Deep Brain Stimulation Results in Greater Symptomatic Improvement in Tourette Syndrome than Conservative Measures: A Meta-Analysis

Abstract

Introduction: Deep brain stimulation (DBS) has emerged as a safe and effective therapy for refractory Tourette syndrome (TS). Recent studies have identified several neural targets as effective in reducing TS symptoms with DBS, but, to our knowledge, none has compared the effectiveness of DBS with conservative therapy. Methods: A literature review was performed to identify studies investigating adult patient outcomes reported as Yale Global Tic Severity Scale (YGTSS) scores after DBS surgery, pharmacotherapy, and psychotherapy. Data were pooled using a random-effects model of inverse variance-weighted meta-analysis (n = 168 for DBS, n = 131 for medications, and n = 154 for behavioral therapy). Results: DBS resulted in a significantly greater reduction in YGTSS total score (49.9 ± 17.5%) than pharmacotherapy (22.5 ± 15.2%, p = 0.001) or psychotherapy (20.0 ± 11.3%, p < 0.001), with a complication (adverse effect) rate of 0.15/ case, 1.13/case, and 0.60/case, respectively. Conclusion: Our data suggest that adult patients with refractory TS undergoing DBS experience greater symptomatic improvement with surprisingly low morbidity than can be obtained with pharmacotherapy or psychotherapy.

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

“…Based on the present results, we suggest that DBS is capable of reducing TS symptomatology in patients with treatmentrefractory TS, which is in line with previous research (36,37,123). DBS significantly reduces tic-related symptoms as well as comorbid OCD and affective symptoms in TS patients.…”

“…Moreover, time appears to play an important role in DBS for TS, as the beneficial effects of DBS seem to increase up to more than 1 year after surgery. Recent evidence implicates that this is not the case with conservative therapies, including pharmacological and behavioral therapy, which effects tend to decline over time (123). The individual optimization of stimulus parameters, especially during the first 6 months after surgery, likely contributes to this particular time course of DBS effects (74).…”

Bilateral Posteroventral GPi-DBS in a Patient with Tourette’s Syndrome – A Rapidly Effective But Under-utilized Therapy

“…Recently, Mahajan et al . [ 10 ] published a crucial paper evaluating the efficacy of DBS therapy on adult patients with refractory TS. In conclusion, they determined that those patients undergoing DBS experience greater symptomatic improvement with surprisingly low morbidity than can be obtained with pharmacotherapy or psychotherapy.…”

“…In conclusion, they determined that those patients undergoing DBS experience greater symptomatic improvement with surprisingly low morbidity than can be obtained with pharmacotherapy or psychotherapy. [ 10 ] In this study, DBS targets included the GPi (94 patients), thalamus (70 patients), and ventral capsule/ventral striatum (1 patient). However, they did not find a difference in the effectiveness of DBS between targets.…”

International Regulatory Standards for the Qualitative Measurement of Deep Brain Stimulation in Clinical Research

“…Over the course of roughly seventy years, subcortical neurostimulation has grown from a tool utilized predominantly for the neurological localization of brain structures for ablation to effective therapies for medically refractory movement disorders, including Parkinson’s Disease (PD), dystonia, and essential tremor (Hariz et al, 2010; Larson, 2014). Over this time, neurostimulatory devices referred to here as deep brain stimulation (DBS), have also either been empirically supported or are being explored for intractable psychiatric disorders including Obsessive-Compulsive Disorder (OCD), Tourette Syndrome, Anorexia Nervosa, Addiction, and Major Depressive Disorder (Hassan et al, 2020; Mahajan et al, 2020; Mayberg et al, 2005; Murray et al, 2020; Welter et al, 2020). These devices have gradually become more favored than the traditional neuro-ablative procedures as palliative care for medically refractory diseases due, in part, to the impermanence of the intervention.…”