Deep Brain Stimulation for Refractory Tourette Syndrome: Electrode Position and Clinical Outcome

Area of Science:

• Neurology
• Neurosurgery
• Psychiatry

Background:

• Deep brain stimulation (DBS) is an established treatment for refractory Tourette syndrome (TS).
• The efficacy and safety of DBS in the Japanese population remain under investigation.
• This study assesses DBS outcomes in Japanese patients with refractory TS.

Observation:

• Twenty-five patients with refractory TS received thalamic centromedian-parafascicular nucleus DBS.
• Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS) pre-surgery, at 1 year, and over 3 years post-surgery.
• Adverse events, active contact locations, and stimulation parameters were recorded.

Findings:

• YGTSS scores decreased by an average of 45.2% at 1 year and 56.6% at long-term follow-up.
• Significant reductions were observed in motor tics, phonic tics, and impairment.
• Efficacy and stimulation parameters were comparable to international reports, with side effects including dysarthria (32.0%) and paresthesia (12.0%).
• Surgical complications included device infection in 12.0% of patients.

Implications:

• DBS is a viable and effective treatment for refractory Tourette syndrome in Japanese patients.
• Outcomes appear consistent with international findings, supporting its global applicability.
• Careful patient selection is crucial due to surgical risks, including infection, and the need for long-term outcome monitoring.