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  • “Psychosocial” Outcome After GPi-Deep Brain Stimulation in Tourette`s Syndrome (GTS) – What`s Beyond the Scores and Scales?

    Final Number:

    Jan H. Mehrkens MD; Berend Feddersen; Kai Boetzel; Norbert Mueller; Sandra Dehning

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Up to now there is only scarce data available on “psychosocial outcome after DBS. Aim of the present naturalistic observational study therefore was to focus on the “psychosocial changes” in 5 GTS-patients` life after GPi-DBS (follow-up at least 12 months) not assessed in the standard “Tourette-specific” scores

    Methods: DBS-electrodes were implanted stereotactically (propofol anesthesia) in the posteroventrolateral (motor part) of the Globus Pallidus internus (GPi) exactly as established for dystonia. Localisation was verified by MRI. Outcome was assessed by Clinical Global Impression (CGI), Tourette Syndrome Global Scale (TSGS), and the Yale Global Tic Severity Scale (YGTSS)), the Verbal Learning Memory Test (VLMT) and the Stroop-Test. Moreover, any relevant “psychosocial changes” were assessed including the Global Assessment of Functioning Scale (GAF). Median follow-up was 24 months (range 12-66 months).

    Results: Mean age at surgery was 34 years (range 26-44 years, 3 female / 2 male). There was a significant (p=0.001) tic-improvement in 3/5 patients documented by a reduction in the YGTSS of 88% (tic-free) in Pat. I (12/66 months), 80% in Pat. IV (21/32 months) and 60% in Pat. V (12 months), respectively. In all the responders significant psychosocial changes occurred: Pat. I: once tic-free the patient was deprived of her “stable” everyday-life which had consisted of regular physician-care leading to a severe episode of depression. Pat. IV: after being-off any “GTS-specific” medication, the patient became pregnant and gave birth to a healthy baby-boy. Pat. V: struck with self-inflicted blindness, the patient realized this severe deficit with the tics no longer dominating his life – he is now in search of a partner for life.

    Conclusions: GPi-DBS seems to offer a promising therapy in otherwise intractable GTS in selected patients. However, “success” must not only be assessed by the classic tic-scales but must also take into account the possible subsequent significant psychosocial changes.

    Patient Care: We do believe that knowing about and understanding of the possible striking psychosocaial changes induced by DBS in the life of a GTS-patient will greatly improve adaequat follow-up and patient care.

    Learning Objectives: By the conclusion of this session, participants should be able to: Comprehend that there is much more to assess in the follow-up of GTS patients after GPi-DBS than just the standard tic-scores and scales


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