gms | German Medical Science

Objective: Deep brain stimulation (DBS) in different targets for Gilles de la Tourette syndrome (GTS) has been in the focus for some years with over 60 cases published. However, there is hardly any data on "psychosocial" outcome after DBS for GTS. Aim of the present naturalistic observational study therefore was to focus on the "psychosocial changes" in 6 GTS-patients' life after GPi-DBS.

Methods: All patients (mean age at surgery 34 years (range 26–44), 3 female / 3 male) had undergone GPi-DBS (posteroventrolateral (motor) part). Outcome was assessed by Clinical Global Impression (CGI), Tourette Syndrome Global Scale (TSGS), Yale Global Tic Severity Scale (YGTSS), Verbal Learning Memory Test (VLMT) and the Stroop-Test. Moreover, "psychosocial changes" were assessed using the Global Assessment of Functioning Scale (GAF), the Social and Occupational Functioning Scale (SOFAS) and the GTS-Quality-of-Life scale. Moreover, any "major psycho-social event" was recorded. Median follow-up was 24 months (range 12–72 months).

Results: There was a significant (p = 0.001) tic-improvement in 4/6 patients: Reduction in the YGTSS of 100% (tic-free) in Pat. I (12/72 months), 90% in Pat. IV (21/48 months), 80% in Pat. V (8/18 months) and 60% in Pat VI (10 months). "Symptomatic" improvement was associated with significant "functional" improvement in all responders, with psychosocial "life-events" occurring in addition, not adequately assessed by the applied "scales": Pat. I: going through a severe episode of depression despite being tic-free after loss of secondary benefit. Pat. IV: after being-off any "GTS-specific" medication post-DBS, the patient became pregnant and gave birth to a healthy baby-boy. Pat. V: struck with self-inflicted blindness, the patient realized this severe deficit with the tics no longer dominating his life post-DBS – he is now in search of a partner for life.

Conclusions: GPi-DBS – in the posteroventrolateral part - seems to offer a promising therapy in otherwise intractable GTS in selected patients. However, "success" is not only to be assessed and determined by the classic "tic-scales" but must also take into account the functional outcome. Both – the patient and the clinician in charge – should be prepared for possible significant psychosocial changes.