Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome
Daniel Martinez-Ramirez
(1)
,
Joohi Jimenez-Shahed
(2)
,
James Frederick Leckman
(3)
,
Mauro Porta
(4)
,
Domenico Servello
(5)
,
Fan-Gang Meng
(6)
,
Jens Kuhn
(7)
,
Daniel Huys
(7)
,
Juan Carlos Baldermann
(7)
,
Thomas Foltynie
(8)
,
Marwan Hariz
(9)
,
Eileen Joyce
(8)
,
Ludvic Zrinzo
(8)
,
Zinovia Kefalopoulou
(8)
,
Peter Silburn
(10)
,
Terry Coyne
(10)
,
Alon Mogilner
(11)
,
Michael Pourfar
(11)
,
Suketu Khandhar
,
Man Auyeung
(12)
,
Jill Louise Ostrem
(13)
,
Veerle Visser-Vandewalle
(14)
,
Marie-Laure Welter
(15)
,
Luc Mallet
(15)
,
Carine Karachi
(16)
,
Jean Luc Houeto
(17)
,
Bryan Timothy Klassen
(18)
,
Linda Ackermans
(19)
,
Takanobu Kaido
,
Yasin Temel
(19)
,
Robert Gross
(20)
,
Harrison Walker
(21)
,
Andres Lozano
(22)
,
Benjamin Walter
(23, 24, 25)
,
Zoltan Mari
(26)
,
William Anderson
(26)
,
Barbara Kelly Changizi
,
Elena Moro
(27, 28)
,
Sarah Elizabeth Zauber
(29)
,
Lauren Schrock
(30)
,
Jian-Guo Zhang
,
Wei Hu
(1)
,
Kyle Rizer
(1)
,
Erin Monari
(1)
,
Kelly Foote
(1)
,
Irene Malaty
(1)
,
Wissam Deeb
(1)
,
Aysegul Gunduz
,
Michael Okun
(1)
1
UF -
University of Florida [Gainesville]
2 BCM - Baylor College of Medicine
3 Yale University [New Haven]
4 Movement Disorders and Tourette Centre
5 IRCCS Istituto Ortopedico Galeazzi
6 University of Medical Sciences / Beijing
7 Universität zu Köln = University of Cologne
8 Institute of Neurology [London]
9 UCL Queen Square Institute of Neurology
10 Queensland Brain Institute
11 NYU Langone Medical Center - New York University Langone Medical Center
12 Pamela Youde Nethersole Eastern Hospital
13 UC San Francisco - University of California [San Francisco]
14 University Hospital of Cologne [Cologne]
15 ICM - Institut du Cerveau = Paris Brain Institute
16 CHU Pitié-Salpêtrière [AP-HP]
17 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
18 Mayo Clinic [Rochester]
19 MUMC - Maastricht University Medical Centre
20 Emory University School of Medicine
21 UAB - University of Alabama at Birmingham [ Birmingham]
22 University of Toronto
23 Louis Stokes Cleveland Veterans Affairs Medical Center
24 UH Cleveland Medical Center - University Hospitals Case Medical Center
25 Case Western Reserve University [Cleveland]
26 JHU - Johns Hopkins University
27 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
28 UGA - Université Grenoble Alpes
29 Indiana University School of Medicine
30 CUMS - Capital University of Medical Sciences [Beijing]
2 BCM - Baylor College of Medicine
3 Yale University [New Haven]
4 Movement Disorders and Tourette Centre
5 IRCCS Istituto Ortopedico Galeazzi
6 University of Medical Sciences / Beijing
7 Universität zu Köln = University of Cologne
8 Institute of Neurology [London]
9 UCL Queen Square Institute of Neurology
10 Queensland Brain Institute
11 NYU Langone Medical Center - New York University Langone Medical Center
12 Pamela Youde Nethersole Eastern Hospital
13 UC San Francisco - University of California [San Francisco]
14 University Hospital of Cologne [Cologne]
15 ICM - Institut du Cerveau = Paris Brain Institute
16 CHU Pitié-Salpêtrière [AP-HP]
17 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
18 Mayo Clinic [Rochester]
19 MUMC - Maastricht University Medical Centre
20 Emory University School of Medicine
21 UAB - University of Alabama at Birmingham [ Birmingham]
22 University of Toronto
23 Louis Stokes Cleveland Veterans Affairs Medical Center
24 UH Cleveland Medical Center - University Hospitals Case Medical Center
25 Case Western Reserve University [Cleveland]
26 JHU - Johns Hopkins University
27 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
28 UGA - Université Grenoble Alpes
29 Indiana University School of Medicine
30 CUMS - Capital University of Medical Sciences [Beijing]
Suketu Khandhar
- Fonction : Auteur
Takanobu Kaido
- Fonction : Auteur
Barbara Kelly Changizi
- Fonction : Auteur
Jian-Guo Zhang
- Fonction : Auteur
Aysegul Gunduz
- Fonction : Auteur
Résumé
Importance: Collective evidence has strongly suggested that deep brain stimulation (DBS) is a promising therapy for Tourette syndrome.
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.