Format

Send to

Choose Destination
J Neurosurg. 2018 Aug;129(2):308-314. doi: 10.3171/2017.6.JNS17626. Epub 2017 Sep 29.

Report of a patient undergoing chronic responsive deep brain stimulation for Tourette syndrome: proof of concept.

Author information

1
Departments of1Electrical and Computer Engineering.
2
2Center for Movement Disorders and Neurorestoration; and.
3
3Neurology, and.
4
5J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida.
5
4Neurosurgery.

Abstract

Deep brain stimulation (DBS) has emerged as a promising intervention for the treatment of select movement and neuropsychiatric disorders. Current DBS therapies deliver electrical stimulation continuously and are not designed to adapt to a patient's symptoms. Continuous DBS can lead to rapid battery depletion, which necessitates frequent surgery for battery replacement. Next-generation neurostimulation devices can monitor neural signals from implanted DBS leads, where stimulation can be delivered responsively, moving the field of neuromodulation away from continuous paradigms. To this end, the authors designed and chronically implemented a responsive stimulation paradigm in a patient with medically refractory Tourette syndrome. The patient underwent implantation of a responsive neurostimulator, which is capable of responsive DBS, with bilateral leads in the centromedian-parafascicular (Cm-Pf) region of the thalamus. A spectral feature in the 5- to 15-Hz band was identified as the control signal. Clinical data collected prior to and after 12 months of responsive therapy revealed improvements from baseline scores in both Modified Rush Tic Rating Scale and Yale Global Tic Severity Scale scores (64% and 48% improvement, respectively). The effectiveness of responsive stimulation (p = 0.16) was statistically identical to that of scheduled duty cycle stimulation (p = 0.33; 2-sided Wilcoxon unpaired rank-sum t-test). Overall, responsive stimulation resulted in a 63.3% improvement in the neurostimulator's projected mean battery life. Herein, to their knowledge, the authors present the first proof of concept for responsive stimulation in a patient with Tourette syndrome.

KEYWORDS:

DBS = deep brain stimulation; IPG = implantable pulse generator; MRTRS = Modified Rush Tic Rating Scale; NIH = National Institutes of Health; TS = Tourette syndrome; Tourette syndrome; YGTSS = Yale Global Tic Severity Scale; functional neurosurgery; next-generation deep brain stimulation systems; responsive deep brain stimulation

PMID:
28960154
DOI:
10.3171/2017.6.JNS17626

Supplemental Content

Full text links

Icon for Sheridan PubFactory
Loading ...
Support Center