Thalamic deep brain stimulation for treatment-refractory Tourette syndrome

Porta, Mauro; Brambilla, Arianna; Cavanna, Andrea E.; Servello, Domenico; Sassi, Marco; Rickards, Hugh; Robertson, MM

doi:10.1212/wnl.0b013e3181bd809b

Cited by 162 publications

(107 citation statements)

References 19 publications

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“…An open-label study of 18 patients preliminarily reported positive results at 3-and 18-month follow-ups, and a 2-year evaluation indicated that the severity of spasms, obsessive-compulsive symptoms, anxiety and depression had decreased remarkably (62,71). A case report also declared that DBS of the GPI and VC/VS may have potential curative effects in patients with severe TS (66).…”

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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“…235 Based on this early work, successful control of tics with DBS at the CM-PF was reported in 1999, 285 and more than 20 studies have subsequently reported successful treatment of TS with stimulation in the CM-PF and ventral tier of the thalamus. 254 The majority of studies constitute Class IV evidence in the form of case reports 2,4,21,159,263,289 or small case series, 123,199,224,247,256 with many containing previously reported patients. 149,183,225,257,290 Reported outcomes are variable, with 1 report of worsening tic behavior with stimulation, 60 and some series reporting 100% reduction in tic frequency.…”

Section: Centromedian-parafascicular Thalamic Complexmentioning

confidence: 99%

Deep brain stimulation for psychiatric disorders: where we are now

Cleary

Ozpinar

Raslan

et al. 2015

FOC

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Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned. Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry. This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.

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“…Results from a phase I clinical trial of bilateral forniceal stimulation have shown a delay in the rate of cognitive decline and a reversal of the glucose hypometabolic uptake seen in Alzheimer's disease as well as activation of the memory circuitry 8,44 . Furthermore, in recent years neurosurgeons have conducted DBS trials for treating neuropsychiatric disorders such as OCD (Obsessive Compulsive Disorder), treatment-resistant depression, Tourette syndrome and addiction 10,[45][46][47][48][49][50][51][52][53][54][55] .…”

Section: Discussionmentioning

confidence: 99%

Analysis of Gene Expression Changes in the Rat Hippocampus After Deep Brain Stimulation of the Anterior Thalamic Nucleus

Selvakumar

Alavian

Tierney

2015

JoVE

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Deep brain stimulation (DBS) surgery, targeting various regions of the brain such as the basal ganglia, thalamus, and subthalamic regions, is an effective treatment for several movement disorders that have failed to respond to medication. Recent progress in the field of DBS surgery has begun to extend the application of this surgical technique to other conditions as diverse as morbid obesity, depression and obsessive compulsive disorder. Despite these expanding indications, little is known about the underlying physiological mechanisms that facilitate the beneficial effects of DBS surgery. One approach to this question is to perform gene expression analysis in neurons that receive the electrical stimulation. Previous studies have shown that neurogenesis in the rat dentate gyrus is elicited in DBS targeting of the anterior nucleus of the thalamus 1 . DBS surgery targeting the ATN is used widely for treatment refractory epilepsy. It is thus of much interest for us to explore the transcriptional changes induced by electrically stimulating the ATN. In this manuscript, we describe our methodologies for stereotactically-guided DBS surgery targeting the ATN in adult male Wistar rats. We also discuss the subsequent steps for tissue dissection, RNA isolation, cDNA preparation and quantitative RT-PCR for measuring gene expression changes. This method could be applied and modified for stimulating the basal ganglia and other regions of the brain commonly clinically targeted. The gene expression study described here assumes a candidate target gene approach for discovering molecular players that could be directing the mechanism for DBS. Video LinkThe video component of this article can be found at

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Thalamic deep brain stimulation for treatment-refractory Tourette syndrome

Abstract: This study provides class IV evidence that bilateral thalamic deep brain stimulation reduces global tic severity measured 24 months after implantation in patients with severe intractable Tourette syndrome.

Cited by 162 publications

References 19 publications

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

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

Deep brain stimulation for psychiatric disorders: where we are now

Analysis of Gene Expression Changes in the Rat Hippocampus After Deep Brain Stimulation of the Anterior Thalamic Nucleus

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