Session Information
Date: Monday, June 20, 2016
Session Title: Surgical therapy: Other movement disorders
Session Time: 12:30pm-2:00pm
Location: Exhibit Hall located in Hall B, Level 2
Objective: To explore whether individual patient characteristics can indicate response to treatment in a trial of bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) in patients with severe medically refractory Tourette’s Syndrome (TS).
Background: There is accumulating evidence to support the therapeutic potential of DBS for severe TS. Nevertheless, the choice of optimal brain target, the magnitude of its beneficial effect on different aspects of TS, as well as predictors of individual patient responsiveness to DBS remain subjects of debate.
Methods: In this randomised, double-blind, crossover trial, eligible patients were randomly assigned to either “stimulation-ON first” or “stimulation-OFF first” for 3 months, after which they were switched to the opposite condition. The primary outcome was the difference in Yale Global Tic Severity Scale (YGTSS) total score between the two blinded conditions. Secondary outcomes included the change in quality of life (TS-QoL) and psychiatric comorbidities. Evaluations tools were the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Beck Depression inventory (BDI), the State-Trait Anxiety Index (STAI) and the Neuropsychiatric Inventory (NPI). After the crossover period patients were assessed in an open-label fashion. In this updated analysis, the percentage of change in YGTSS were correlated with patients’ characteristics at baseline.
Results: Of the 15 patients enrolled, 13 patients completed both blinded assessments with mean YGTSS of 87.9 at baseline, 80.7 during OFF-stimulation, and 68.3 during ON stimulation (p=0.048). Open-label (n=15) YGTSS total scores at latest follow-up improved by 40.1% (p<0.001) and TS-QOL by 38.9% (p=0.001) compared with baseline. A negative correlation was found between pre-operative Y-BOCS scores and YGTSS improvement in both the blinded (p=0.024) and open-label (p=0.042) phases. Furthermore, higher YGTSS scores at baseline were associated with a better response at open-label latest follow-up (p=0.043). No correlation was found between disease duration, baseline BDI, STAI and NPI scores, vocal vs motor preponderance, and outcome.
Conclusions: The results of the present study support the role of GPi-DBS as a valid treatment for severe tics in TS. More severe tic and obsessive-compulsive disorder at baseline may represent positive and negative indicators of treatment responses to GPi-DBS, respectively.
To cite this abstract in AMA style:
Z. Kefalopoulou, L. Zrinzo, M. Jahanshahi, J. Candelario, C. Milabo, M. Beigi, H. Akram, J. Hyam, J. Clayton, L. Kass-Iliyya, M. Silverdale, J. Evans, P. Limousin, M. Hariz, E. Joyce, T. Foltynie. Results from a double-blind trial of pallidal DBS for Tourette’s syndrome: Are there any predictors of surgery outcome? [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/results-from-a-double-blind-trial-of-pallidal-dbs-for-tourettes-syndrome-are-there-any-predictors-of-surgery-outcome/. Accessed May 24, 2025.« Back to 2016 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/results-from-a-double-blind-trial-of-pallidal-dbs-for-tourettes-syndrome-are-there-any-predictors-of-surgery-outcome/