Long-term Outcome of Globus Pallidus Internus Deep Brain Stimulation in Patients With Tourette Syndrome

Zhang, Jian Guo; Ge, Yan; Stead, Matt; Zhang, Kai; Yan, Shuang; Hu, Wei; Meng, Fan Gang

doi:10.1016/j.mayocp.2014.05.019

Cited by 44 publications

(30 citation statements)

References 41 publications

(50 reference statements)

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“…In a follow‐up of 13 patients with medically intractable TS treated with GPi DBS, there was a mean 52.1% reduction in the YGTSS score, with gradual improvement during the follow‐up period . In 1 patient with cervical myelopathy secondary to cervical tics, anteromedial pallidal DBS resulted in marked, sustained improvement in her tics, limb strength, and bladder symptoms …”

Section: New Treatments and Discoveriesmentioning

confidence: 99%

Therapeutic Developments for Tics and Myoclonus

Jankovic

2015

Movement Disorders

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Tics and myoclonus are phenomenologically similar given that both are jerk-like movements, but, in contrast to myoclonus, tics are often preceded by premonitory sensations and are typically associated with a variety of behavioral comorbidities, including attention deficit and obsessive-compulsive disorder. There are many other clinical features that help differentiate these two hyperkinetic disorders. Whereas behavioral and antidopaminergic therapies are most effective in the management of tics, clonazepam, other anticonvulsants, and serotonergic drugs are often used to control myoclonic movements. Botulinum toxin may also be helpful in focal tics and in segmental forms of myoclonus. DBS plays an increasingly important role in the treatment of these disorders, particularly when they are generalized and are disabling despite optimal medical therapy.

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Section: New Treatments and Discoveriesmentioning

confidence: 99%

Therapeutic Developments for Tics and Myoclonus

Jankovic

2015

Movement Disorders

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“…Additionally, in a double-blind randomized controlled trial comparing CM-Pf and GPi DBS, stimulation of either target was found to be effective for tic suppression in three patients, with better results obtained with GPi than with CM-Pf DBS (78.3 versus 44.7% reduction in YGTSS scores) (83, 86). Open-label studies including more than ten patients report percent tic score reductions ranging between 44.8 and 52.3, with 59.6% of patients experiencing a YGTSS reduction of 50% or higher (91–93). Further studies comparing CM-Pf and GPi stimulation are warranted to establish a definitive target of choice in the treatment of TS.…”

Section: Clinical Outcomes Of Cm-pf Dbs For Tsmentioning

confidence: 99%

Deep Brain Stimulation for Tourette’s Syndrome: The Case for Targeting the Thalamic Centromedian–Parafascicular Complex

et al. 2016

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Tourette’s syndrome (TS) is a neurologic condition characterized by both motor and phonic tics and is typically associated with psychiatric comorbidities, including obsessive-compulsive disorder/behavior and attention-deficit hyperactivity disorder, and can be psychologically and socially debilitating. It is considered a disorder of the cortico–striato–thalamo–cortical circuitry, as suggested by pathophysiology studies and therapeutic options. Among these, deep brain stimulation (DBS) of the centromedian–parafascicular nucleus (CM-Pf) of the thalamus is emerging as a valuable treatment modality for patients affected by severe, treatment-resistant TS. Here, we review the most recent experimental evidence for the pivotal role of CM-Pf in the pathophysiology of TS, discuss potential mechanisms of action that may mediate the effects of CM-Pf DBS in TS, and summarize its clinical efficacy.

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“…However, we consider that this is not the case for a well‐established diagnosis of severe TS followed‐up for more than 10 years. The striking clinical benefit observed after surgery, which is further maintained with unilateral stimulation, adds casuistry to progress in terms of long‐term outcomes for these complicated patients …”

Section: Clinical Outcomesmentioning

confidence: 99%

“…The long‐term persistence of clinical benefit with unilateral stimulation after left extension lead discontinuity, comparable with previous bilateral stimulation as observed in our patient, challenge the default indication of bilateral DBS implantation in TS. However, because a direct on‐off stimulation comparison could not be done because of the patient's reluctance to turn the active lead off, beneficial effects at the last follow‐up could also be attributed to an acute change of the basal ganglia activity provided by DBS or also by a microlesion effects from either the electrodes or neuroplasticity or even a natural waning of disease severity, which is well known for this condition …”

Section: Clinical Outcomesmentioning

confidence: 99%