TY - JOUR
T1 - Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome
T2 - The International Tourette Syndrome Deep Brain Stimulation Public Database and Registry
AU - Martinez-Ramirez, Daniel
AU - Jimenez-Shahed, Joohi
AU - Leckman, James Frederick
AU - Porta, Mauro
AU - Servello, Domenico
AU - Meng, Fan-Gang
AU - Kuhn, Jens
AU - Huys, Daniel
AU - Baldermann, Juan Carlos
AU - Foltynie, Thomas
AU - Hariz, Marwan I.
AU - Joyce, Eileen M.
AU - Zrinzo, Ludvic
AU - Kefalopoulou, Zinovia
AU - Silburn, Peter
AU - Coyne, Terry
AU - Mogilner, Alon Y.
AU - Pourfar, Michael H.
AU - Khandhar, Suketu M.
AU - Auyeung, Man
AU - Ostrem, Jill Louise
AU - Visser-Vandewalle, Veerle
AU - Welter, Marie-Laure
AU - Mallet, Luc
AU - Karachi, Carine
AU - Houeto, Jean Luc
AU - Klassen, Bryan Timothy
AU - Ackermans, Linda
AU - Kaido, Takanobu
AU - Temel, Yasin
AU - Gross, Robert E.
AU - Walker, Harrison C.
AU - Lozano, Andres M.
AU - Walter, Benjamin L.
AU - Mari, Zoltan
AU - Anderson, William S.
AU - Changizi, Barbara Kelly
AU - Moro, Elena
AU - Zauber, Sarah Elizabeth
AU - Schrock, Lauren E.
AU - Zhang, Jian-Guo
AU - Hu, Wei
AU - Rizer, Kyle
AU - Monari, Erin H.
AU - Foote, Kelly D.
AU - Malaty, Irene A.
AU - Deeb, Wissam
AU - Gunduz, Aysegul
AU - Okun, Michael S.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - 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%]). MAINOUTCOMES 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 stimulationwas 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.
AB - 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%]). MAINOUTCOMES 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 stimulationwas 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.
KW - PARKINSONS-DISEASE
KW - RECOMMENDATIONS
U2 - 10.1001/jamaneurol.2017.4317
DO - 10.1001/jamaneurol.2017.4317
M3 - Article
C2 - 29340590
SN - 2168-6149
VL - 75
SP - 353
EP - 359
JO - JAMA Neurology
JF - JAMA Neurology
IS - 3
ER -