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

Abstract

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

Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

“…There is some variation in the lowest recommended age for DBS; patients > 25 years, 182 > 20 years 177 and > 18 years. 183 …”

“…159,177,182,183 Although DBS has been performed in TS patients < 18 years of age, 181 TS guidelines only recommend its use in adults. There is some variation in the lowest recommended age for DBS; patients > 25 years, 182 > 20 years 177 and > 18 years.…”

“…193 Acupuncture is used to treat a wide variety of physical and mental conditions; however, acupuncture was not assessed for recommendation in recent TS guidelines. 159,183 Included studies…”

Functional Neuroanatomy of Secondary Self-Injurious Behavior

“…However, tic severity is considered the major inclusion factor for DBS in TS patients, and DBS can be considered in pediatric patients if present for a minimum of 5 years [49]. Furthermore, comorbidities such as SSIB may have a greater impact on quality of life than the TS disease itself, and those too can be indicative of DBS surgery [49]. The few exceptions to the stated selection criteria have yielded some experience with pediatric cases.…”

“…Among the European Society for the Study of Tourette Syndrome (ESSTS), there has been a consensus on including TS patients in DBS treatment only if they are adult, treatment resistant, and severely affected. However, tic severity is considered the major inclusion factor for DBS in TS patients, and DBS can be considered in pediatric patients if present for a minimum of 5 years [49]. Furthermore, comorbidities such as SSIB may have a greater impact on quality of life than the TS disease itself, and those too can be indicative of DBS surgery [49].…”