Objective: To present the open phase outcomes of a trial of anterior pallidal stimulation (antGPi DBS) on tic severity in patients with severe Tourette syndrome (TS).

Background: Severe and disabling tics can persist in a proportion of TS patients even into adulthood.  GPi DBS has been associated with tic improvement in previous trials and case reports but with heterogeneous outcomes. Double blind studies have shown more limited improvements, in part due to the difficulties in optimising parameters when patients are blinded to the stimulation condition.

Method: Patients with severe TS (YGTSS Global>50) were implanted under general anaesthesia in the bilateral antGPi using MRI localisation. They were seen monthly during a 5 months open label phase for optimisation of DBS parameters. Assessments were conducted before surgery and at the end of the open label “On DBS” phase.

Results: Twenty patients had DBS systems implanted. Their mean age (SD) at baseline was 36.8 (10.4), including 13 males and 7 females. Median tic severity (IQR), assessed with the Yale Global Tic Severity Scale was 87.5 (76.5-94). OCD was assessed with Yale-Brown Obsessive Compulsive Scale; 2 patients were scored as “extreme”, 1 “severe”, 5 “moderate”, 3 “mild” and 9 “none”. Anxiety, assessed with the Beck Anxiety Inventory, was “concerning” in 5 patients, “moderate” in 4 and “low” in 11. Depression assessed with the Beck depression Inventory was “severe to extreme” in 2 patients, “borderline to moderate” in 8 patients and “mild or normal” in 10. No patients suffered from severe adverse events in that period.

The outcome of the open phase (before entering the double blind phase) will be presented in 19 patients. One patient exited the trial before the end of the open phase due to personal situation not allowing her travelling to the trial centre.

Conclusion: antGPi DBS can be safely performed in patients with Tourette with severe tics and different levels of co-morbidity.

Funded by NIHR eme Grant. 

Boston Scientific Grant for DBS equipment

Acknowledgements: Prof Anette Schrag, Prof Nicola Pavese, Dr Gary Price, Dr Antonella Macerollo, Dr Jeremy Stern, UCL-CCTU, overseeing committee and PPI members, Hughlings Jackson Ward.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/anterior-pallidal-stimulation-for-severe-tourette-syndrome-open-phase-outcomes/