Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome : The International Tourette Syndrome Deep Brain Stimulation Public Database and Registry

Importance Collective evidence has strongly suggested that deep brain stimulation(DBS) is a promising therapy for Tourette syndrome. Objective To assess the efficacy and safety of DBS in a multinational cohort of patients with Tourette syndrome. Design, Setting, and Participants The prospective International Deep Brain StimulationDatabase and Registry included 185 patients with medically refractory Tourette syndromewho underwent DBS implantation from January 1, 2012, to December 31, 2016, at 31 institutions in 10 countries worldwide. Exposures Patients with medically refractory symptoms received DBS implantation in the centromedian thalamic region (93 of 163 [57.1%]), the anterior globus pallidus internus(41 of 163 [25.2%]), the posterior globus pallidus internus(25 of 163 [15.3%]), and the anterior limb of the internal capsule(4 of 163 [2.5%]). Main Outcomes and Measures Scores on the Yale Global Tic Severity Scale and adverse events. Results The International Deep Brain StimulationDatabase and Registry enrolled 185 patients (of 171 with available data, 37 females and 134 males; mean [SD] age at surgery, 29.1 [10.8] years [range, 13-58 years]). Symptoms of obsessive-compulsive disorder were present in 97 of 151 patients (64.2%) and 32 of 148 (21.6%) had a history of self-injurious behavior. The mean (SD) total Yale Global Tic Severity Scale score improved from 75.01 (18.36) at baseline to 41.19 (20.00) at 1 year after DBS implantation ( P P P Conclusions and Relevance Deep brain stimulationwas associated with symptomatic improvement in patients with Tourette syndromebut also with important adverse events. A publicly available website on outcomes of DBS in patients with Tourette syndromehas been provided.