Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome: The International Tourette Syndrome Deep Brain Stimulation Public Database and Registry.
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Martinez-Ramirez Daniel, Jimenez-Shahed Joohi, Leckman James Frederick, Porta Mauro, Servello Domenico, Meng Fan-Gang, Kuhn Jens, Huys Daniel, Baldermann Juan Carlos, Foltynie Thomas, Hariz Marwan I, Joyce Eileen M, Zrinzo Ludvic, Kefalopoulou Zinovia, Silburn Peter, Coyne Terry, Mogilner Alon Y, Pourfar Michael H, Khandhar Suketu M, Auyeung Man, Ostrem Jill Louise, Visser-Vandewalle Veerle, Welter Marie-Laure, Mallet Luc, Karachi Carine, Houeto Jean Luc, Klassen Bryan Timothy, Ackermans Linda, Kaido Takanobu, Temel Yasin, Gross Robert E, Walker Harrison C, Lozano Andres M, Walter Benjamin L, Mari Zoltan, Anderson William S, Changizi Barbara Kelly, Moro Elena, Zauber Sarah Elizabeth, Schrock Lauren E, Zhang Jian-Guo, Hu Wei, Rizer Kyle, Monari Erin H, Foote Kelly D, Malaty Irene A, Deeb Wissam, Gunduz Aysegul, Okun Michael S
Аннотация
OBJECTIVE: To assess the efficacy and safety of DBS in a multinational cohort of patients with Tourette syndrome.
DESIGN, SETTING, AND PARTICIPANTS: The prospective International Deep Brain Stimulation Database and Registry included 185 patients with medically refractory Tourette syndrome who underwent DBS implantation from January 1, 2012, to December 31, 2016, at 31 institutions in 10 countries worldwide.
EXPOSURES: Patients with medically refractory symptoms received DBS implantation in the centromedian thalamic region (93 of 163 [57.1%]), the anterior globus pallidus internus (41 of 163 [25.2%]), the posterior globus pallidus internus (25 of 163 [15.3%]), and the anterior limb of the internal capsule (4 of 163 [2.5%]).
MAIN OUTCOMES AND MEASURES: Scores on the Yale Global Tic Severity Scale and adverse events.
RESULTS: The International Deep Brain Stimulation Database and Registry enrolled 185 patients (of 171 with available data, 37 females and 134 males; mean [SD] age at surgery, 29.1 [10.8] years [range, 13-58 years]). Symptoms of obsessive-compulsive disorder were present in 97 of 151 patients (64.2%) and 32 of 148 (21.6%) had a history of self-injurious behavior. The mean (SD) total Yale Global Tic Severity Scale score improved from 75.01 (18.36) at baseline to 41.19 (20.00) at 1 year after DBS implantation (P < .001). The mean (SD) motor tic subscore improved from 21.00 (3.72) at baseline to 12.91 (5.78) after 1 year (P < .001), and the mean (SD) phonic tic subscore improved from 16.82 (6.56) at baseline to 9.63 (6.99) at 1 year (P < .001). The overall adverse event rate was 35.4% (56 of 158 patients), with intracranial hemorrhage occurring in 2 patients (1.3%), infection in 4 patients with 5 events (3.2%), and lead explantation in 1 patient (0.6%). The most common stimulation-induced adverse effects were dysarthria (10 [6.3%]) and paresthesia (13 [8.2%]).
CONCLUSIONS AND RELEVANCE: Deep brain stimulation was associated with symptomatic improvement in patients with Tourette syndrome but also with important adverse events. A publicly available website on outcomes of DBS in patients with Tourette syndrome has been provided.