Objective: To elucidate how deep brain stimulation (DBS) for Tourette’s syndrome (TS) impacts psychiatric comorbidities including attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, and depression.

Background: The use of DBS in patients with refractory TS is well documented in case reports and meta-analyses with results focused on target selection and tic improvement; however, there has been less focus on the impact of DBS on comorbid conditions.

Method: We describe three patients with medically refractory TS who underwent DBS implantation. All three patients were implanted in the anteromedial globus pallidus interna (amGPI). Confirmation of lead placement was performed by overlaying  their pre-op targeting MRI and post-op imaging. Each patient completed the following standardized rating scales before implantation and 6 months after implantation: Yale Global Tic Severity Scale (YGTSS), Premonitory Urge to Tic Scale (PUTS), Yale Brown Obsessive-Compulsive Scale (YBOCS), NeuroQoL Depression, NeuroQoL Anxiety, and ADHD Self-Rating Scale for DSM-5 (ASRS-5).

Results: The three patients had respective decreases of their YGTSS global scores by 36, 37 and 6 points. In addition, all three had decreases in their YGTSS impairment scores of 20, 30 and 10 respectively. For comorbidities, all patients had improvement of at least 30% on the OCD rating scale (YBOCS) . Two patients showed improvement in the ADHD rating scale. All three patients had increases on the anxiety scale of 1, 2 and 8 points. One patient had a small decrease on the depression scale of 2 points, while two had increases of 1 and 5 points.

Conclusion: At 6-months post-DBS implantation in the amGPI, tic and OCD symptom severity had improved for all patients, while comorbid anxiety, depression and ADHD symptom severity change was more variable. These results indicate the need for formal evaluation of comorbid conditions before and after implantation to fully understand the effects of DBS in TS patients.

Patient Characteristics

Pre and Post Yale Global Tic Severity Scores

Pre and Post Comorbidity Scales

References: 1. Baldermann JC, Schüller T, Huys D, Becker I, Timmermann L, Jessen F, Visser-Vandewalle V, Kuhn J. Deep Brain Stimulation for Tourette-Syndrome: A Systematic Review and Meta-Analysis. Brain Stimul. 2016 Mar-Apr;9(2):296-304. doi: 10.1016/j.brs.2015.11.005. Epub 2015 Dec 29. PMID: 26827109.

2. Mahajan UV, Purger DA, Mantovani A, Williams NR, Espil FM, Han SS, Stein SC, Halpern CH. Deep Brain Stimulation Results in Greater Symptomatic Improvement in Tourette Syndrome than Conservative Measures: A Meta-Analysis. Stereotact Funct Neurosurg. 2020;98(4):270-277. doi: 10.1159/000507059. Epub 2020 May 20. PMID: 32434201.

3. Schrock, L.E., Mink, J.W., Woods, D.W., Porta, M., Servello, D., Visser-Vandewalle, V., Silburn, P.A., Foltynie, T., Walker, H.C., Shahed-Jimenez, J., Savica, R., Klassen, B.T., Machado, A.G., Foote, K.D., Zhang, J.-G., Hu, W., Ackermans, L., Temel, Y., Mari, Z., Changizi, B.K., Lozano, A., Auyeung, M., Kaido, T., Agid, Y., Welter, M.L., Khandhar, S.M., Mogilner, A.Y., Pourfar, M.H., Walter, B.L., Juncos, J.L., Gross, R.E., Kuhn, J., Leckman, J.F., Neimat, J.A., Okun, M.S. and (2015), Tourette syndrome deep brain stimulation: A review and updated recommendations. Mov Disord., 30: 448-471. https://doi.org/10.1002/mds.26094

« Back to 2024 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-in-tourette-syndrome-characteristics-of-three-patients-pre-and-post-implantation/