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

2007 ◽  
Vol 107 (5) ◽  
pp. 1004-1014 ◽  
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.

scholarly journals Target-Specific Effects of Deep Brain Stimulation for Tourette Syndrome: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Laura Wehmeyer ◽  
Thomas Schüller ◽  
Jana Kiess ◽  
Petra Heiden ◽  
Veerle Visser-Vandewalle ◽  
...  
Keyword(s):  
Systematic Review ◽  
Deep Brain Stimulation ◽  
Tourette Syndrome ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Centromedian Nucleus ◽  
Treatment Refractory ◽  
Deep Brain

Background: Extended research has pointed to the efficacy of deep brain stimulation (DBS) in treatment of patients with treatment-refractory Tourette syndrome (TS). The four most commonly used DBS targets for TS include the centromedian nucleus–nucleus ventrooralis internus (CM-Voi) and the centromedian nucleus–parafascicular (CM-Pf) complexes of the thalamus, and the posteroventrolateral (pvIGPi) and the anteromedial portion of the globus pallidus internus (amGPi). Differences and commonalities between those targets need to be compared systematically.Objective: Therefore, we evaluated whether DBS is effective in reducing TS symptoms and target-specific differences.Methods: A PubMed literature search was conducted according to the PRISMA guidelines. Eligible literature was used to conduct a systematic review and meta-analysis.Results: In total, 65 studies with 376 patients were included. Overall, Yale Global Tic Severity Scale (YGTSS) scores were reduced by more than 50 in 69% of the patients. DBS also resulted in significant reductions of secondary outcome measures, including the total YGTSS, modified Rush Video-Based Tic Rating Scale (mRVRS), Yale-Brown Obsessive Compulsive Scale (YBOCS), and Becks Depression Inventory (BDI). All targets resulted in significant reductions of YGTSS scores and, with the exception of the CM-Pf, also in reduced YBOCS scores. Interestingly, DBS of pallidal targets showed increased YGTSS and YBOCS reductions compared to thalamic targets. Also, the meta-analysis including six randomized controlled and double-blinded trials demonstrated clinical efficacy of DBS for TS, that remained significant for GPi but not thalamic stimulation in two separate meta-analyses.Conclusion: We conclude that DBS is a clinically effective treatment option for patients with treatment-refractory TS, with all targets showing comparable improvement rates. Future research might focus on personalized and symptom-specific target selection.

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

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.

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

Neurosurgery ◽  
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

scholarly journals The Canadian multicenter trial of pallidal deep brain stimulation for cervical dystonia: preliminary results in three patients

2004 ◽  
Vol 17 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Zelma H. T. Kiss ◽  
Kristina Doig ◽  
Michael Eliasziw ◽  
Ranjiit Ranawaya ◽  
Oksana Suchowersky
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Cervical Dystonia ◽  
Rating Scale ◽  
Short Form ◽  
Spasmodic Torticollis ◽  
Secondary Outcome ◽  
Preliminary Results ◽  
Abnormal Movements ◽  
Deep Brain

Object Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is beneficial for generalized dystonia and has been proposed as a treatment for cervical dystonia. The Canadian Stereotactic/Functional and Movement Disorders Groups designed a pilot project to investigate the following hypothesis: that bilateral DBS of the GPi will reduce the severity of cervical dystonia at 1 year of follow up, as scored in a blinded fashion by two neurologists using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Secondary outcome measures included pain and disability subscores of the TWSTRS, Short Form–36 quality of life index, and the Beck Depression Inventory. Methods Three patients have undergone surgery in Calgary with a followup duration of 7.4 ± 5.9 months (mean ± standard deviation). One patient underwent inadvertent ineffective stimulation for the first 3 months and did not experience a benefit until DBS programming was corrected. All three patients had rapid response to stimulation, with the muscles relaxing immediately and abnormal movements improving within days. Total TWSTRS scores improved by 79%, and severity subscores improved significantly, from 15.7 ± 2.1 to 7.7 ± 2.9 (paired ttest, p = 0.02). Pain and disability subscores improved from 25.5 ± 4.1 to 3.3 ± 3.1 (paired ttest, p = 0.002) and from 13.3 ± 4.9 to 3.3 ± 4.2 (paired ttest, p = 0.06), respectively. Conclusions Although it is too early to reach broad conclusions, this report of preliminary results confirms the efficacy of DBS of the GPi for cervical dystonia.

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

Neurosurgery ◽  
2012 ◽  
Vol 71 (1) ◽  
pp. 173-192 ◽  
Author(s):  
John Carlo Pansaon Piedad ◽  
Hugh Edward Rickards ◽  
Andrea Eugenio Cavanna
Keyword(s):  
Deep Brain Stimulation ◽  
Tourette Syndrome ◽  
Brain Stimulation ◽  
Case Reports ◽  
Neurodevelopmental Disorder ◽  
Case Series ◽  
Current Evidence ◽  
Double Blind ◽  
Randomized Controlled Studies ◽  
Deep Brain

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.

scholarly journals Report of a patient undergoing chronic responsive deep brain stimulation for Tourette syndrome: proof of concept

2018 ◽  
Vol 129 (2) ◽  
pp. 308-314 ◽  
Author(s):  
Rene Molina ◽  
Michael S. Okun ◽  
Jonathan B. Shute ◽  
Enrico Opri ◽  
P. Justin Rossi ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Tourette Syndrome ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Spectral Feature ◽  
Battery Life ◽  
Proof Of Concept ◽  
Scale Scores ◽  
Tic Severity ◽  
Deep Brain

Deep brain stimulation (DBS) has emerged as a promising intervention for the treatment of select movement and neuropsychiatric disorders. Current DBS therapies deliver electrical stimulation continuously and are not designed to adapt to a patient’s symptoms. Continuous DBS can lead to rapid battery depletion, which necessitates frequent surgery for battery replacement. Next-generation neurostimulation devices can monitor neural signals from implanted DBS leads, where stimulation can be delivered responsively, moving the field of neuromodulation away from continuous paradigms. To this end, the authors designed and chronically implemented a responsive stimulation paradigm in a patient with medically refractory Tourette syndrome. The patient underwent implantation of a responsive neurostimulator, which is capable of responsive DBS, with bilateral leads in the centromedian-parafascicular (Cm-Pf) region of the thalamus. A spectral feature in the 5- to 15-Hz band was identified as the control signal. Clinical data collected prior to and after 12 months of responsive therapy revealed improvements from baseline scores in both Modified Rush Tic Rating Scale and Yale Global Tic Severity Scale scores (64% and 48% improvement, respectively). The effectiveness of responsive stimulation (p = 0.16) was statistically identical to that of scheduled duty cycle stimulation (p = 0.33; 2-sided Wilcoxon unpaired rank-sum t-test). Overall, responsive stimulation resulted in a 63.3% improvement in the neurostimulator’s projected mean battery life. Herein, to their knowledge, the authors present the first proof of concept for responsive stimulation in a patient with Tourette syndrome.

Deep Brain Stimulation in Gilles de la Tourette Syndrome

Neurosurgery ◽  
2015 ◽  
Vol 78 (1) ◽  
pp. 91-100 ◽  
Author(s):  
Domenico Servello ◽  
Edvin Zekaj ◽  
Christian Saleh ◽  
Nicholas Lange ◽  
Mauro Porta
Keyword(s):  
Deep Brain Stimulation ◽  
Tourette Syndrome ◽  
Scale Score ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Severity Rating ◽  
Wide Range ◽  
Tic Severity ◽  
Deep Brain

Abstract BACKGROUND: Gilles de la Tourette syndrome (GTS) is a severe neuropsychiatric disorder with childhood onset, characterized by disabling motor and vocal tics lasting for more than 1 year and associated with a wide range of psychiatric comorbidities. Pharmacological treatment is indicated for moderate to severe GTS patients. However, when GTS is refractory to conventional medical and behavioral treatments, deep brain stimulation (DBS) can be considered as a last resort therapeutic avenue. OBJECTIVE: To evaluate the efficacy of DBS and its comorbidities in the largest pool of GTS patients to date. METHODS: Our cohort study was based on 48 patients' refractory to conventional treatment who underwent DBS for GTS at Galeazzi Institute, Milan, Italy. An exhaustive preoperative and a follow-up battery of tests was performed including the Yale Global Tic Severity Rating Scale, the Yale-Brown Obsessive Compulsive Scale, the Beck Depression Inventory, the State Trait Anxiety Inventory, and the Subjective Social Impairment on a 10-point Visual Analogue Scale tests. RESULTS: Eleven patients in whom the device was removed for inflammatory complications or for poor compliance were excluded from final analysis. Twenty-seven of the remaining 37 patients had a Yale Global Tic Severity Rating Scale score at the last follow-up that was less than 35. Of the 37 patients, in 29 cases (78%) a reduction of more than 50% of the Yale Global Tic Severity Rating Scale score was observed. CONCLUSION: The clinical efficacy of DBS in GTS is promising. Although DBS is associated with risks, as is any surgical intervention, DBS should be considered as a last resort therapeutic option in carefully selected GTS patients.

scholarly journals Neuroanatomical Considerations for Optimizing Thalamic Deep Brain Stimulation in Tourette Syndrome

2020 ◽  
Author(s):  
Takashi Morishita ◽  
Yuki Sakai ◽  
Hitoshi Iida ◽  
Saki Yoshimura ◽  
Atsushi Ishii ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Side Effects ◽  
Clinical Outcomes ◽  
Tourette Syndrome ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Anatomical Location ◽  
Therapeutic Effects ◽  
Electrode Position ◽  
Deep Brain

Background: Deep brain stimulation (DBS) of the centromedian (CM) thalamic nucleus has reportedly been used to treat severe Tourette syndrome (TS) with promising outcomes; however, it remains unclear how DBS electrode position and stimulation parameters modulate the specific area and related networks. We aimed to evaluate the relationships between the anatomical location of stimulation fields and clinical responses including therapeutic and side effects. Methods: We collected data from eight TS patients treated with DBS. We evaluated the clinical outcomes using Yale Global Tic Severity Scale (YGTSS), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and Hamilton Depression Rating Scale (HAM-D). The DBS lead location was evaluated in the normalised brain space using a 3-D atlas. The volume of tissue activated (VTA) was determined, and the associated normative connective analyses were performed to link the stimulation field with the therapeutic and side effects. Results: The mean follow-up period was 10.9 ± 3.9 months. All clinical scale showed significant significant improvement. While the VTA associated with therapeutic effects covers the CM and ventrolateral nuclei and showed association with motor networks, those associated with paraesthesia and dizziness were associated with stimulation of the ventralis caudalis and red nucleus, respectively. Depressed mood was associated with the spread of stimulation current to the mediodorsal nucleus and showed association with limbic networks. Conclusion: Our study addresses the importance of accurate implantation of DBS electrodes for obtaining standardised clinical outcomes and suggests that meticulous programming with careful monitoring of clinical symptoms may improve outcomes.

scholarly journals Response to Thalamic Ventralis Intermedius Nucleus Deep Brain Stimulation in Essential Tremor vs. Essential Tremor-Plus

2021 ◽  
Vol 12 ◽  
Author(s):  
Gabriela S. Gilmour ◽  
Davide Martino ◽  
Karen Hunka ◽  
Pia Lawrence ◽  
Zelma H. T. Kiss ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Patient Characteristics ◽  
Response To Treatment ◽  
Secondary Outcome ◽  
Gait Disturbances ◽  
Deep Brain

Introduction: Essential tremor (ET) is a tremor syndrome characterized by bilateral, upper limb action tremor. Essential tremor-plus (ET-plus) describes ET patients with additional neurologic signs. It is unknown whether there is a difference in response to treatment with ventralis intermedius nucleus deep brain stimulation (VIM DBS) in patients with ET and ET-plus. Due to potential variability in underlying etiology in ET-plus, there is a concern that ET-plus patients may have worse outcomes. The aim of this study was to identify whether patients with ET-plus have worse tremor outcomes after VIM DBS than patients with ET.Methods: This is a retrospective chart and video review evaluating VIM DBS outcomes by comparing changes from baseline in the Fahn-Tolosa-Marin Tremor Rating Scale Part B (FTM-B) for the treated limb between patients with ET and ET-plus at follow-up examinations. Patients were re-classified as having ET or ET-plus using pre-operative examination videos by two independent movement disorders neurologists blinded to patient characteristics. As a secondary outcome, we evaluated for correlations and potential predictors of treatment response.Results: Twenty-six patients were included: 13 with ET, 13 with ET-plus. There were no significant differences in the change in FTM-B scores between the ET and ET-plus patients at each follow-up examination. None of the included patients developed new symptoms compatible with dystonia, parkinsonism or gait disturbances.Conclusions: Patients with ET-plus had tremor improvement from VIM DBS, with no differences when compared to those with ET, without emergence of postoperative neurological issues. Patients with ET-plus should still be considered good candidates for VIM DBS for treatment of tremor.

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