Tourette's syndrome and deep brain stimulation

Houeto, Jean‐Luc

doi:10.1136/jnnp.2004.043273

Cited by 330 publications

(248 citation statements)

References 20 publications

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“…Preliminary evidence with DBS for Tourette syndrome has also suggested that improvement in tic severity could take several weeks to reach a maximum effect. 113 To account for these observations one would seemingly need to propose that there are changes occurring within the network over multiple timescales. Cessation of abnormal synchronization may be an immediate effect of DBS, but anatomical reorganization (e.g., synaptic plasticity) is likely to be a much slower process.…”

Section: Therapeutic Latencies During Dbs Onset and With Cessationmentioning

confidence: 99%

“…136 The Vim nucleus of the thalamus continues to be the primary target for essential tremor, 137 although stimulation near the STN may also improve essential tremor and both STN and GPi DBS improve the tremor associated with PD. 61,138 At least three regions have been targeted for Tourette syndrome, including the centromedian-parafascicular nucleus, 113,139,140 anterior GPi, 113,141,142 and anterior limb of the internal capsule. 143 Given the multiplicity of effective stimulation targets, the question naturally arises whether the therapeutic mechanisms are the same.…”

Section: Why So Many Targets?mentioning

confidence: 99%

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Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

et al. 2008

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Summary:Chronic electrical stimulation of the brain, known as deep brain stimulation (DBS), has become a preferred surgical treatment for medication-refractory movement disorders. Despite its remarkable clinical success, the therapeutic mechanisms of DBS are still not completely understood, limiting opportunities to improve treatment efficacy and simplify selection of stimulation parameters. This review addresses three questions essential to understanding the mechanisms of DBS. 1) How does DBS affect neuronal tissue in the vicinity of the active electrode or electrodes? 2) How do these changes translate into therapeutic benefit on motor symptoms? 3) How do these effects depend on the particular site of stimulation? Early hypotheses proposed that stimulation inhibited neuronal activity at the site of stimulation, mimicking the outcome of ablative surgeries. Recent studies have challenged that view, suggesting that although somatic activity near the DBS electrode may exhibit substantial inhibition or complex modulation patterns, the output from the stimulated nucleus follows the DBS pulse train by direct axonal excitation. The intrinsic activity is thus replaced by high-frequency activity that is time-locked to the stimulus and more regular in pattern. These changes in firing pattern are thought to prevent transmission of pathologic bursting and oscillatory activity, resulting in the reduction of disease symptoms through compensatory processing of sensorimotor information. Although promising, this theory does not entirely explain why DBS improves motor symptoms at different latencies. Understanding these processes on a physiological level will be critically important if we are to reach the full potential of this powerful tool.

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Section: Therapeutic Latencies During Dbs Onset and With Cessationmentioning

confidence: 99%

Section: Why So Many Targets?mentioning

confidence: 99%

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

et al. 2008

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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

151

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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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“…Hardware complications, such as lead fracture, infection, patient compliance issues (e.g., basic wound care problems at best, self mutilation of the implanted device at worst), and in some cases the need for very frequent battery changes, are all potential disadvantages of DBS over lesioning procedures. [3][4][5][6][7][8] The three psychiatric disorders currently under investigation with DBS are Tourette's syndrome (TS), obsessive-compulsive disorder (OCD), and treatment-resistant depression (TRD). All three have a history of being successfully treated with lesioning procedures in various targets, making them a logical place to start.…”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation for Psychiatric Disorders

Larson

2008

Neurotherapeutics

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Summary: Surgery for psychiatric disorders first began in the early part of the last century when the therapeutic options for these patients were limited. The introduction of deep brain stimulation (DBS) has caused a new interest in the surgical treatment of these disorders. DBS may have some advantage over lesioning procedures used in the past. A critical review of the major DBS targets under investigation for Tourette's syndrome, obsessive-compulsive disorder, and major depression is presented. Current and future challenges for the use of DBS in psychiatric disorders are discussed, as well as a rationale for referring to this subspecialty as limbic disorders surgery based on the parallels with movement disorders surgery.

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Tourette's syndrome and deep brain stimulation

Cited by 330 publications

References 20 publications

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

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

Deep Brain Stimulation for Psychiatric Disorders

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