Deep brain stimulation for Gilles de la Tourette syndrome: a case series targeting subregions of the globus pallidus internus.
Identifieur interne : 001231 ( PubMed/Corpus ); précédent : 001230; suivant : 001232Deep brain stimulation for Gilles de la Tourette syndrome: a case series targeting subregions of the globus pallidus internus.
Auteurs : Raul Martínez-Fernández ; Ludvic Zrinzo ; Iciar Aviles-Olmos ; Marwan Hariz ; Irene Martinez-Torres ; Eileen Joyce ; Marjan Jahanshahi ; Patricia Limousin ; Thomas FoltynieSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2011.
English descriptors
- KwdEn :
- Aged, Deep Brain Stimulation (methods), Disability Evaluation, Dopamine Agents (therapeutic use), Female, Globus Pallidus (physiology), Humans, Longitudinal Studies, Male, Middle Aged, Neurologic Examination, Retrospective Studies, Survival Analysis, Time Factors, Tourette Syndrome (mortality), Tourette Syndrome (therapy), Treatment Outcome.
- MESH :
- chemical , therapeutic use : Dopamine Agents.
- methods : Deep Brain Stimulation.
- mortality : Tourette Syndrome.
- physiology : Globus Pallidus.
- therapy : Tourette Syndrome.
- Aged, Disability Evaluation, Female, Humans, Longitudinal Studies, Male, Middle Aged, Neurologic Examination, Retrospective Studies, Survival Analysis, Time Factors, Treatment Outcome.
Abstract
Deep brain stimulation remains an experimental treatment for patients with Gilles de la Tourette syndrome. Currently, a major controversial issue is the choice of brain target that leads to optimal patient outcomes within a presumed network of basal ganglia and cortical pathways involved in tic pathogenesis. This report describes our experience with patients with severe refractory Gilles de la Tourette syndrome treated with globus pallidus internus deep brain stimulation. Five patients were selected for surgery, 2 targeting the posteroventral globus pallidus internus and 2 targeting the anteromedial region. The remaining patient was first targeted on the posterolateral region, but after 18 months the electrodes were relocated in the anteromedial area. Tics were clinically assessed in all patients pre- and postoperatively using the Modified Rush Video protocol and the Yale Global Tic Severity Scale. Obsessive-compulsive behaviors were quantified with the Yale-Brown Obsessive Compulsive Scale. The Gilles de la Tourette Syndrome-Quality of Life Scale was also completed. All patients experienced improvements in tic severity but to variable extents. More convincing improvements were seen in patients with electrodes sited in the anteromedial region of the globus pallidus internus than in those with posterolateral implants. Mean reduction in the Modified Rush Video Rating scale for each group was 54% and 37%, respectively. Our open-label limited experience supports the use of the anteromedial globus pallidus internus as a promising target for future planned randomized double-blind trials of deep brain stimulation for patients with Gilles de la Tourette syndrome.
DOI: 10.1002/mds.23734
PubMed: 21538528
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Hariz</name></author><author><name sortKey="Martinez Torres, Irene" sort="Martinez Torres, Irene" uniqKey="Martinez Torres I" first="Irene" last="Martinez-Torres">Irene Martinez-Torres</name></author><author><name sortKey="Joyce, Eileen" sort="Joyce, Eileen" uniqKey="Joyce E" first="Eileen" last="Joyce">Eileen Joyce</name></author><author><name sortKey="Jahanshahi, Marjan" sort="Jahanshahi, Marjan" uniqKey="Jahanshahi M" first="Marjan" last="Jahanshahi">Marjan Jahanshahi</name></author><author><name sortKey="Limousin, Patricia" sort="Limousin, Patricia" uniqKey="Limousin P" first="Patricia" last="Limousin">Patricia Limousin</name></author><author><name sortKey="Foltynie, Thomas" sort="Foltynie, Thomas" uniqKey="Foltynie T" first="Thomas" last="Foltynie">Thomas Foltynie</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2011">2011</date><idno type="doi">10.1002/mds.23734</idno><idno type="RBID">pubmed:21538528</idno><idno 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qualifier="mortality" xml:lang="en"><term>Tourette Syndrome</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Globus Pallidus</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Tourette Syndrome</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Disability Evaluation</term><term>Female</term><term>Humans</term><term>Longitudinal Studies</term><term>Male</term><term>Middle Aged</term><term>Neurologic Examination</term><term>Retrospective Studies</term><term>Survival Analysis</term><term>Time Factors</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Deep brain stimulation remains an experimental treatment for patients with Gilles de la Tourette syndrome. Currently, a major controversial issue is the choice of brain target that leads to optimal patient outcomes within a presumed network of basal ganglia and cortical pathways involved in tic pathogenesis. This report describes our experience with patients with severe refractory Gilles de la Tourette syndrome treated with globus pallidus internus deep brain stimulation. Five patients were selected for surgery, 2 targeting the posteroventral globus pallidus internus and 2 targeting the anteromedial region. The remaining patient was first targeted on the posterolateral region, but after 18 months the electrodes were relocated in the anteromedial area. Tics were clinically assessed in all patients pre- and postoperatively using the Modified Rush Video protocol and the Yale Global Tic Severity Scale. Obsessive-compulsive behaviors were quantified with the Yale-Brown Obsessive Compulsive Scale. The Gilles de la Tourette Syndrome-Quality of Life Scale was also completed. All patients experienced improvements in tic severity but to variable extents. More convincing improvements were seen in patients with electrodes sited in the anteromedial region of the globus pallidus internus than in those with posterolateral implants. Mean reduction in the Modified Rush Video Rating scale for each group was 54% and 37%, respectively. Our open-label limited experience supports the use of the anteromedial globus pallidus internus as a promising target for future planned randomized double-blind trials of deep brain stimulation for patients with Gilles de la Tourette syndrome.</div></front></TEI><pubmed><MedlineCitation Owner="NLM" Status="MEDLINE"><PMID Version="1">21538528</PMID><DateCreated><Year>2011</Year><Month>12</Month><Day>16</Day></DateCreated><DateCompleted><Year>2012</Year><Month>04</Month><Day>23</Day></DateCompleted><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1531-8257</ISSN><JournalIssue CitedMedium="Internet"><Volume>26</Volume><Issue>10</Issue><PubDate><Year>2011</Year><Month>Aug</Month><Day>15</Day></PubDate></JournalIssue><Title>Movement disorders : official journal of the Movement Disorder Society</Title><ISOAbbreviation>Mov. 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The remaining patient was first targeted on the posterolateral region, but after 18 months the electrodes were relocated in the anteromedial area. Tics were clinically assessed in all patients pre- and postoperatively using the Modified Rush Video protocol and the Yale Global Tic Severity Scale. Obsessive-compulsive behaviors were quantified with the Yale-Brown Obsessive Compulsive Scale. The Gilles de la Tourette Syndrome-Quality of Life Scale was also completed. All patients experienced improvements in tic severity but to variable extents. More convincing improvements were seen in patients with electrodes sited in the anteromedial region of the globus pallidus internus than in those with posterolateral implants. Mean reduction in the Modified Rush Video Rating scale for each group was 54% and 37%, respectively. 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ValidYN="Y"><LastName>Martinez-Torres</LastName><ForeName>Irene</ForeName><Initials>I</Initials></Author><Author ValidYN="Y"><LastName>Joyce</LastName><ForeName>Eileen</ForeName><Initials>E</Initials></Author><Author ValidYN="Y"><LastName>Jahanshahi</LastName><ForeName>Marjan</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Limousin</LastName><ForeName>Patricia</ForeName><Initials>P</Initials></Author><Author ValidYN="Y"><LastName>Foltynie</LastName><ForeName>Thomas</ForeName><Initials>T</Initials></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><Agency>Department of Health</Agency><Country>United Kingdom</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate 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