Bilateral globus pallidus stimulation for severe Tourette's syndrome: a double-blind, randomised crossover trial

Kefalopoulou, Zinovia; Zrinzo, Ludvic; Jahanshahi, Marjan; Candelario, Joseph; Milabo, Catherine; Beigi, Mazda; Akram, Harith; Hyam, Jonathan A.; Clayton, Juliet; Kass-Iliyya, Lewis; Silverdale, Monty; Evans, Julian; Limousin, Patricia; Hariz, Marwan; Joyce, Eileen M.; Foltynie, Thomas

doi:10.1016/s1474-4422(15)00008-3

Cited by 158 publications

(110 citation statements)

References 32 publications

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“…Additionally, it is documented that the rate of infection of DBS hardware seems increased in patients with GTS patients 167,168 . Whether this is due to tic-related behaviours and comorbidity (e.g., picking at wound), or distinct immunological profiles remains unclear 168 .…”

Section: Thoughts For Dougmentioning

confidence: 99%

Gilles de la Tourette syndrome

Robertson

Eapen

Singer

et al. 2017

Nat Rev Dis Primers

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The unstructured abstract of 200 words maximum should summarize the main points of the article. All information mentioned in the abstract must be addressed somewhere in the main article. The abstract should not contain references or display item citations. Gilles de la Tourette Syndrome (GTS), a reasonably common disorder, has had a long, tortuous and somewhat controversial history. First and well described in the 18th century 1,2 , the main features of GTS have, however, remained fairly constant. The core diagnostic features are multiple motor and one or more vocal (phonic) tics lasting for over a year. In addition, almost pathognomic, but not necessary, features described in the early documentations include coprolalia (involuntary, inappropriate swearing), and echophenomena (copying behaviours), as well as many co-morbidities and psychopathologies 3 . Introduction [suggested 500 words, is 544 words -8 refs] Mary Robertson Thoughts for Mary -Your word count when combining sections 1 and 2 is 1001 (1000 limit)-so OKGTS was originally described in France and the majority of early literature came from and standardised schedules such as diagnostic confidence, measurement of severity, QoL, and assessment of both co-morbidities and co-existent psychopathologies are currently available.Large international collaborative consortia are engaged in studies exploring aetiological factors in particular, and some international treatment studies are also underway. Perhaps as a result of earlier small patient numbers, the treatment trials have given good clues to management, but unsurprisingly systematic reviews and meta-analyses have been hampered, giving disappointing, if not unexpected, results. Intriguingly medications from the typical NRDP -Gilles de la Tourette Syndrome 3 antipsychotic family including haloperidol, which first had documented success in 1961 6,7 are still being used, although successive generations of "atypicals" are currently more in vogue,as are medications such as alpha-2-adrenergic agonists. Interestingly, haloperidol remains the only medication prescribed on licence in many parts of the world. In contrast to disorders such as ADHD, in which it is clear which treatments work and which do not require further study 8 , a variety of treatment studies in GTS are still being undertaken, including using other medications (trying to improve efficacy and reduce side effects), behavioural therapies, deep brain stimulation (for refractory cases), and other more "alternative" methods such as "orthotics" (teeth braces). The GTS community has to first agree on how common GTS is and then seek funding for research in the areas of major importance.2. Epidemiology [suggested 500 words, is 444 words, 6 additional refs] Mary Robertson GTS was for many years thought to be not only very rare, but a bizarre curiosity, with sporadic case reports peppering the literature. The belief that GTS was uncommon at the very least was held by many until Comings 9 controversially suggested that GTS occurred in between 0.66% and...

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Section: Thoughts For Dougmentioning

confidence: 99%

Gilles de la Tourette syndrome

Robertson

Eapen

Singer

et al. 2017

Nat Rev Dis Primers

Self Cite

284

244

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“…Within this context of target choice, one should mind the existing interdependence between symptoms and also the complex interconnection between the various nuclei (Saleh et al 2012). The largest experience comes from thalamic and pallidal DBS, which appear the most promising targets Wardell et al 2015;Kefalopoulou et al 2015;Ackermans et al 2011;Welter et al 2008). At our institution, we have a medication-guided DBS approach.…”

Section: Discussionmentioning

confidence: 99%

“…1). Based on double-blind studies the most robust and promising data comes from thalamic and pallidal stimulation (Ackermans et al 2011;Kefalopoulou et al 2015). Despite promising results (Saleh et al 2012;Servello et al 2015 • 2012: Canada (Steeves et al 2012).…”

Section: Neurosurgery In Tsmentioning

confidence: 99%

Why so many deep brain stimulation targets in Tourette’s syndrome? Toward a broadening of the definition of the syndrome

et al. 2016

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“…There have been randomized, double-blind trials of Centromedian/parafascicular (CM-Pfc) thalamic DBS [82][83][84] as well as DBS within the GPi [84,85], with accompanying improvement in quality of life. Of these, one small trial compared bilateral stimulation of the CM-Pfc, the anteromedial GPi, both targets combined, and sham stimulation, and found that the anteromedial GPi was the most effective target for stimulation in all 3 Tourette's patients treated [84].…”

Section: Experimental Uses Of Dbs In Movement Disordersmentioning

confidence: 99%

Deep brain stimulation for movement disorders: update on recent discoveries and outlook on future developments

2015

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Modern deep brain stimulation (DBS) has become a routine therapy for patients with movement disorders such as Parkinson's disease, generalized or segmental dystonia and for multiple forms of tremor. Growing numbers of publications also report beneficial effects in other movement disorders such as Tourette's syndrome, various forms of chorea and DBS is even being studied for Parkinson's-related dementia. While exerting remarkable effects on many motor symptoms, DBS does not restore normal neurophysiology and therefore may also have undesirable side effects including speech and gait deterioration. Furthermore, its efficacy might be compromised in the long term, due to progression of the underlying disease. Various programming strategies have been studied to try and address these issues, e.g., the use of low-frequency rather than high-frequency stimulation or the targeting of alternative brain structures such as the pedunculopontine nucleus. In addition, further technical developments will soon provide clinicians with an expanded choice of hardware such as segmented electrodes allowing for a steering of the current to optimize beneficial effects and reduce side effects as well as the possibility of adaptive stimulation systems based on closed-loop concepts with or without accompanying advances in programming and imaging software. In the present article, we will provide an update on the most recent achievements and discoveries relevant to the application of DBS in the treatment of movement disorder patients and give an outlook on future clinical and technical developments.

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Bilateral globus pallidus stimulation for severe Tourette's syndrome: a double-blind, randomised crossover trial

Abstract: UK National Health Service.

Cited by 158 publications

References 32 publications

Gilles de la Tourette syndrome

Gilles de la Tourette syndrome

Why so many deep brain stimulation targets in Tourette’s syndrome? Toward a broadening of the definition of the syndrome

Deep brain stimulation for movement disorders: update on recent discoveries and outlook on future developments

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