Connectivity Patterns of Deep Brain Stimulation Targets in Patients with Gilles de la Tourette Syndrome

Heiden, Petra; Hoevels, Mauritius; Bayram, Dilruba; Baldermann, Juan Carlos; Schüller, Thomas; Huys, Daniel; Visser‐Vandewalle, Veerle; Andrade, Pablo

doi:10.3390/brainsci11010087

Cited by 6 publications

(9 citation statements)

References 47 publications

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“…Therefore, the pvlGPi is also preferably chosen for DBS in TS patients with dystonic tics (67,85). Given its anatomical connections to sensorimotor regions, the modulation of these fibers seem like a probable mechanism of action for pvlGPi DBS (28,32). However, stimulation of projections from pvlGPi to sensorimotor networks was found to correlate negatively or not at all with tic improvement (31,131).…”

Section: Interpretation Of Main Findingsmentioning

confidence: 99%

“…Identification of such connectivity patterns could potentially lead to the optimization of targets or discovery of new targets. Several studies have investigated structural connectivity patterns in DBS for TS (31,32,103,115,131,144). Importantly, studies showed that the VTA of the target alone did not predict the clinical efficacy of DBS for TS (103,145).…”

Section: Future Directions For Dbs Targeting In Tsmentioning

confidence: 99%

“…Importantly, studies showed that the VTA of the target alone did not predict the clinical efficacy of DBS for TS (103,145). Instead, results of several studies indicated that the connectivity between the VTA and cortical regions was linked to the clinical outcome after DBS in TS patients (31,32,103,115). However, the various targets used for DBS in TS show different connectivity profiles, and cortical networks linked to clinical improvement have been shown to differ across targets (31,32).…”

Section: Future Directions For Dbs Targeting In Tsmentioning

confidence: 99%

“…Instead, results of several studies indicated that the connectivity between the VTA and cortical regions was linked to the clinical outcome after DBS in TS patients (31,32,103,115). However, the various targets used for DBS in TS show different connectivity profiles, and cortical networks linked to clinical improvement have been shown to differ across targets (31,32). In particular, networks positively correlated with tic improvement included limbic and associative regions for the GPi, and sensorimotor as well as parietal-temporal-occipital regions for the thalamus.…”

Section: Future Directions For Dbs Targeting In Tsmentioning

confidence: 99%

“…The GPi consists of an anteromedial part (amGPi), which is densely connected with associative and limbic networks, and a posteroventrolateral part (pvlGPi), which mainly projects to sensorimotor areas (26,27). Based on this differentiation, it can be assumed that the pvlGPi may be particularly effective in reducing tic symptoms, while the amGPi might be especially effective for the treatment of comorbid OCD symptoms (28)(29)(30)(31)(32). The selection of an ideal target for TS treatment is still a matter of debate and differences regarding clinical relevance remain unclear (33)(34)(35)(36)(37)(38).…”

Section: Introductionmentioning

confidence: 99%

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Target-Specific Effects of Deep Brain Stimulation for Tourette Syndrome: A Systematic Review and Meta-Analysis

et al. 2021

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Background: Extended research has pointed to the efficacy of deep brain stimulation (DBS) in treatment of patients with treatment-refractory Tourette syndrome (TS). The four most commonly used DBS targets for TS include the centromedian nucleus–nucleus ventrooralis internus (CM-Voi) and the centromedian nucleus–parafascicular (CM-Pf) complexes of the thalamus, and the posteroventrolateral (pvIGPi) and the anteromedial portion of the globus pallidus internus (amGPi). Differences and commonalities between those targets need to be compared systematically.Objective: Therefore, we evaluated whether DBS is effective in reducing TS symptoms and target-specific differences.Methods: A PubMed literature search was conducted according to the PRISMA guidelines. Eligible literature was used to conduct a systematic review and meta-analysis.Results: In total, 65 studies with 376 patients were included. Overall, Yale Global Tic Severity Scale (YGTSS) scores were reduced by more than 50 in 69% of the patients. DBS also resulted in significant reductions of secondary outcome measures, including the total YGTSS, modified Rush Video-Based Tic Rating Scale (mRVRS), Yale-Brown Obsessive Compulsive Scale (YBOCS), and Becks Depression Inventory (BDI). All targets resulted in significant reductions of YGTSS scores and, with the exception of the CM-Pf, also in reduced YBOCS scores. Interestingly, DBS of pallidal targets showed increased YGTSS and YBOCS reductions compared to thalamic targets. Also, the meta-analysis including six randomized controlled and double-blinded trials demonstrated clinical efficacy of DBS for TS, that remained significant for GPi but not thalamic stimulation in two separate meta-analyses.Conclusion: We conclude that DBS is a clinically effective treatment option for patients with treatment-refractory TS, with all targets showing comparable improvement rates. Future research might focus on personalized and symptom-specific target selection.

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Section: Interpretation Of Main Findingsmentioning

confidence: 99%

Section: Future Directions For Dbs Targeting In Tsmentioning

confidence: 99%

Section: Future Directions For Dbs Targeting In Tsmentioning

confidence: 99%

Section: Future Directions For Dbs Targeting In Tsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Target-Specific Effects of Deep Brain Stimulation for Tourette Syndrome: A Systematic Review and Meta-Analysis

et al. 2021

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Subthalamic deep brain stimulation for refractory Gilles de la Tourette’s syndrome: clinical outcome and functional connectivity

Dai

Yang

et al. 2022

J Neurol

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Background Deep brain stimulation (DBS) is a promising novel approach for managing refractory Gilles de la Tourette’s syndrome (GTS). The subthalamic nucleus (STN) is the most common DBS target for treating movement disorders, and smaller case studies have reported the efficacy of bilateral STN-DBS treatment for relieving tic symptoms. However, management of GTS and treatment mechanism of STN-DBS in GTS remain to be elucidated. Methods Ten patients undergoing STN-DBS were included. Tics severity was evaluated using the Yale Global Tic Severity Scale. The severities of comorbid psychiatric symptoms of obsessive–compulsive behavior (OCB), attention-deficit/hyperactivity disorder, anxiety, and depression; social and occupational functioning; and quality of life were assessed. Volumes of tissue activated were used as seed points for functional connectivity analysis performed using a control dataset. Results The overall tics severity significantly reduced, with 62.9% ± 26.2% and 58.8% ± 27.2% improvements at the 6- and 12-months follow-up, respectively. All three patients with comorbid OCB showed improvement in their OCB symptoms at both the follow-ups. STN-DBS treatment was reasonably well tolerated by the patients with GTS. The most commonly reported side effect was light dysarthria. The stimulation effect of STN-DBS might regulate these symptoms through functional connectivity with the thalamus, pallidum, substantia nigra pars reticulata, putamen, insula, and anterior cingulate cortices. Conclusions STN-DBS was associated with symptomatic improvement in severe and refractory GTS without significant adverse events. The STN is a promising DBS target by stimulating both sensorimotor and limbic subregions, and specific brain area doses affect treatment outcomes.

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European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part IV: deep brain stimulation

Szejko

Worbe

Hartmann

et al. 2021

Eur Child Adolesc Psychiatry

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In 2011 the European Society for the Study of Tourette Syndrome (ESSTS) published its first European clinical guidelines for the treatment of Tourette Syndrome (TS) with part IV on deep brain stimulation (DBS). Here, we present a revised version of these guidelines with updated recommendations based on the current literature covering the last decade as well as a survey among ESSTS experts. Currently, data from the International Tourette DBS Registry and Database, two meta-analyses, and eight randomized controlled trials (RCTs) are available. Interpretation of outcomes is limited by small sample sizes and short follow-up periods. Compared to open uncontrolled case studies, RCTs report less favorable outcomes with conflicting results. This could be related to several different aspects including methodological issues, but also substantial placebo effects. These guidelines, therefore, not only present currently available data from open and controlled studies, but also include expert knowledge. Although the overall database has increased in size since 2011, definite conclusions regarding the efficacy and tolerability of DBS in TS are still open to debate. Therefore, we continue to consider DBS for TS as an experimental treatment that should be used only in carefully selected, severely affected and otherwise treatment-resistant patients.

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Connectivity Patterns of Deep Brain Stimulation Targets in Patients with Gilles de la Tourette Syndrome

Cited by 6 publications

References 47 publications

Target-Specific Effects of Deep Brain Stimulation for Tourette Syndrome: A Systematic Review and Meta-Analysis

Target-Specific Effects of Deep Brain Stimulation for Tourette Syndrome: A Systematic Review and Meta-Analysis

Subthalamic deep brain stimulation for refractory Gilles de la Tourette’s syndrome: clinical outcome and functional connectivity

European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part IV: deep brain stimulation

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