Introduction: A current challenge lies in finding an effective and safe treatment for patients with severely disabling Tourette’s syndrome (TS) and comorbid psychiatric disorders who fail to respond to conventional treatments. Here, we evaluate the utility of globus pallidus internus deep brain stimulation (GPi-DBS) combined with bilateral anterior capsulotomy in treating these clinically challenging patients.
Methods: We conducted a retrospective review of the clinical history and outcomes of 14 patients with treatment-refractory, severely disabling TS and psychiatric comorbidity (8 males; mean age: 21.8 years, range: 12-43) who underwent GPi-DBS combined with bilateral anterior capsulotomy in our hospital. At the time of surgery, patients presented mainly with obsessive-compulsive disorder and affective disorders. Clinical outcome assessments of tic and psychiatric symptoms, as well as of general adaptive functioning and quality of life, were performed at the time of surgery and at 6 months, at 12 months, and between 24 and 96 months after surgery.
Results: After surgery, all patients showed significant progressive improvements in tic and psychiatric symptoms along with improvements in general adaptive functioning and quality of life. At the final follow-up, patients were functionally recovered and displayed no or only mild tic and psychiatric symptoms. All patients tolerated the treatment reasonably well, with no complications or serious side effects.
Conclusions: GPi-DBS combined with bilateral anterior capsulotomy seems to offer major clinical benefits to patients with severely disabling and otherwise treatment-refractory TS and psychiatric comorbidity. Randomized controlled trials are warranted to assess the combined treatment under experimentally controlled conditions.
Patient Care: The study involves a retrospective review of the clinical history and outcomes of a series of patients with treatment-refractory, severely disabling Tourette’s symptom(TS) and psychiatric comorbidity who underwent deep brain stimulation (DBS) combined with bilateral anterior capsulotomy in our hospital. After surgery, all patients showed significant progressive improvements in tic and psychiatric symptoms along with improvements in general adaptive functioning and quality of life. To our knowledge, this study offers the first evidence indicating that DBS combined with bilateral anterior capsulotomy could offer a valuable alternative treatment option for patients with severely disabling TS and psychiatric comorbidity who do not respond to conventional treatments.
Learning Objectives: Over recent decades, DBS has gained popularity in neurologic and psychiatric disorders such as TS, obsessive compulsive disorders, tardive dyskinesia, but stereotactic ablative surgery is worthy of consideration on its own merits with respect to both efficacy and safety.