Internal Pallidal and Thalamic Stimulation in Patients With Tourette Syndrome

Welter, Marie‐Laure; Mallet, Luc; Houeto, Jean‐Luc; Karachi, Carine; Czernecki, Virginie; Cornu, Philippe; Navarro, Soledad; Pidoux, B.; Dormont, Didier; Bardinet, Éric; Yelnik, Jérôme; Damier, Philippe; Agid, Yves

doi:10.1001/archneur.65.7.952

Cited by 221 publications

(216 citation statements)

References 18 publications

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“…These studies have reported significant improvements in twitch scores, although a proportion of patients experienced a variety of side effects, including energy loss, fatigue, lazy speech, less movement and decreasing libido (38,74). However, the maximum sample size investigated thus far contained only 18 subjects and few randomized double-blind trials have been conducted (62,75). The present evidence, however, is enough to support large-scale randomized clinical trials of DBS treatment for TS, with an aim to clarify the mechanism.…”

Section: Targets Of Tsmentioning

confidence: 99%

Advanced research on deep brain stimulation in treating mental disorders (Review)

et al. 2017

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Section: Targets Of Tsmentioning

confidence: 99%

Advanced research on deep brain stimulation in treating mental disorders (Review)

et al. 2017

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“…[24][25][26][27][28][29] GPi DBS has also been used to treat writer's cramp, 30 and GPi is also targeted for the treatment of Tourette syndrome. 31,32 In this indication, the effect of GPi DBS has been compared with the effect of centromedianparafascicular complex (CM-Pf) of the thalamus DBS. 31 It has been shown that GPi stimulation resulted in a dramatic improvement on the Yale Global Tic Severity Scale with a ticseverity reduction of 65%-96%.…”

Section: Imaging Of Patients Before Electrode Implantationmentioning

confidence: 99%

“…31,32 In this indication, the effect of GPi DBS has been compared with the effect of centromedianparafascicular complex (CM-Pf) of the thalamus DBS. 31 It has been shown that GPi stimulation resulted in a dramatic improvement on the Yale Global Tic Severity Scale with a ticseverity reduction of 65%-96%. Bilateral stimulation of the CM-Pf was less effective with a reduction in tic severity from 30% to 64%.…”

Section: Imaging Of Patients Before Electrode Implantationmentioning

confidence: 99%

Neuroimaging and Deep Brain Stimulation

Dormont¹,

Seidenwurm²,

Galanaud³

et al. 2009

AJNR Am J Neuroradiol

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SUMMARY: Deep brain stimulation (DBS) is a new neurosurgical method principally used for the treatment of Parkinson disease (PD).Many new applications of DBS are under development, including the treatment of intractable psychiatric diseases. Brain imaging is used for the selection of patients for DBS, to localize the target nucleus, to detect complications, and to evaluate the final electrode contact position. In patients with implanted DBS systems, there is a risk of electrode heating when MR imaging is performed. This contraindicates MR imaging unless specific precautions are taken. Involvement of neuroradiologists in DBS procedures is essential to optimize presurgical evaluation, targeting, and postoperative anatomic results. The precision of the neuroradiologic correlation with anatomic data and clinical outcomes in DBS promises to yield significant basic science and clinical advances in the future. Chronic high-frequency stimulation of the ventral intermediate nucleus (VIM) of the thalamus was first described in the early 1990s by Benabid et al.1 These authors implanted chronic stimulating electrodes in the VIM connected to a subcutaneous pulse generator positioned in the thoracic region to treat disabling tremor in 26 patients with Parkinson disease (PD) and in 6 with essential tremor.1 They demonstrated the effectiveness of this technique and its ability to produce complete relief from tremor. Improvement was maintained for up to 29 months. This was the first clinical demonstration that chronic high-frequency stimulation of nuclei (deep brain stimulation [DBS]) could replace destructive lesion-producing functional neurosurgery such as thalamotomy. This new technique was reversible and led to a renaissance in functional neurosurgery.Next, the same team introduced bilateral DBS of the subthalamic nucleus (STN) in patients with disabling akineticrigid PD and severe motor fluctuations.2 This work extended data obtained in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine monkey model of PD showing that lesions and electric stimulation of the subthalamic nucleus reduced all of the major motor disturbances in this animal model. The results in patients with advanced PD were striking and were reproduced in many centers internationally. The US Food and Drug Administration approved the use of DBS for treatment of advanced PD with bilateral STN stimulation in 2002 and internal globus pallidus (GPi) stimulation in 2003. The main indication for DBS remains advanced PD, but numerous additional applications have been developed, ranging from dystonia to cluster headache, Tourette syndrome, and even psychiatric indications like obsessive-compulsive disorders (OCD) and major depression.DBS is a neurosurgical method, but the role of neuroimaging in successful DBS intervention is critical. Neuroimaging is used for the preoperative selection of patients who will have DBS and to localize the intended target nuclei. In the postoperative period, imaging detects complications that uncommonly accompany the procedure, confirms the pos...

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“…There is only weak evidence that simultaneous stimulation at two different targets (thalamus+GPi, AIC/NA+thalamus) bilaterally (= 4 electrodes) is superior to bilateral stimulation at one target [16,35,46]. However, there is some evidence that bilateral stimulation is superior to unilateral (GPi) stimulation [14].…”

Section: Rationalementioning

confidence: 99%

“…While DBS is a well established treatment option in different neurological disorders including Parkinsons"s disease, dystonia, and tremor, in TS DBS is still experimental. stimulation is "on" or "off") "N of 1" trial) [16], three (controlled double-blind randomized cross-over trail) [46], and five (prospective double-blind randomized) [21] patients, respectively, have been conducted so far (table 1). Taking all these data together, in 59 of 63 TS patients (93.7%) DBS resulted in a significant tic improvement (table 2).…”

Section: Introductionmentioning

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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Internal Pallidal and Thalamic Stimulation in Patients With Tourette Syndrome

Cited by 221 publications

References 18 publications

Advanced research on deep brain stimulation in treating mental disorders (Review)

Advanced research on deep brain stimulation in treating mental disorders (Review)

Neuroimaging and Deep Brain Stimulation

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

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