Main Targets for Deep Brain Stimulation in Tourette Syndrome

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.

Faculty Opinions recommendation of Deep Brain Stimulation of the internal globus pallidus in refractory Tourette Syndrome.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726103215.793546321 ◽

2018 ◽

Author(s):

Luc Mallet

Keyword(s):

Deep Brain Stimulation ◽

Tourette Syndrome ◽

Globus Pallidus ◽

Brain Stimulation ◽

Deep Brain ◽

Stimulation Of

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

Neurosurgery ◽

10.1227/neu.0b013e3182535a00 ◽

2012 ◽

Vol 71 (1) ◽

pp. 173-192 ◽

Cited By ~ 37

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 ◽

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.

Deep Brain Stimulation of the internal globus pallidus in refractory Tourette Syndrome

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2016.01.020 ◽

2016 ◽

Vol 142 ◽

pp. 54-59 ◽

Cited By ~ 21

Author(s):

A.Y.J.M Smeets ◽

A.A Duits ◽

B.R Plantinga ◽

A.F.G Leentjens ◽

M. Oosterloo ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Tourette Syndrome ◽

Globus Pallidus ◽

Brain Stimulation ◽

Deep Brain ◽

Stimulation Of

10 / Anaesthetic considerations in a patient with kernicterus for stereotactic bilateral insertion of deep brain stimulation (DBS) electrodes into internal globus pallidus (GPi) nuclei.

10.26226/morressier.5aeb0ac907b0d6001a79a69e ◽

2018 ◽

Author(s):

Sofia Diaz

Keyword(s):

Deep Brain Stimulation ◽

Globus Pallidus ◽

Brain Stimulation ◽

Mapping efficacious deep brain stimulation for pediatric dystonia

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.7.peds20322 ◽

2021 ◽

pp. 1-11

Author(s):

Ailish Coblentz ◽

Gavin J. B. Elias ◽

Alexandre Boutet ◽

Jurgen Germann ◽

Musleh Algarni ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Clinical Outcome ◽

Brain Stimulation ◽

Pediatric Patients ◽

Rating Scale ◽

Structural Connectivity ◽

Response To Treatment ◽

Probabilistic Map ◽

OBJECTIVEThe objective of this study was to report the authors’ experience with deep brain stimulation (DBS) of the internal globus pallidus (GPi) as a treatment for pediatric dystonia, and to elucidate substrates underlying clinical outcome using state-of-the-art neuroimaging techniques.METHODSA retrospective analysis was conducted in 11 pediatric patients (6 girls and 5 boys, mean age 12 ± 4 years) with medically refractory dystonia who underwent GPi-DBS implantation between June 2009 and September 2017. Using pre- and postoperative MRI, volumes of tissue activated were modeled and weighted by clinical outcome to identify brain regions associated with clinical outcome. Functional and structural networks associated with clinical benefits were also determined using large-scale normative data sets.RESULTSA total of 21 implanted leads were analyzed in 11 patients. The average follow-up duration was 19 ± 20 months (median 5 months). Using a 7-point clinical rating scale, 10 patients showed response to treatment, as defined by scores < 3. The mean improvement in the Burke-Fahn-Marsden Dystonia Rating Scale motor score was 40% ± 23%. The probabilistic map of efficacy showed that the voxel cluster most associated with clinical improvement was located at the posterior aspect of the GPi, comparatively posterior and superior to the coordinates of the classic GPi target. Strong functional and structural connectivity was evident between the probabilistic map and areas such as the precentral and postcentral gyri, parietooccipital cortex, and brainstem.CONCLUSIONSThis study reported on a series of pediatric patients with dystonia in whom GPi-DBS resulted in variable clinical benefit and described a clinically favorable stimulation site for this cohort, as well as its structural and functional connectivity. This information could be valuable for improving surgical planning, simplifying programming, and further informing disease pathophysiology.

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 ◽

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.

Pallidal Deep Brain Stimulation for Primary Dystonia in Children

Neurosurgery ◽

10.1227/neu.0b013e3182077396 ◽

2011 ◽

Vol 68 (3) ◽

pp. 738-743 ◽

Cited By ~ 51

Author(s):

Abilash Haridas ◽

Michele Tagliati ◽

Irene Osborn ◽

Ioannis Isaias ◽

Yakov Gologorsky ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Clinical Improvement ◽

Brain Stimulation ◽

Functional Disability ◽

Rating Scale ◽

Retrospective Chart Review ◽

Consecutive Series ◽

Abstract BACKGROUND: Deep brain stimulation (DBS) at the internal globus pallidus (GPi) has replaced ablative procedures for the treatment of primary generalized dystonia (PGD) because it is adjustable, reversible, and yields robust clinical improvement that appears to be long lasting. OBJECTIVE: To describe the long-term responses to pallidal DBS of a consecutive series of 22 pediatric patients with PGD. METHODS: Retrospective chart review of 22 consecutive PGD patients, ≤21 years of age treated by one DBS team over an 8-year period. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to evaluate symptom severity and functional disability, pre- and post-operatively. Adverse events and medication changes were also noted. RESULTS: The median follow-up was 2 years (range, 1-8 years). All 22 patients reached 1-year follow-up; 14 reached 2 years, and 11 reached 3 years. The BFMDRS motor subscores were improved 84%, 93%, and 94% (median) at these time points. These motor responses were matched by equivalent improvements in function, and the response to DBS resulted in significant reductions in oral and intrathecal medication requirements after 12 and 24 months of stimulation. There were no hemorrhages or neurological complications related to surgery and no adverse effects from stimulation. Significant hardware-related complications were noted, in particular, infection (14%), which delayed clinical improvement. CONCLUSION: Pallidal DBS is a safe and effective treatment for PGD in patients <21 years of age. The improvement appears durable. Improvement in device design should reduce hardware-related complications over time.