Deep brain stimulation for Tourette’s syndrome

Stereotact Funct Neurosurg

et al. 2020

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Introduction: Globus pallidus internus (GPi) deep brain stimulation (DBS) combined with anterior capsulotomy offers a promising treatment option for severe medication-refractory cases of Tourette’s syndrome (TS) with psychiatric comorbidities. Several patients treated with this combined surgery experienced sustained relief after discontinuation of stimulation over the course of treatment. Methods: Retrospectively, the medical records and clinical outcomes were reviewed of 8 patients (6 men; 2 women with mean age of 20.3 years) who had undergone bilateral GPi-DBS combined with anterior capsulotomy for medically intractable TS and psychiatric comorbidities. All patients had experienced an accidental interruption or intentional withdrawal of pallidal stimulation during treatment. Results: The widespread clinical benefits achieved during the combined treatment were fully maintained after intentional or accidental DBS discontinuation. The improvement in overall tic symptoms achieved was on average 78% at the follow-up or close to the DBS discontinuation, while it was 83% at last follow-up (LFU). At LFU, most patients had functionally recovered; exhibited only mild tics; displayed minor or no obsessive-compulsive disorder symptoms, anxiety, or depression; and experienced a much better quality of life. Conclusion: Bilateral GPi-DBS combined with anterior capsulotomy appears to result in marked and sustained improvements in TS symptoms and psychiatric comorbidities, which are fully maintained over time, even without pallidal stimulation.

Section: Introductionmentioning

confidence: 99%

Sustained Relief after Pallidal Stimulation Interruption in Tourette’s Syndrome Treated with Simultaneous Capsulotomy

Zhang

Stereotact Funct Neurosurg

et al. 2020

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“…In recent years, deep brain stimulation (DBS) has been found to be useful in the clinical management of several treatment-resistant psychiatric diseases, particularly obsessive-compulsive disorder (OCD), 5 Tourette's syndrome, 6 addiction, 7 and depression. 8 However, to date, only 3 clinical trials of DBS for treatment-refractory schizophrenia have been registered (ClinicalTrials.gov [accessed February 2020]).…”

mentioning

confidence: 99%

Habenula deep brain stimulation for intractable schizophrenia: a pilot study

Zhang

et al. 2020

Neurosurgical Focus

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Schizophrenia is a psychiatric disorder associated with significant morbidity and mortality. Although antipsychotic medications and electroconvulsive therapy can be used to manage the clinical symptoms of schizophrenia, a substantial portion (10%–30%) of patients do not clinically respond to these treatments or cannot tolerate the side effects. Recently, deep brain stimulation (DBS) has emerged as a promising safe and effective therapeutic intervention for various psychiatric disorders. Here, the authors explore the utility of DBS of the habenula (HB) in the clinical management of 2 young adult male patients with severe, chronic, and treatment-resistant schizophrenia. After HB DBS surgery, both patients experienced improvements in clinical symptoms during the first 6 months of treatment. However, only 1 patient retained the clinical benefits and reached a favorable outcome at 12-month follow-up. The symptoms of the other patient subsequently worsened and became so profound that he needed to be hospitalized at 10-month follow-up and withdrawn from further study participation. It is tentatively concluded that HB DBS could ultimately be a relatively safe and effective surgical intervention for certain patients with treatment-resistant schizophrenia.

“…In recent years, DBS has been considered a last resort treatment option for severe TS resistant to medical and behavioral therapy (2). There is currently no consensus on the optimal brain target for tics treatment; however, our studies indicated that targeting the anteromedial globus pallidus (am GPi) or thalamic centromedian-parafascicular (CM-Pf) are more likely to reduce tic severity (101). Although utilizing DBS in TS management is still investigational, DBS has reached an innovative era.…”

Section: Tele-programming Dbsmentioning

confidence: 96%

Multidisciplinary Telemedicine Care for Tourette Syndrome: Minireview

Cen

et al. 2020

Front. Neurol.

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Tourette syndrome (TS) is a childhood-onset, chronic neuropsychiatric disorder characterized by multiple motor and vocal tics. TS poses a considerable burden on both patients and health care providers, leading to a major detriment of educational success, occupation, and interpersonal relationships. A multidisciplinary, specialist-driven management approach is required due to the complexity of TS. However, access to such specialty care is often dramatically limited by the patients' locations and the specialists' geographic clustering in large urban centers. Telemedicine uses electronic information and communication technology to provide and support health care when distance separates participants. Therefore, we conducted this mini-review to describe the latest information on telemedicine in the assessment and management of TS and discuss the potential contributions to care for TS patients with a multidisciplinary approach. We believe that telemedicine could be a revolutionary method in improving medical access to patients with TS.