From psychosurgery to neuromodulation: Deep brain stimulation for intractable Tourette syndrome

Abstract

Tourette syndrome is a neuropsychiatric disorder characterized by motor and vocal tics. It is often associated with depression, obsessive-compulsive symptoms, self-injurious behaviour and attention deficit-hyperactivity disorder (ADHD). In intractable patients, neuromodulation using deep brain stimulation (DBS) has widely replaced psychosurgery. Three different key structures are defined for DBS, the medial portion of the thalamus, the globus pallidus internus and the anterior limb of the internal capsule/nucleus accumbens. This is a comprehensive overview on the effect of DBS on motor and non-motor symptoms using different case series and two larger studies.

The Nucleus Accumbens: A Comprehensive Review

“…The success of DBS in improving motor function in dystonia, essential tremor, and Parkinson's disease [320,321], with better stability and fewer adverse effects compared with lesioning, has opened the door for trials evaluating its efficacy in treating a host of neurologic and psychiatric disorders. There have been a number of studies evaluating DBS of the NAc for the treatment of obsessive-compulsive disorder [310,316,322], Tourette syndrome [311,323,324,325], depression [303,304,305], addiction to certain drugs of abuse, including alcohol [312,326,327,328,329], heroin [330], and nicotine [313], and central pain syndrome [331,332]. Given the known connections outlined above, it is not surprising that a recent large animal study supported the influence of NAc DBS on a variety of brain structures which could influence these and other psychiatric disorders [333].…”

Influence of sympathetic autonomic arousal on tics: Implications for a therapeutic behavioral intervention for Tourette syndrome

“…A number of sites have been targeted in DBS trials, notably centromedian-parafascicular complex [12], thalamus [13], internal globus pallidus [14], and nucleus accumbens/internal capsule [15][16][17]. Neuner et al [18] reported good prognosis with the DBS in nucleus accumbens, which was followed up until 36 months.…”

Transcranial Electrical Stimulation: Methodology and Applications

“…It has been used primarily for the improvement of motor function in patients with movement disorders, such as Parkinson's Disease (PD; Breit, Schulz, & Benabid, 2004), and more recently dystonia (Ostrem & Starr, 2008;Sakas et al, 2010), pain (Owen et al, 2007), obsessive-compulsive disorder (Greenberg et al, 2006), epilepsy (Handforth, DeSalles, & Krahl, 2006), depression (Mayberg et al, 2005), and Tourette's syndrome (Neuner et al, 2008). Although the original rationale for DBS was to replace neurosurgical lesions by inducing a reversible functional lesion in overactivated subcortical structures, such as the globus pallidus interna or the subthalamic nucleus, more recent insights hypothesize that the mechanisms of action of DBS are more complex, including depolarization blockade, synaptic inhibition, synaptic depression, and stimulation-induced modulation of pathological network activity (McIntyre, Savasta, KerkerianLe Goff, & Vitek, 2004).…”