The use of deep brain stimulation in Tourette's syndrome

Abstract

<jats:p>Tourette's syndrome (TS) is a childhood neuropsychiatric disorder characterized by multiple involuntary motor and vocal tics. It is commonly associated with other behavioral disorders including attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, anxiety, depression, and self-injurious behaviors. Tourette's syndrome can be effectively managed with psychobehavioral and pharmacological treatments, and many patients experience an improvement in tics in adulthood. However, symptoms may persist and cause severe impairment in a small subset of patients despite available therapies. In recent years, deep brain stimulation (DBS) has been shown to be a promising treatment option for such patients. Since the advent of its use in 1999, multiple targets have been identified in DBS for TS, including the medial thalamus, globus pallidus internus, globus pallidus externus, anterior limb of the internal capsule/nucleus accumbens, and subthalamic nucleus. While the medial thalamus is the most commonly reported trajectory, the optimal surgical target for TS is still a topic of much debate. This paper provides a review of the available literature regarding the use of DBS for TS.</jats:p>

The International Deep Brain Stimulation Registry and Database for Gilles de la Tourette Syndrome: How Does It Work?

“…As data expand we will be able to move toward more advanced queries that can be used to address complex questions such as the relationship between electrode placement and clinical outcomes, as well as the correlation of lead location to adverse events. These basic, yet critical questions remain unanswered (Rotsides and Mammis, 2013 ; Jimenez-Shahed, 2015 ). Importantly, the systematic conglomeration of TS DBS datasets will generate the “higher n” critical to design clinical trials, power meaningful analyses, and generate recommendations for patient, target, and stimulation parameter selection.…”

“…These studies reveal generally positive results with occasional side effects (e.g., hemorrhage, stimulation-induced), however it should be kept in mind that most studies have been small and uncontrolled (Duits et al, 2012 ; Sachdev et al, 2012 ; Savica et al, 2012 ; Ackermans et al, 2013 ; Dehning et al, 2014 ; Kim and Pouratian, 2014 ; Malaty and Akbar, 2014 ; Zhang et al, 2014 ; Kefalopoulou et al, 2015 ). Additionally, there were other important differences in the DBS intervention such as the brain target (Martínez-Fernández et al, 2011 ; Viswanathan et al, 2012 ), the surgical targeting methods, the type(s) of devices implanted, the stimulation paradigm (Rotsides and Mammis, 2013 ), and the baseline disease characteristics (Okun et al, 2008 ).…”

The Relationship between Neurocircuitry Dysfunctions and Attention Deficit Hyperactivity Disorder: A Review

“…If a single therapy or combined therapies of psychotherapy, cognitive behavioral therapy, or pharmacologic treatment are invalid, DBS can be applied for comorbidity of TS or OCD in refractory ADHD with serious behavioral disorder. DBS has been focused on the globus pallidus internus, globus pallidus externus, and medial thalamus for significantly improving refractory mental behavior of ADHD symptoms [ 57 , 58 ]. The nucleus accumbens fiber is in contact with the networks of motivation and action in ADHD which has a key role in the feedback from emotional experience to behavior.…”

Deep Brain Stimulation of the Globus Pallidus Internus in Patients with Intractable Tourette Syndrome

“…Indeed, some symptoms might last into adulthood, making TS a life-long disease. [ 1 8 ] The management of patients with malignant TS can be very challenging, to the extent that some individuals might opt for surgical treatments.…”