) (14 patients), evaluating clinical response over time by means of Yale Global Tic Severity Scale (YGTSS) and Yale–Brown Obsessive-Compulsive Scale (YBOCS) scores over a period of 48 months. A significant and stable improvement in the YGTSS and YBOCS has been obtained in both groups (p < 0.001). There was a significant difference in YBOCS improvement over time between the am-GPi group and the Voi-Cm/Pf group, indicating a better and faster control of OCD/OCB symptoms in the former group. The ratio of hardware removal was 23% and limited to 13 patients in the Voi-Cm/Pf group. These results confirm that DBS is an effective therapy in treating GTS and suggest that the am-GPi might be superior to Voi-Cm/Pf in alleviating comorbid OCD/OCB. View Full-Text
Keywords: Deep Brain Stimulation; antero-medial Globus Pallidus internus; ventralis oralis/centromedian-parascicular nucleus of the thalamus; Tourette Syndrome; obsessive compulsive disorder Deep Brain Stimulation; antero-medial Globus Pallidus internus; ventralis oralis/centromedian-parascicular nucleus of the thalamus; Tourette Syndrome; obsessive compulsive disorder
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Servello, D.; Galbiati, T.F.; Balestrino, R.; Iess, G.; Zekaj, E.; De Michele, S.; Porta, M. Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets. Brain Sci. 2020, 10, 301.

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