Stereotactic Surgery for Treating Intractable Tourette Syndrome: A Single-Center Pilot Study

Area of Science:

• Neurology
• Neurosurgery
• Psychiatry

Background:

• Tourette syndrome (TS) is a complex neurological disorder characterized by involuntary movements and vocalizations (tics).
• Treatment-refractory TS poses significant challenges, often necessitating advanced therapeutic interventions.
• Stereotactic ablative procedures and deep brain stimulation (DBS) are emerging options for severe, intractable cases.

Purpose of the Study:

• To evaluate the efficacy of radiofrequency ablation and DBS in managing treatment-refractory Tourette syndrome.
• To assess the impact of these interventions on tic severity, obsessive-compulsive disorder (OCD) symptoms, and quality of life.
• To identify factors influencing post-operative quality of life in TS patients undergoing these procedures.

Main Methods:

• A cohort of thirteen patients with treatment-refractory TS underwent either radiofrequency ablation, DBS, or a combination of both.
• Symptom severity and quality of life were assessed using standardized scales (YGTSS, YBOCS, GTS-QOL) pre-operatively and post-operatively.
• Statistical analyses, including paired-sample t tests and multiple linear regression, were employed to analyze the data.

Main Results:

• Both radiofrequency ablation and DBS resulted in significant reductions in Yale Global Tic Severity Scale (YGTSS) scores at one month and final follow-up (p < 0.05).
• Obsessive-compulsive symptoms, measured by Yale−Brown Obsessive Compulsive Scale (YBOCS), and quality of life (GTS-QOL) also showed significant improvements (p < 0.05).
• Post-operative quality of life improvement was independently associated with tic reduction (YGTSS), but not with OCD symptom reduction (YBOCS).

Conclusions:

• Stereotactic ablation and deep brain stimulation are effective in alleviating tics, psychiatric symptoms, and enhancing quality of life in patients with intractable Tourette syndrome.
• The improvement in tic severity appears to be a more significant contributor to enhanced quality of life than the reduction in obsessive-compulsive symptoms.
• These findings support the consideration of ablative surgery and DBS as valuable therapeutic options for carefully selected patients with severe, refractory Tourette syndrome.