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Arch Neurol. 2008 Jul;65(7):952-7. doi: 10.1001/archneur.65.7.952.

Internal pallidal and thalamic stimulation in patients with Tourette syndrome.

Author information

1
National Institute of Health and Medical Research (INSERM), Unit 679, Pierre et Marie Curie University-Paris 6, France. marie-laure.welter@psl.aphp.fr

Abstract

BACKGROUND:

Tourette syndrome (TS) is thought to result from dysfunction of the associative-limbic territories of the basal ganglia, and patients with severe symptoms of TS respond poorly to medication. High-frequency stimulation has recently been applied to patients with TS in open studies using the centromedian-parafascicular complex (CM-Pf) of the thalamus, the internal globus pallidus (GPi), or the anterior limb of the internal capsule as the principal target.

OBJECTIVE:

To report the effect of high-frequency stimulation of the CM-Pf and/or the GPi, 2 associative-limbic relays of the basal ganglia, in patients with TS.

DESIGN:

Controlled, double-blind, randomized crossover study.

SETTING:

Medical research.

PATIENTS:

Three patients with severe and medically refractory TS.

INTERVENTION:

Bilateral placement of stimulating electrodes in the CM-Pf (associative-limbic part of the thalamus) and the GPi (ventromedial part).

MAIN OUTCOME MEASURES:

Effects of thalamic, pallidal, simultaneous thalamic and pallidal, and sham stimulation on neurologic, neuropsychological, and psychiatric symptoms.

RESULTS:

A dramatic improvement on the Yale Global Tic Severity Scale was obtained with bilateral stimulation of the GPi (reduction in tic severity of 65%, 96%, and 74% in patients 1, 2, and 3, respectively). Bilateral stimulation of the CM-Pf produced a 64%, 30%, and 40% reduction in tic severity, respectively. The association of thalamic and pallidal stimulation showed no further reduction in tic severity (60%, 43%, and 76%), whereas motor symptoms recurred during the sham condition. No neuropsychological, psychiatric, or other long-term adverse effect was observed.

CONCLUSIONS:

High-frequency stimulation of the associative-limbic relay within the basal ganglia circuitry may be an effective treatment of patients with TS, thus heightening the hypothesis of a dysfunction in these structures in the pathophysiologic mechanism of the disorder.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00139308.

PMID:
18625864
DOI:
10.1001/archneur.65.7.952
[Indexed for MEDLINE]

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