Junghan Lee #,1, Kyung Won Chang #,2, Hyun Ho Jung 2, Dre Kim 3, Jin Woo Chang 2, Dong Ho Song 1
1Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
2Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
3Iian Psychiatric Clinic, Sejong, Republic of Korea.
CORRESPONDING AUTHORS: Jin Woo Chang M.D., Ph.D., Dong Ho Song M.D., Ph.D.
Aim: Deep brain stimulation (DBS) is one option for treating refractory TS; however, it remains unclear which preoperative factors are predictive of DBS outcomes. This study investigated the efficacy of DBS targeting the anteromedial globus pallidus internus (amGPi) and evaluated predisposing factors affecting the outcomes of DBS in a single center in Korea.
Method: Twenty patients who had undergone DBS for refractory TS were reviewed retrospectively. Tic symptoms were followed up at 3-months intervals for up to 1 year after surgery. The Yale Global Tic Severity Score (YGTSS) was used to evaluate preoperative/postoperative tic symptoms. Scores from the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI) were also evaluated.
Results: Patients with refractory TS achieved improvement in tic symptoms within 1 year after DBS. Initial responders who achieved a 35% reduction in YGTSS total score within the first 3 months after DBS showed larger treatment effects during 1-year follow up. Although no clinical or demographic factors were predictive of initial responses, patients with serious self-injurious behaviors tended to show delayed responses.
Conclusion: This is the first study to report the DBS outcomes of 20 TS patients in a single center in Asia. Our study supports the efficacy of DBS targeting amGPi in refractory TS with no evident serious adverse events. Initial responses after DBS seem to be a predictor of long-term outcomes after surgery.