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Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets

Gilles de la Tourette syndrome (GTS) is a complex neurodevelopmental disorder characterized by tics and, frequently, psychiatric and behavioral comorbidities. Above all, obsessive compulsive disorder/behavior (OCD/OCB) influences the clinical picture and has a severe impact on quality of life, event...

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Autores principales: Servello, Domenico, Galbiati, Tommaso Francesco, Balestrino, Roberta, Iess, Guglielmo, Zekaj, Edvin, De Michele, Sara, Porta, Mauro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287742/
https://www.ncbi.nlm.nih.gov/pubmed/32429219
http://dx.doi.org/10.3390/brainsci10050301
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author Servello, Domenico
Galbiati, Tommaso Francesco
Balestrino, Roberta
Iess, Guglielmo
Zekaj, Edvin
De Michele, Sara
Porta, Mauro
author_facet Servello, Domenico
Galbiati, Tommaso Francesco
Balestrino, Roberta
Iess, Guglielmo
Zekaj, Edvin
De Michele, Sara
Porta, Mauro
author_sort Servello, Domenico
collection PubMed
description Gilles de la Tourette syndrome (GTS) is a complex neurodevelopmental disorder characterized by tics and, frequently, psychiatric and behavioral comorbidities. Above all, obsessive compulsive disorder/behavior (OCD/OCB) influences the clinical picture and has a severe impact on quality of life, eventually more than the tics themselves. Deep brain stimulation (DBS) is an effective therapy in selected, refractory cases. Clinical response to DBS may vary according to the clinical picture, comorbidities, and to the anatomical target. This retrospective study compares the results obtained from DBS in the ventralis oralis/centromedian-parascicular nucleus of the thalamus (Voi-Cm/Pf) (41 patients) and antero-medial Globus Pallidus internus (am-GPi) (14 patients), evaluating clinical response over time by means of Yale Global Tic Severity Scale (YGTSS) and Yale–Brown Obsessive-Compulsive Scale (YBOCS) scores over a period of 48 months. A significant and stable improvement in the YGTSS and YBOCS has been obtained in both groups (p < 0.001). There was a significant difference in YBOCS improvement over time between the am-GPi group and the Voi-Cm/Pf group, indicating a better and faster control of OCD/OCB symptoms in the former group. The ratio of hardware removal was 23% and limited to 13 patients in the Voi-Cm/Pf group. These results confirm that DBS is an effective therapy in treating GTS and suggest that the am-GPi might be superior to Voi-Cm/Pf in alleviating comorbid OCD/OCB.
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spelling pubmed-72877422020-06-15 Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets Servello, Domenico Galbiati, Tommaso Francesco Balestrino, Roberta Iess, Guglielmo Zekaj, Edvin De Michele, Sara Porta, Mauro Brain Sci Article Gilles de la Tourette syndrome (GTS) is a complex neurodevelopmental disorder characterized by tics and, frequently, psychiatric and behavioral comorbidities. Above all, obsessive compulsive disorder/behavior (OCD/OCB) influences the clinical picture and has a severe impact on quality of life, eventually more than the tics themselves. Deep brain stimulation (DBS) is an effective therapy in selected, refractory cases. Clinical response to DBS may vary according to the clinical picture, comorbidities, and to the anatomical target. This retrospective study compares the results obtained from DBS in the ventralis oralis/centromedian-parascicular nucleus of the thalamus (Voi-Cm/Pf) (41 patients) and antero-medial Globus Pallidus internus (am-GPi) (14 patients), evaluating clinical response over time by means of Yale Global Tic Severity Scale (YGTSS) and Yale–Brown Obsessive-Compulsive Scale (YBOCS) scores over a period of 48 months. A significant and stable improvement in the YGTSS and YBOCS has been obtained in both groups (p < 0.001). There was a significant difference in YBOCS improvement over time between the am-GPi group and the Voi-Cm/Pf group, indicating a better and faster control of OCD/OCB symptoms in the former group. The ratio of hardware removal was 23% and limited to 13 patients in the Voi-Cm/Pf group. These results confirm that DBS is an effective therapy in treating GTS and suggest that the am-GPi might be superior to Voi-Cm/Pf in alleviating comorbid OCD/OCB. MDPI 2020-05-15 /pmc/articles/PMC7287742/ /pubmed/32429219 http://dx.doi.org/10.3390/brainsci10050301 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Servello, Domenico
Galbiati, Tommaso Francesco
Balestrino, Roberta
Iess, Guglielmo
Zekaj, Edvin
De Michele, Sara
Porta, Mauro
Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets
title Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets
title_full Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets
title_fullStr Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets
title_full_unstemmed Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets
title_short Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets
title_sort deep brain stimulation for gilles de la tourette syndrome: toward limbic targets
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287742/
https://www.ncbi.nlm.nih.gov/pubmed/32429219
http://dx.doi.org/10.3390/brainsci10050301
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