Objective: To evaluate possible influence of DBS on quality of life and cognition in a small group of patients with drug-resistant Tourette syndrome (TS).

Background: TS is a relatively common neuropsychiatric disorder characterized by complex motor and vocal tics with disease start in childhood. Many people with TS experience fewer or no symptoms by the time of their adulthood, however, some of them suffer from drug-resistant and malignant forms of TS. For such patients, deep brain stimulation (DBS) might be a treatment option. Although published results are encouraging, a lot of important questions still remain unclear, like impact of the procedure on quality of life (QOL), mood, and cognitive functions (CF).

Method: 5 patients with drug-resistant TS underwent DBS surgery. In all patients, TS was comorbid with obsessive compulsive disorder (OCD). Patients were randomized to receive either DBS of posterolateral globus pallidus internus – GPi (3 patients: 2 males, 1 female), or thalamic centromedian-parafascicular complex – Cm-Pf (2 patients, males). We used following scales for evaluation: Tic Severity Scale (YGTSS), Yale-Brown Obsessive Compulsive Scale (YBOCS), Beck Depression Inventory (BDI), SF-36 QOL questionnaire (physical and mental component summary scores – PCSS and MCSS), Mini Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Clock Drawing Test (CDT). All patients were assessed before surgery and at 6 and 12-month follow-up (6m, 12m).

Results: We analyzed the outcome for the entire group. Both GPi DBS and Cm-Pf DBS produced improvement in tic severity (altogether, 47.1% and 43.3% reduction in YGTSS score at 6m and 12m, respectively) and in OCD symptoms (26.9% and 26.3% reduction in YBOCS score at 6m and 12m, respectively). BDI score worsened at 6m and 12m (6.6% and 17.0%, respectively). PCSS improved greater than MCSS at both time points of follow-up (PCSS – 34.8% and 30.3% at 6m and 12m; MCSS – 11.3% and 18.1% at 6m and 12m). CF did not change significantly during the whole observation period. We observed no evident difference between two structures targeted.

Conclusion: DBS does not worsen significantly CF in patients with TS. The procedure could improve tic severity and OCD symptoms. Impact on QOL and mood may be not pronounced, since they depend also on patient’s expectations from the surgery, premorbid features, and cognitive state. Further research is needed.

References: 1. Bos M.J. et al. Effect of Anesthesia on Microelectrode Recordings during Deep Brain Stimulation Surgery in Tourette Syndrome Patients. Stereotact Funct Neurosurg. 2019;97(4):225-231. 2. Cappon D. et al. Globus pallidal deep brain stimulation for Tourette syndrome: Effects on cognitive function. Parkinsonism Relat Disord. 2019 Dec;69:14-18. 3. Daniel Martinez-Ramirez et al. Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome. JAMA Neurol. 2018 Mar; 75(3): 353–359. 4. Mark Hallett. Tourette Syndrome: Update Brain Dev. 2015 Aug; 37(7): 651–655.

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