gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Bilateral globus pallidus internus stimulation for intractable Gilles de la Tourette syndrome – are we after the right target?

Meeting Abstract

  • J.H. Mehrkens - Neurochirurgische Universitätsklinik, Ludwig-Maximilians-Universität München
  • S. Dehning - Psychiatrische Universitätsklinik, Ludwig-Maximilians-Universität München
  • B. Feddersen - Neurologische Universitätsklinik, Ludwig-Maximilians-Universität München
  • N. Müller - Psychiatrische Universitätsklinik, Ludwig-Maximilians-Universität München
  • K. Bötzel - Neurologische Universitätsklinik, Ludwig-Maximilians-Universität München

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.12.04

DOI: 10.3205/11dgnc089, URN: urn:nbn:de:0183-11dgnc0894

Published: April 28, 2011

© 2011 Mehrkens et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: The application of deep brain stimulation (DBS) in Gilles de la Tourette syndrome (GTS) has come into focus in recent years with the Globus pallidus internus (GPi) as one possible target. Here, we present the results of six patients with intractable GTS who underwent bilateral GPi-DBS.

Methods: Electrode implantation (DBS 3387, Medtronic) was performed under propofol anesthesia with MRI-guided stereotaxy followed by implantation of the permanent stimulation system (Soletra (1)/Kinetra (3), Activa PC (2), Medtronic). Initially, the standard settings also used for dystonia were chosen (monopolar stimulation, amplitude 2.5 V, pulse width 120 µsec, 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 17 months (range 3-54 months).

Results: Mean age at surgery was 34 years (range 26-44 years, 3 female / 3 male). There was significant (p=0.001) clinical improvement in four patients documented by a reduction in the YGTSS of 88% (tic-free) in patient I (at 12/54 months), 80% in patient IV (at 21/30 months), 60% in patient V (at 6 months) and 50% in patient VI (at 3 months), respectively. Patients I and IV are off any “GTS-specific” medication. Very moderate/no effect was observed in patients II and III. A comparison of the responders and non-responders revealed that the predominant symptoms of the responders were vocal tics and self-injurious behaviour, whereas these symptoms were almost absent in the non-responders. Neuropsychological testing pre- and post-operatively showed identical cognitive function. No surgery- or therapy-related morbidity was observed.

Conclusions: GPi-DBS – in the posteroventrolateral part – seems to offer a promising therapy in otherwise intractable GTS in selected patients. Vocal tics, self-injurious behavior, and complex motor tics seem to form a cluster of symptoms that may eventually respond better to (pvl) GPi-DBS. Controlled prospective studies are mandatory, not only to detect the “best” target point, but also to select suitable candidates on the basis of their individual symptoms that may predict their responsiveness to DBS.