Efficient internal pallidal stimulation in Gilles de la Tourette syndrome: A case report

Diederich, Nico J.; Kalteis, Karin; Stamenkovic, M.; Pieri, Vannina; Alesch, François

doi:10.1002/mds.20551

Cited by 187 publications

(125 citation statements)

References 10 publications

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“…136 The Vim nucleus of the thalamus continues to be the primary target for essential tremor, 137 although stimulation near the STN may also improve essential tremor and both STN and GPi DBS improve the tremor associated with PD. 61,138 At least three regions have been targeted for Tourette syndrome, including the centromedian-parafascicular nucleus, 113,139,140 anterior GPi, 113,141,142 and anterior limb of the internal capsule. 143 Given the multiplicity of effective stimulation targets, the question naturally arises whether the therapeutic mechanisms are the same.…”

Section: Why So Many Targets?mentioning

confidence: 99%

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

et al. 2008

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Summary:Chronic electrical stimulation of the brain, known as deep brain stimulation (DBS), has become a preferred surgical treatment for medication-refractory movement disorders. Despite its remarkable clinical success, the therapeutic mechanisms of DBS are still not completely understood, limiting opportunities to improve treatment efficacy and simplify selection of stimulation parameters. This review addresses three questions essential to understanding the mechanisms of DBS. 1) How does DBS affect neuronal tissue in the vicinity of the active electrode or electrodes? 2) How do these changes translate into therapeutic benefit on motor symptoms? 3) How do these effects depend on the particular site of stimulation? Early hypotheses proposed that stimulation inhibited neuronal activity at the site of stimulation, mimicking the outcome of ablative surgeries. Recent studies have challenged that view, suggesting that although somatic activity near the DBS electrode may exhibit substantial inhibition or complex modulation patterns, the output from the stimulated nucleus follows the DBS pulse train by direct axonal excitation. The intrinsic activity is thus replaced by high-frequency activity that is time-locked to the stimulus and more regular in pattern. These changes in firing pattern are thought to prevent transmission of pathologic bursting and oscillatory activity, resulting in the reduction of disease symptoms through compensatory processing of sensorimotor information. Although promising, this theory does not entirely explain why DBS improves motor symptoms at different latencies. Understanding these processes on a physiological level will be critically important if we are to reach the full potential of this powerful tool.

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Section: Why So Many Targets?mentioning

confidence: 99%

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

et al. 2008

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“…Stimulation-dependent changes in the execution of movements reported in one case, 29 and a vertical, gaze palsy reported in another case, 34 were both due to a small hematoma around the tip of the electrode. Unexpected stimulation-induced side effects, such as drowsiness, reduced energy, changes in sexual behavior, and mild dysarthria, seem to be emerging in the majority of reported cases.…”

mentioning

confidence: 80%

“…At 6 months follow-up, a tic reduction of 95% was noted. In 2004, Diederich et al 29 described the beneficial effects of chronic stimulation of the same target in a 27-year-old Tourette patient, with a follow-up of 14 months. Tic frequency per minute decreased by 73% in the postoperative phase and, in particular, the vocal tics became less intense, and the patient noticed a decrease of the internal urge to produce tics; however, there was no change in the patient's "very mild compulsive tendencies."…”

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confidence: 99%

Deep Brain Stimulation in Tourette’s Syndrome

2008

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Summary: Tourette's Syndrome (TS) is a neuropsychiatric disorder characterized by motor and vocal tics, often associated with behavioral disorders. Symptoms often disappear before or during adulthood. The pathophysiology of TS is still a matter of considerable debate. Current knowledge of cortico-basal ganglia-thalamocortical circuits provide explanations for the beneficial effects of deep brain stimulation (DBS) on tics. When conservative treatment fails in patients with severe TS, DBS may be a therapeutic option. In 1999, thalamic DBS was introduced for intractable TS. Since then, multiple targets have been used in a small number of patients, including the globus pallidus pars interna and the nucleus accumbens. Inclusion and exclusion criteria have been formulated to identify good candidates for DBS.

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“…This means that at age 18, tics already persist for [10][11][12] years. Since fluctuations of tics are most obvious during the early course of the disease, DBS…”

Section: Rationalementioning

confidence: 99%

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

Müller‐Vahl

Cath

Cavanna

et al. 2011

Eur Child Adolesc Psychiatry

150

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Objective: Ten years ago deep brain stimulation (DBS) has been introduced as an alternative and promising treatment option for patients suffering from severe Tourette Syndrome (TS). It seemed timely to develop a European guideline on DBS by a working group of the European Society for the Study of Tourette Syndrome (ESSTS).Methods: For a narrative review a systematic literature search was conducted and expert opinions of the guidelines group contributed also to the suggestions.Results: Of 63 patients reported so far in the literature 59 had a beneficial outcome following DBS with moderate to marked tic improvement. However, randomized controlled studies including a larger number of patients are still lacking. Although persistent serious adverse effects (AEs) have hardly been reported, surgery-(e.g., bleeding, infection) as well as stimulation-related AEs (e.g., sedation, anxiety, altered mood, changes in sexual function) may occur. Conclusion:At present time, DBS in TS is still in its infancy. Due to both different legality and practical facilities in different European countries these guidelines, therefore, have to be understood as recommendations of experts. However, among the ESSTS working group on DBS in TS there is general agreement that, at present time, DBS should only be used in adult, treatment resistant, and severely affected patients. It is highly recommended to perform DBS in the context of controlled trials.3

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Efficient internal pallidal stimulation in Gilles de la Tourette syndrome: A case report

Cited by 187 publications

References 10 publications

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

Deep Brain Stimulation in Tourette’s Syndrome

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

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