What Patients With Gilles de la Tourette Syndrome Should Be Treated With Deep Brain Stimulation and What Is the Best Target?

AbstractBACKGROUND:Gilles de la Tourette syndrome (GTS) is a chronic neurodevelopmental disorder characterized by tics and associated behavioral symptoms. Over the past decade, deep brain stimulation (DBS) has been increasingly advocated as a reversible and controllable procedure for selected cases of GTS.OBJECTIVE:We set out to answer 2 clinically relevant questions: what patients with GTS should be treated with DBS and what is the best target?METHODS:We conducted a systematic literature review of the published studies of DBS in GTS and critically evaluated the current evidence for both patient and target selection.RESULTS:Since 1999, up to 99 cases of DBS in GTS have been reported in the scientific literature, with varying selection criteria, stimulation targets, and assessment protocols. The vast majority of studies published to date are case reports or case series reporting successful outcomes in terms of both tic severity improvement and tolerability. The reviewed studies suggest that the best candidates are patients with significant functional impairment related to the tic symptoms, who did not respond to conventional pharmacological and behavioral interventions. The globus pallidus internus and thalamus appear to be the safest and most effective targets, especially for patients with “pure” GTS and patients with comorbid obsessive-compulsive symptoms, anxiety, and depression.CONCLUSION:DBS is a promising treatment option for severe cases of GTS. There is a need to reach consensus on the definition of “treatment-refractoriness” and to conduct larger double-blind randomized controlled studies on the most promising targets.

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Inhibitory Control on a Stop Signal Task in Tourette Syndrome before and after Deep Brain Stimulation of the Internal Segment of the Globus Pallidus

Brain Sciences ◽

10.3390/brainsci11040461 ◽

2021 ◽

Vol 11 (4) ◽

pp. 461

Author(s):

Francesca Morreale ◽

Zinovia Kefalopoulou ◽

Ludvic Zrinzo ◽

Patricia Limousin ◽

Eileen Joyce ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Tourette Syndrome ◽

Globus Pallidus ◽

Brain Stimulation ◽

Stop Signal ◽

Stop Signal Task ◽

Healthy Controls ◽

Reactive Inhibition ◽

Double Blind ◽

Deep Brain

As part of the first randomized double-blind trial of deep brain stimulation (DBS) of the globus pallidus (GPi) in Tourette syndrome, we examined the effect of stimulation on response initiation and inhibition. A total of 14 patients with severe Tourette syndrome were recruited and tested on the stop signal task prior to and after GPi-DBS surgery and compared to eight age-matched healthy controls. Tics were significantly improved following GPi-DBS. The main measure of reactive inhibition, the stop signal reaction time did not change from before to after surgery and did not differ from that of healthy controls either before or after GPi-DBS surgery. This suggests that patients with Tourette syndrome have normal reactive inhibition which is not significantly altered by GPi-DBS.

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A Prospective Randomized Double-blind Trial of Bilateral Thalamic Deep Brain Stimulation in Adults with Tourette Syndrome

Neurosurgery ◽

10.1227/00006123-200608000-00123 ◽

2006 ◽

Vol 59 (2) ◽

pp. 482

Author(s):

Robert J. Maciunas ◽

Brian Maddux ◽

David E. Riley ◽

Christina M. Whitney ◽

Michael R. Schoenberg ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Tourette Syndrome ◽

Brain Stimulation ◽

Double Blind Trial ◽

Double Blind ◽

Blind Trial ◽

Deep Brain

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Main Targets for Deep Brain Stimulation in Tourette Syndrome

10.5327/1516-3180.196 ◽

2021 ◽

Author(s):

Cláudio Vinícius Araújo Pinheiro ◽

Thifanny Rodrigues de Oliveira

Keyword(s):

Deep Brain Stimulation ◽

Tourette Syndrome ◽

Brain Stimulation ◽

Standard Treatment ◽

Neurodevelopmental Disorder ◽

Internal Globus Pallidus ◽

Cortical Circuit ◽

Deep Brain ◽

Analyze Data ◽

The Ideal

Introduction: Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by fast and recurrent vocal and motors tics, with classical onset in infancy. Psychotherapy and medicament are the treatments of choice, but as of lately the use of the Deep Brain Stimulation (DBS), still considered an experimental intervention, has shown promising results. Objective: Describe and analyze data regarding modern targets for DBS in TS. Methods: A narrative review was conducted. Research in the following databases was performed: MedLine, PubMed, Scielo. Criteria of inclusion were articles published between 2016 and 2021, selected according to relevancy and adequacy. Criteria of exclusion were non-pertinent articles. Results: Being TS a dysfunction in the Basal Ganglia and cortical-striatalthalamic-cortical circuit, it is thought to be in one those sites that DBS may present best results, nonetheless the precise optimal location it is still debatable and a myriad of targets have arisen. Recent studies showed the ideal target is likely the Internal Globus Pallidus, improving symptoms in 50%, followed by Centromedian parafascicular nucleus complex of Thalamus, with an improvement of 46.6%, measured by the Yale Global Tics Severity Scale (YGTSS). Conclusion: DBS is possible to become a gold standard treatment for TS with no improvement by the usual therapy, but larger studies showing the efficacy of new targets are still necessary.

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Prospective randomized double-blind trial of bilateral thalamic deep brain stimulation in adults with Tourette syndrome

Journal of Neurosurgery ◽

10.3171/jns-07/11/1004 ◽

2007 ◽

Vol 107 (5) ◽

pp. 1004-1014 ◽

Cited By ~ 191

Author(s):

Robert J. Maciunas ◽

Brian N. Maddux ◽

David E. Riley ◽

Christina M. Whitney ◽

Mike R. Schoenberg ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Tourette Syndrome ◽

Outcome Measures ◽

Brain Stimulation ◽

Rating Scale ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Double Blind ◽

Exact Test ◽

Deep Brain

Object The severity of Tourette syndrome (TS) typically peaks just before adolescence and diminishes afterward. In some patients, however, TS progresses into adulthood, and proves to be medically refractory. The authors conducted a prospective double-blind crossover trial of bilateral thalamic deep brain stimulation (DBS) in five adults with TS. Methods Bilateral thalamic electrodes were implanted. An independent programmer established optimal stimulator settings in a single session. Subjective and objective results were assessed in a double-blind randomized manner for 4 weeks, with each week spent in one of four states of unilateral or bilateral stimulation. Results were similarly assessed 3 months after unblinded bilateral stimulator activation while repeated open programming sessions were permitted. Results In the randomized phase of the trial, a statistically significant (p < 0.03, Friedman exact test) reduction in the modified Rush Video-Based Rating Scale score (primary outcome measure) was identified in the bilateral on state. Improvement was noted in motor and sonic tic counts as well as on the Yale Global Tic Severity Scale and TS Symptom List scores (secondary outcome measures). Benefit was persistent after 3 months of open stimulator programming. Quality of life indices were also improved. Three of five patients had marked improvement according to all primary and secondary outcome measures. Conclusions Bilateral thalamic DBS appears to reduce tic frequency and severity in some patients with TS who have exhausted other available means of treatment.

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Sensory phenomena and obsessive-compulsive symptoms in Tourette syndrome following deep brain stimulation: Two case reports

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2018.06.046 ◽

2018 ◽

Vol 56 ◽

pp. 199-201 ◽

Cited By ~ 4

Author(s):

Yukiko Kano ◽

Natsumi Matsuda ◽

Maiko Nonaka ◽

Miyuki Fujio ◽

Toshiaki Kono ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Tourette Syndrome ◽

Brain Stimulation ◽

Case Reports ◽

Obsessive Compulsive ◽

Obsessive Compulsive Symptoms ◽

Deep Brain

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Anteromedial GPi deep brain stimulation in Tourette syndrome: The first case series from Iran

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2018.06.045 ◽

2018 ◽

Vol 172 ◽

pp. 116-119 ◽

Cited By ~ 1

Author(s):

Alireza Azimi ◽

Mansour Parvaresh ◽

Gholamali Shahidi ◽

Amirhassan Habibi ◽

Sadra Rohani ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Tourette Syndrome ◽

Brain Stimulation ◽

Case Series ◽

First Case ◽

Deep Brain

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Deep brain stimulation for the treatment of drug addiction

Neurosurgical FOCUS ◽

10.3171/2018.5.focus18163 ◽

2018 ◽

Vol 45 (2) ◽

pp. E11 ◽

Cited By ~ 13

Author(s):

Tony R. Wang ◽

Shayan Moosa ◽

Robert F. Dallapiazza ◽

W. Jeffrey Elias ◽

Wendy J. Lynch

Keyword(s):

Prefrontal Cortex ◽

Deep Brain Stimulation ◽

Drug Addiction ◽

Brain Stimulation ◽

Case Reports ◽

Case Series ◽

Health Concern ◽

Lateral Habenula ◽

Reward Pathway ◽

Deep Brain

Drug addiction represents a significant public health concern that has high rates of relapse despite optimal medical therapy and rehabilitation support. New therapies are needed, and deep brain stimulation (DBS) may be an effective treatment. The past 15 years have seen numerous animal DBS studies for addiction to various drugs of abuse, with most reporting decreases in drug-seeking behavior with stimulation. The most common target for stimulation has been the nucleus accumbens, a key structure in the mesolimbic reward pathway. In addiction, the mesolimbic reward pathway undergoes a series of neuroplastic changes. Chief among them is a relative hypofunctioning of the prefrontal cortex, which is thought to lead to the diminished impulse control that is characteristic of drug addiction. The prefrontal cortex, as well as other targets involved in drug addiction such as the lateral habenula, hypothalamus, insula, and subthalamic nucleus have also been stimulated in animals, with encouraging results. Although animal studies have largely shown promising results, current DBS studies for drug addiction primarily use stimulation during active drug use. More data are needed on the effect of DBS during withdrawal in preventing future relapse. The published human experience for DBS for drug addiction is currently limited to several promising case series or case reports that are not controlled. Further animal and human work is needed to determine what role DBS can play in the treatment of drug addiction.

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