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