Objective: To investigate the neurophysiological activity of dual-target bi-pallidal DBS in Tourette Syndrome (TS) patients using chronic local field potential (LFP) recordings in an outpatient setting.

Background: DBS can be considered to treat patients with medication-resistant TS. While anterior and posterior globus pallidus internus (aGPI, pGPi) have been individually studied, their respective contributions to tic modulation are not fully understood. Recent advances allow chronic local field potentials (LFPs) monitoring, providing real-time insights into the neurophysiology of TS.

Method: TS patients underwent bilateral simultaneous aGPi and pGPi DBS implantation with BrainSense™-enabled electrodes. LFPs recordings were obtained under on- and off-stimulation-off conditions after surgery. Power spectral analysis was performed to evaluate oscillatory activity. Electrode positions were reconstructed postoperatively.

Results: Three patients (two males) with a median age of 22 years (range: 13-42) and a median disease duration of 16 years (range: 9-38) were studied. LFP analysis revealed sustained high-beta (20–35 Hz) oscillations predominantly in pGPi in two patients (who exhibited relevant tic reduction). Power spectral analysis demonstrated distinct high-beta peaks in the pGPi during baseline conditions, particularly in these two cases. Additionally, modulation of pGPi activity was observed when aGPi stimulation was applied.

Conclusion: This study provides novel neurophysiological insights into TS, demonstrating the feasibility of chronic LFP monitoring to evaluate DBS effects in real-world settings. To note, dual-target bi-pallidal DBS was effective and well tolerated.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dual-target-bi-pallidal-deep-brain-stimulation-in-tourette-syndrome-deciphering-neurophysiology-with-chronic-local-field-potential-recordings/