by Martha Kerr

Last Updated: 2008-02-07 16:21:33 -0400 (Reuters Health)

NEW YORK (Reuters Health) – In a series of 18 patients with Gilles de la Tourette (GTS) syndrome, deep brain stimulation (DBS) proved safe and well-tolerated and was effective in all cases and very effective in some.

The patients were recruited by Dr. D. Servello of the Istituto Galeazzi in Milan, Italy and colleagues. Tourette syndrome had been resistant to both standard and innovative treatments for at least 6 months, as well as to psychobehavioral approaches.

The investigators implanted stimulating electrodes bilaterally in the centromedian-parafascicular (CM-Pfc) and ventralis oralis complex of the thalamus. Patients were evaluated immediately after surgery and every 3 months thereafter for up to 18 months. Stimulation parameters were adjusted periodically.

"All patients responded well to DBS, although to differing degrees," Dr. Servello’s team reports in the February issue of the Journal of Neurology, Neurosurgery and Psychiatry.

Furthermore, comorbid obsessive-compulsive behavior or disorder, self-injurious behaviors, anxiety and premonitory sensations responded well to DBS.

There were no serious permanent adverse effects.

"DBS is a useful and safe treatment for severe GTS," the investigators conclude. "The results of ours and previous DBS reports suggest that the CM-Pfc and ventralis oralis complex of the thalamus may be a good DBS target for GTS."

In an accompanying editorial, Dr. Michael S. Okun and colleagues at the University of Florida in Gainesville comment that "the importance of the Servello report is that it demonstrates promising safety and efficacy data for the treatment of medication-refractory tic."

"We are very optimistic about the future of DBS and other forms of neuromodulation for Tourette syndrome," Dr. Okun told Reuters Health. "It is becoming increasingly clear that if we choose patients carefully, we have the potential to change lives in meaningful ways."

He added: "As we proceed with Tourette DBS, we must be sure we avoid DBS failures by employing rigorous patient selection and by utilizing a multidisciplinary team approach. Not everyone with Tourette will be a candidate for DBS, but we must try to identify those patients who may enjoy a substantial improvement in their quality of life."

J Neurol Neurosurg Psychiatry 2008;79:110-112,136-142.

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