Objective: To assess the response to deep brain stimulation (DBS) in refractory Tourette syndrome (rTS) of both tics and behavioural comorbidities.

Background: Gilles de la Tourette syndrome is a complex neuropsychiatric disorder characterized by multiple motor tics and at least one phonic tic lasting longer than one year. However, less importance is given to the behavioural comorbidities whereas they demonstrate to be frequent and more invalidating than tics.

Methods: Starting from September 2005, 6 patients from 12 to 37 years-old underwent DBS procedure for rTS in the Resistant Brain Pathology Unit of the Montpellier University Hospital. In order to treat tic manifestations as well as comorbidities, all the patients were treated bilaterally at the globus pallidus internus (Gpi) target, on both anterior (limbic) and posterior (motor) parts. Targets were chosen on the basis of physiopathological hypothesis stating that tics would be controlled by the posterior Gpi DBS, and compulsive behaviors, notably the coprolalia, by the limbic Gpi. Patients still benefit from follow-up until nowadays.

Results: All patients were suffering from comorbid impulse control disorder (ICD). The other main behavioural comorbidities were obsessive-compulsive disorder (5/6), anxious-depressive disorder (5/6) and attention deficit hyperactivity disorder (3/6). Significant improvements were reached for all the patients concerning the tic severity with the Gpi stimulations. However, the behavioural comorbidities have trended to persist despite efficient modulation. Only one patient has stopped drug therapy completely.

Conclusions: Gpi DBS demonstrates significant improvement on tics, however, in our clinical experience, it fails to improve the behavioural comorbidities whereas they demonstrate to be common and even more invalidating than tics. These results should point toward some necessary considerations and caveats about the choice of modulation target in rTS with behavioural comorbidities and question the underpinning physiopathological mechanisms of the illness.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/tourette-syndrome-treated-by-continuous-electrical-neuromodulation-dbs-targeting-the-comorbidities/