Professor Monty Silverdale

£½M study to explore deep brain stimulation for Tourette’s syndrome

A major new research study will explore using brain implants to lessen the symptoms of severe Tourette’s syndrome.

Tourette’s is a neurological condition that affects around one in 100 people and causes involuntary sounds and movements called tics. It often begins in childhood and the tics and other symptoms usually improve after several years.

Sometimes though, they continue into adulthood and the tics can be so severe and extreme that the available treatment options – behavioural interventions and medication – make little difference.

The new £534,000 study is funded by the National Institute for Health Research and will take place at Salford Royal and UCL Queen Square Institute of Neurology in London. It aims to show that deep brain stimulation (DBS) can lead to a significant improvement in the condition’s distressing tics.

Professor Monty Silverdale, a Consultant Neurologist at Salford Royal and neurodegeneration research lead for Greater Manchester, is a Co-Investigator for the study.

He said: “Tics can be extremely forceful and cause serious self-harm and distress. A significant number of patients experience depression, anxiety, obsessive compulsive symptoms or hyperactivity.

“Previous studies in small numbers of patients have shown a benefit from DBS for those with the most severe and disabling tics but more evidence is needed before it can be made available as an NHS treatment.”

DBS was first tried in Tourette’s in 1999. Stimulating electrodes are implanted in the brain and connected through a wire to a pace-maker, which can be positioned under the skin of the chest. This system can be programmed to deliver tiny amounts of electrical stimulation which modulates the abnormal pathways in the brain thought to cause tics.

The study will involve 20 patients who will be admitted to hospital and implanted with a DBS system in a part of the brain called the internal pallidum.

They will be monitored for six months with the expert hospital teams adjusting the stimulation settings.

After this time, patients will be randomly placed into two groups. One group will have DBS kept on and the other will have DBS switched off and all will be assessed after two weeks. Then the patients will be swapped to the other condition for two weeks before further assessments. The patients and doctors doing the assessments will not know if the DBS is on or off. This will test whether any tic reduction is specifically due to DBS.

Professor Silverdale added: “As well as assessing changes to tics using a recognised clinical scale, we will also look at their impact on quality of life, anxiety, hyperactivity and obsessive compulsive symptoms.

“We will also try to assess possible factors that explain why some patients improve more than others as a result of DBS. After the study patients will remain under the long-term care of the study team.”