DBS proven to help Tourette Syndrome patients 

28/05/2015 00:00 
Researchers led by UCLH consultant Tom Foltynie have demonstrated that deep brain stimulation (DBS) can help sufferers of Tourette Syndrome reduce their tics significantly.

The trial, which recruited the most severely affected patients in the largest study of its kind anywhere in the world, showed that DBS of an area of the brain known as the globus pallidus (GPi) could lead to significant reduction in tic severity when stimulation was switched on compared to when it was switched off.

"When we compared patients' tic severity before surgery to severity at their latest follow up, the mean improvement was 40%, accompanied by similar improvements in quality of life," said Dr Foltynie. "We are hoping this will lead to NHS England commissioning a small DBS service for similarly affected patients at the National Hospital for Neurology and Neurosurgery."

Most people affected by Tourette syndrome develop minor involuntary movements or noises (known as motor or phonic tics) during childhood. These tend to disappear as they reach adulthood. In a minority of individuals, however, the tics persist into adulthood and can be severe.

In the most extremely affected people, tics can occur relentlessly preventing normal conversation, walking, or day to day function. Some patients have developed spinal injuries because of the violent nature of their tics.

Drug treatments for Tourette syndrome are only partially helpful, and frequently have sedating side effects. New treatment options are therefore necessary.

DBS is a procedure which allows the implantation of small electrodes into the brain to stimulate affected regions in patients with movement disorders such as Parkinson's disease.

The delivery of electricity is at the root of what makes DBS work. The electrodes are attached to an impulse generator, or pacemaker, implanted under the patient's skin, which provides electrical impulses to the affected region of the brain.

By providing impulses to circuits in the brain associated with a specific motor skill, it becomes possible to change the connections between neurons and stop the abnormal activity that causes the symptoms.

"We are now learning which patients with severe Tourette syndrome really benefit from the technique of DBS. While the safety record of DBS surgery at NHNN is second to none, it is of paramount importance that we only consider surgical treatment option in those most likely to benefit. We very much hope to be able to offer this treatment option to future patients who are severely affected by this disorder," Dr Foltynie said.

The findings were published in a recent edition of Lancet Neurology. The other researchers in the study included NHNN consultants Ludvic Zrinzo, Patricia Limousin, Marwan Hariz and Eileen Joyce and clinical nurse specialists Joseph Candelario and Catherine Milabo, as well as fellow researchers from the UCL unit of functional neurosurgery.

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