Outcomes after deep brain stimulation for uncontrolled Tourette syndrome

Bottom Line: Deep brain stimulation was associated with some symptom improvement in a small group of patients with uncontrolled Tourette syndrome but also some adverse events.

Why The Research Is Interesting: Deep brain stimulation is a surgical treatment where a device is implanted to deliver electrical stimulation to targeted parts of the brain. The procedure is not approved by the U.S. Food and Drug Administration for Tourette syndrome but some reports of its use suggest it may be potentially valuable. An international database and registry was launched in 2012 because only a small number of deep brain stimulation procedures are performed for Tourette syndrome around the world and there was a need to organize all information about outcomes from the procedure in one place.

Who: 171 of 185 patients with uncontrolled Tourette syndrome who underwent deep brain stimulation in 2012-2016 at 31 institutions in 10 countries

What (Study Measures): Deep brain stimulation (exposure); scores on a scale of tic severity and adverse events (outcomes)

How (Study Design): Describes one-year outcome data from patients in the International Deep Brain Stimulation Database and Registry. This is a cohort/observational study. People were followed over time but because researchers are not intervening for purposes of the study they cannot control natural differences that could explain study findings.

Authors: Michael S. Okun M.D., of the University of Florida, Gainesville, and coauthors

Results: Average tic severity improved 45 percent one year after the deep brain stimulation device was implanted; 56 of 158 patients (35.4 percent) reported adverse events, the most common were dysarthria (weakness or difficulty in controlling speech muscles) and paresthesias (pins-and-needles), while a few patients had bleeding in the skull and infection.

Study Limitations: Data come from an observational study and were drawn from multiple sites with a lack of standard inclusion criteria for the registry; different surgical techniques or treatment approaches at the multiple sites also could have affected the results.

Study Conclusions: The first-year results of this multinational electronic collaboration strengthen the notion that DBS could be a potential surgical treatment for select patients with Tourette syndrome. Practitioners should be aware of the high number of stimulation-related adverse events and that these are likely reversible.

More information:
jamanetwork.com/journals/jaman … jamaneurol.2017.4317

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