Chencheng Zhang1, Zhengdao Deng1, Yixin Pan1, Jing Zhang1, Kristina Zeljic2,3, Haiyan Jin4, Odin van der Stelt5, Hengfen Gong6, Shikun Zhan1, Dianyou Li1, Bomin Sun1. 1. 1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. 2. 2Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences. 3. 3University of Chinese Academy of Sciences. 4. 4Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 5. 5Independent Research Consultant, Amsterdam, the Netherlands; and. 6. 6Department of Psychiatry, Pudong Mental Health Center, Shanghai, China.
Abstract
OBJECTIVE: A current challenge is finding an effective and safe treatment for severely disabled patients with Tourette's syndrome (TS) and comorbid psychiatric disorders, in whom conventional treatments have failed. The authors aimed to evaluate the utility of globus pallidus internus deep brain stimulation (GPi-DBS) combined with bilateral anterior capsulotomy in treating these clinically challenging patients. METHODS: The authors conducted a retrospective review of the clinical history and outcomes of 10 severely disabled patients with treatment-refractory TS and a psychiatric comorbidity, who had undergone GPi-DBS combined with bilateral anterior capsulotomy in their hospital. At the time of surgery, patients presented mainly with obsessive-compulsive disorder and affective disorders. Clinical outcome assessments of tic and psychiatric symptoms, as well as of general adaptive functioning and quality of life, were performed at the time of surgery and at 6, 12, and between 24 and 96 months postsurgery. RESULTS: After surgery, all patients showed significant progressive improvements in tic and psychiatric symptoms, along with improvements in general adaptive functioning and quality of life. Tic alleviation reached 64% at 12 months and 77% at the last follow-up on the Yale Global Tic Severity Scale. At the final follow-up, patients had functionally recovered and displayed no or only mild tic and psychiatric symptoms. All patients tolerated treatment reasonably well, with no serious side effects. CONCLUSIONS: GPi-DBS combined with bilateral anterior capsulotomy seems to offer major clinical benefits to severely disabled patients with otherwise treatment-refractory TS and psychiatric comorbidities.
OBJECTIVE: A current challenge is finding an effective and safe treatment for severely disabled patients with Tourette's syndrome (TS) and comorbid psychiatric disorders, in whom conventional treatments have failed. The authors aimed to evaluate the utility of globus pallidus internus deep brain stimulation (GPi-DBS) combined with bilateral anterior capsulotomy in treating these clinically challenging patients. METHODS: The authors conducted a retrospective review of the clinical history and outcomes of 10 severely disabled patients with treatment-refractory TS and a psychiatric comorbidity, who had undergone GPi-DBS combined with bilateral anterior capsulotomy in their hospital. At the time of surgery, patients presented mainly with obsessive-compulsive disorder and affective disorders. Clinical outcome assessments of tic and psychiatric symptoms, as well as of general adaptive functioning and quality of life, were performed at the time of surgery and at 6, 12, and between 24 and 96 months postsurgery. RESULTS: After surgery, all patients showed significant progressive improvements in tic and psychiatric symptoms, along with improvements in general adaptive functioning and quality of life. Tic alleviation reached 64% at 12 months and 77% at the last follow-up on the Yale Global Tic Severity Scale. At the final follow-up, patients had functionally recovered and displayed no or only mild tic and psychiatric symptoms. All patients tolerated treatment reasonably well, with no serious side effects. CONCLUSIONS:GPi-DBS combined with bilateral anterior capsulotomy seems to offer major clinical benefits to severely disabled patients with otherwise treatment-refractory TS and psychiatric comorbidities.
Entities:
Keywords:
ADHD = attention-deficit hyperactivity disorder; ADHD-RS-IV = ADHD Rating Scale IV; ALIC = anterior limbs of the internal capsule; DBS = deep brain stimulation; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; GPi = globus pallidus internus; GTS-QOL = Gilles de la Tourette Syndrome–Quality of Life; OCD = obsessive-compulsive disorder; QOL = quality of life; TS = Tourette’s syndrome; Tourette’s syndrome; Y-BOCS = Yale-Brown Obsessive Compulsive Scale; YGTSS = Yale Global Tic Severity Scale; anterior capsulotomy; deep brain stimulation; functional neurosurgery; globus pallidus internus; psychiatric comorbidity
Authors: Laura Wehmeyer; Thomas Schüller; Jana Kiess; Petra Heiden; Veerle Visser-Vandewalle; Juan Carlos Baldermann; Pablo Andrade Journal: Front Neurol Date: 2021-10-20 Impact factor: 4.086
Authors: Natalia Szejko; Yulia Worbe; Andreas Hartmann; Veerle Visser-Vandewalle; Linda Ackermans; Christos Ganos; Mauro Porta; Albert F G Leentjens; Jan-Hinnerk Mehrkens; Daniel Huys; Juan Carlos Baldermann; Jens Kuhn; Carine Karachi; Cécile Delorme; Thomas Foltynie; Andrea E Cavanna; Danielle Cath; Kirsten Müller-Vahl Journal: Eur Child Adolesc Psychiatry Date: 2021-10-04 Impact factor: 4.785