Treatment-refractory Tourette Syndrome

Kious, Brent M.; Jimenez-Shahed, Joohi; Shprecher, David

doi:10.1016/j.pnpbp.2016.02.003

Cited by 58 publications

(35 citation statements)

References 175 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Landeros-Weisenberger et al (2015) presented the first sham controlled double-blind rTMS study in patients with severe GTS and could not show a significant difference in tic improvement after active rTMS compared to sham rTMS. Thus, results of rTMS in the treatment of GTS are controversial so far (Kious et al, 2016; Pedroarena-Leal and Ruge, 2017). Another emerging NIBS technique, transcranial direct current stimulation (tDCS) has been shown to modulate motor cortex excitability (Nitsche and Paulus, 2001) and frontal network activity (Keeser et al, 2011a).…”

Section: Introductionmentioning

confidence: 99%

Cathodal tDCS Over Motor Cortex Does Not Improve Tourette Syndrome: Lessons Learned From a Case Series

Behler

Leitner

Mezger

et al. 2018

Front. Behav. Neurosci.

View full text Add to dashboard Cite

Introduction: Current pathophysiological hypotheses of Gilles de la Tourette Syndrome (GTS) refer to temporally abnormal neuronal activation in cortico-striato-thalamo-cortical (CSTC) networks. Modifying cortical activity by non-invasive brain-stimulation appears to be a new treatment option in GTS.Background: Previous studies suggested therapeutic effects of cathodal transcranial direct current stimulation (tDCS) to pre-supplementary motor areas (SMA), however, treatment modalities concerning electrode placement, current intensity and stimulation-rate have not been systematically explored. Aim of this study was to assess efficacy of an alternative stimulation regime on GTS symptoms in a pilot study. To test a treatment protocol with tDCS twice a day, we administered 10 sessions over 5 days of bilateral cathodal tDCS (30 min, 2 mA) over the pre-SMA in three patients with severe GTS. Tic severity as well as obsessive-compulsive (OC) symptoms and affective scales were rated before and after tDCS treatment.Discussion: Only one out of three patients showed a 34.5% reduction in tic severity. The two other patients showed an increase in tic severity. All patients showed a mild increase in positive affect and a reduction in negative affect, OC symptom changes were heterogeneous. Our results do not support earlier findings of extensive therapeutic effects of cathodal tDCS on tics in patients with GTS and show that prediction of stimulation effects on a targeted brain area remains inaccurate.Concluding Remarks: Future research will have to focus on the determination of most effective stimulation modes regarding site, polarity and frequency of tDCS in GTS patients.

show abstract

Section: Introductionmentioning

confidence: 99%

Cathodal tDCS Over Motor Cortex Does Not Improve Tourette Syndrome: Lessons Learned From a Case Series

Behler

Leitner

Mezger

et al. 2018

Front. Behav. Neurosci.

View full text Add to dashboard Cite

show abstract

“…Approximately 5% of individuals with TS in a tertiary referral setting may meet criteria for “malignant” TS in which symptoms are self-injurious or may lead to emergency room visits or hospitalizations (Cheung et al, 2007 ). Pharmacologic and non-pharmacologic therapies exist for management of TS symptoms, and several new treatments are currently being investigated (Kious et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

GPi Oscillatory Activity Differentiates Tics from the Resting State, Voluntary Movements, and the Unmedicated Parkinsonian State

et al. 2016

Self Cite

View full text Add to dashboard Cite

Background: Deep brain stimulation (DBS) is an emerging treatment strategy for severe, medication-refractory Tourette syndrome (TS). Thalamic (Cm-Pf) and pallidal (including globus pallidus interna, GPi) targets have been the most investigated. While the neurophysiological correlates of Parkinson's disease (PD) in the GPi and subthalamic nucleus (STN) are increasingly recognized, these patterns are not well characterized in other disease states. Recent findings indicate that the cross-frequency coupling (CFC) between beta band and high frequency oscillations (HFOs) within the STN in PD patients is pathologic.Methods: We recorded intraoperative local field potentials (LFPs) from the postero-ventrolateral GPi in three adult patients with TS at rest, during voluntary movements, and during tic activity and compared them to the intraoperative GPi-LFP activity recorded from four unmedicated PD patients at rest.Results: In all PD patients, we noted excessive beta band activity (13–30 Hz) at rest which consistently modulated the amplitude of the co-existent HFOs observed between 200 and 400 Hz, indicating the presence of beta-HFO CFC. In all 3TS patients at rest, we observed theta band activity (4–7 Hz) and HFOs. Two patients had beta band activity, though at lower power than theta oscillations. Tic activity was associated with increased high frequency (200–400 Hz) and gamma band (35–200 Hz) activity. There was no beta-HFO CFC in TS patients at rest. However, CFC between the phase of 5–10 Hz band activity and the amplitude of HFOs was found in two TS patients. During tics, this shifted to CFC between the phase of beta band activity and the amplitude of HFOs in all subjects.Conclusions: To our knowledge this is the first study that shows that beta-HFO CFC exists in the GPi of TS patients during tics and at rest in PD patients, and suggests that this pattern might be specific to pathologic/involuntary movements. Furthermore, our findings suggest that during tics, resting state 5–10 Hz-HFO CFC shifts to beta-HFO CFC which can be used to trigger stimulation in a closed loop system when tics are present.

show abstract

“…There is also a newer class of drugs that diminish presynaptic dopamine by inhibiting vesicular monoamine transporter type 2 (VMAT2), such as tetrabenazine [55], and the emergence of other VMAT2 inhibitors, including deutetrabenazine and valbenazine [56], that could show a better pharmacologic and side effect profile for the treatment of patients with Tourette disorder. Hence, targeted neurostimulation such as the repetitive transcranial magnetic stimulation and the tDCS, as well as the deep brain stimulation [57] also showed promising results for the treatment of refractory GTS [58]. …”

Section: New Treatment Of Tic Disordersmentioning

confidence: 99%

Toward a Multifactorial Conception of the Gilles de la Tourette Syndrome and Persistent Chronic Tic Disorder

Lavoie

O’Connor

2017

Brain Sciences

View full text Add to dashboard Cite

Despite recent giant leaps in understanding Gilles de la Tourette’s syndrome (now Tourette Disorder in the DSM 5), accurate multi-modal description, rigorous assessment procedures, and the improvement of evidence-based treatment currently pose a considerable challenge. In this context, the current special edition aims to elaborate three important dimensions in Tourette Disorder. Firstly, the effective characterization and etiological basis of the disorder are reviewed, since such characterization impacts accurate assessment. Secondly, subsequent articles cover the comprehensive evaluation and assessment of tic disorders, essential for treatment planning. Thirdly, the final group of articles propose novel and innovative treatment strategies for pharmacologically and behaviorally reducing tic frequency. In the current editorial address, two main issues seem crucial to the development of interventions for Tourette disorder. Primarily, integrating new technology in treatments, while supporting cognitive and behavioral recovery through learning self-controlled strategies. Additionally, the dissemination of study results to frontline resources, needs streamlining and empirically validated treatments for tic disorders should be the subject of knowledge translation to community organizations and be more widely available to the public.

show abstract

Treatment-refractory Tourette Syndrome

Cited by 58 publications

References 175 publications

Cathodal tDCS Over Motor Cortex Does Not Improve Tourette Syndrome: Lessons Learned From a Case Series

Cathodal tDCS Over Motor Cortex Does Not Improve Tourette Syndrome: Lessons Learned From a Case Series

GPi Oscillatory Activity Differentiates Tics from the Resting State, Voluntary Movements, and the Unmedicated Parkinsonian State

Toward a Multifactorial Conception of the Gilles de la Tourette Syndrome and Persistent Chronic Tic Disorder

Contact Info

Product

Resources

About