University Hospitals Case Medical Center finds new treatment holds promise for Tourette syndrome

Cleveland 12 November 2007Research out of the Neurological Institute at University Hospitals Case Medical Center (UHCMC) finds that Deep Brain Stimulation (DBS) helps patients who suffer from Tourette Syndrome (TS). This first-of-its-kind study of five adults with TS determined that DBS can reduce tic frequency and severity in some people who have exhausted other medical treatments. Tourette syndrome is a neurobehavioural disorder characterized by sudden, repetitive muscle movements - motor tics - and vocalizations - vocal tics. It often begins in childhood. By young adulthood the tics have usually diminished in frequency and severity. However, in some adults, like those that participated in this clinical trial, the tics become more disabling even with best medical therapy.

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The UHCMC team's prospective double-blind study followed these five adults with TS over the course of 12 months. The 3-month data are published in the November issue of the Journal of Neurosurgery. The team concluded that the majority of patients experienced a significant reduction in symptoms and an improved quality of life. The study followed their landmark case in 2004 when the UHCMC neurological team used DBS to treat a 31-year-old man with Tourette Syndrome. Once his deep brain stimulators were turned on he had an immediate and nearly complete resolution of his symptoms.

"This is this first and only careful scientific surgical trial for Tourette Syndrome, and provides the highest level of data showing that this surgery is proven to be significantly beneficial for medically refractory Tourette", stated Robert Maciunas, MD, Vice Chairman and Professor of Neurological Surgery at UHCMC and lead author of the paper. "This study promises to change the standard of care for patients who fail to respond to traditional medications. It promises to usher in a new era of medical research and treatment for Tourette Syndrome with DBS", he stated.

DBS is approved by the Food and Drug Administration for treatment of Parkinson's disease, essential tremor and dystonia. DBS involves the surgical implantation of electrodes in the brain and pulse generators in the upper chest just beneath the collarbones. The implanted pulse generator (IPG) is connected to the electrode in the brain by a thin cable that is placed under the skin. The IPG is then programmed to deliver a high-frequency electrical stimulation to the targeted area of the brain.

In this double-blind study the electrodes were placed in the thalamus, a portion of the brain that is involved in controlling movement. Prior to surgery the neurologic team at UHCMC mapped out regions of the patients' brains using magnetic resonance imaging (MRI) scans and 3D computer images. Their goal was to locate the safest and most direct route to reach the thalamus. Following surgery the researchers conducted double-blind video-based rating assessments of tic frequency and severity. They found that three of five patients had a marked reduction in their motor and vocal tics and all but one patient had a significant improvement in quality of life.

"Deep Brain Stimulation has been used to successfully treat certain movement disorders for years", stated David Riley, MD, Director of the UH Movement Disorders Center and Professor of Neurology at Case Western Reserve University. "We carefully studied its use in these five patients suffering from refractory Tourette Syndrome and found that it significantly reduced the tics in most of the patients and improved their quality of life."

"The use of DBS for Tourette syndrome is still an emerging area of study but in this first of its kind clinical trial, our team found that DBS has good potential to be a viable treatment for people with this potentially debilitating syndrome", stated Christina Whitney, DNSc, RN, clinical nurse specialist in the movement disorders centre. "The treatment was found to be safe and we plan to conduct a larger clinical trial to further determine its efficacy in helping patients who have failed traditional medical therapy for Tourette syndrome."

With 150 locations throughout Northeast Ohio, University Hospitals serves the needs of patients through an integrated network of hospitals, outpatient centres and primary care physicians. At the core of the Health System is University Hospitals Case Medical Center. The primary affiliate of Case Western Reserve University School of Medicine, University Hospitals Case Medical Center is home to some of the most prestigious clinical and research centres of excellence in the United States and the world, including cancer, paediatrics, women's health, orthopaedics and spine, radiology and radiation oncology, neurosurgery and neuroscience, cardiology and cardiovascular surgery, organ transplantation and human genetics. Its main campus includes the internationally celebrated Rainbow Babies & Children's Hospital, ranked best in the Midwest and first in the United States for the care of critically ill newborns; MacDonald Women's Hospital, Ohio's only hospital for women; and Ireland Cancer Center, which holds the USA's highest designation by the National Cancer Institute of Comprehensive Cancer Center.


Leslie Versweyveld

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