Bilateral DBS of Globus Pallidus is effective for Tourette’s Syndrome

Bilateral globus pallidus stimulation for severe Tourette’s syndrome: a double-blind, randomized crossover trial.

The largest study of deep brain stimulation (DBS) of the anteromedial globus pallidus interna (GPi) for Tourette’s syndrome was performed as a double-blind, randomized, cross-over trial.  There is substantial evidence for targeting anteromedial GPi DBS for movement disorders such as dystonia and Parkinson’s disease. Patients over 20yo with severe intractable Tourette’s received either on-first stimulation or off-first GPi stimulation for 3 months, followed by a 3-month cross-over, then all patients were offered continued stimulation. Thirteen patients completed both blinded assessments with stimulation parameters that were similar to DBS for Parkinson’s disease. Patients on stimulation showed a statistically significant improvement in mean Yale Global Tic Severity Scale. All patients chose to receive stimulation in the open-label phase. Three adverse events occurred: 2 infections and 1 hypomanic episode on stimulation. This data suggest that GPi DBS for intractable Tourette’s syndrome is a viable alternative to thalamic DBS, and future studies for optimal targeting are needed.

Jennifer Sweet, MD
Jennifer A Sweet, MD
Cleveland, OH
Johathan P Miller, MD
Cleveland, OH