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DBS in Tourette syndrome: where are we standing now?

  • Neurology and Preclinical Neurological Studies - Review Article
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Abstract

Deep brain stimulation (DBS) has emerged as an established effective and safe treatment option for a small subset of patients with severe Tourette syndrome (TS) refractory to psychological and pharmacological treatments. Several targets have been implicated in the study of the effects of DBS on TS symptomatology. The targets applied for DBS in TS include the thalamus, the globus pallidus internus, the internal capsule/nucleus accumbens, the globus pallidus externus and the subthalamic nucleus. In the majority of studies there has been a significant clinical benefit on tics. Nevertheless, the best target has not been defined yet. Up until now, only five double blind randomized controlled trials have been carried out worldwide for a total of 32 patients. Thus, the new recommendations for DBS in TS emphasize the importance of standardized recordings of all pre-, intra-, and postoperative data to optimize the registration of patients so that results can be compared. Recent reports have shown that standard continuous DBS for TS patients may not be the most optimal paradigms to pursue. Adaptive stimulation and the use of human–computer interfaces might in the future optimize the results of DBS in TS because of the paroxysmal nature of the disease.

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References

  • Ackermans L, Temel Y, Cath D, van der Linden C, Bruggeman R, Kleijer M et al (2006) Deep brain stimulation in Tourette’s syndrome: two targets? Mov Disord 21:709–713

    Article  PubMed  Google Scholar 

  • Ackermans L, Duits A, van der Linden C, Tijssen M, Schruers K, Temel Y et al (2011) Double blind thalamic stimulation in six patients with refractory Tourette syndrome. Brain 134:832–844

    Article  PubMed  Google Scholar 

  • Bajwa RJ, de Lotbinière AJ, King RA, Jabbari B, Quatrano S, Kunze K et al (2007) Deep brain stimulation in Tourette’s syndrome. Mov Disord 22:1346–1350

    Article  PubMed  Google Scholar 

  • Bloch MH, Leckman JF (2009) Clinical course of Tourette syndrome. J Psychosom Res 67:497–501

    Article  PubMed  PubMed Central  Google Scholar 

  • Flaherty AW, Williams ZM, Amirnovin R, Kasper E, Rauch SL, Cosgrove GR et al (2005) Deep brain stimulation of the internal capsule for the treatment of Tourette syndrome: technical case report. Neurosurgery 57(Suppl):E403

    PubMed  Google Scholar 

  • Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P (2000) An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries. Dev Med Child Neurol 42:436–447

    Article  CAS  PubMed  Google Scholar 

  • Garcia-Rill E, Hyde J, Kezunovic N, Urbano FJ, Petersen E (2015) The physiology of the pedunculopontine nucleus: implications for deep brain stimulation. J Neural Transm 122:225–235

    Article  CAS  PubMed  Google Scholar 

  • Hariz M, Blomstedt P, Zrinzo L (2013) Future of brain stimulation: new targets, new indications, new technology. Mov Disord 28:1784–1792

    Article  PubMed  Google Scholar 

  • Hassler R, Dieckmann G (1970) Stereotaxic treatment of tics and inarticulate cries or coprolalia considered as motor obsessional phenomena in Gilles de la Tourette’s disease. Rev Neurol (Paris) 123:89–100

    CAS  Google Scholar 

  • Houeto JL, Karachi C, Mallet L, Pillon B, Yelnik J, Mesnage V et al (2005) Tourette’s syndrome and deep brain stimulation. J Neurol Neurosurg Psychiatry 76:9992–9995

    Article  Google Scholar 

  • Kefalopoulou Z, Zrinzo L, Jahanshahi M, Candelario J, Milabo C, Beigi M et al (2015) Bilateral globus pallidus stimulation for severe Tourette’s syndrome: a double-blind, randomised crossover trial. Lancet Neurol 14:595–605

    Article  PubMed  Google Scholar 

  • Kezunovic N, Hyde J, Simon C, Urbano FJ, Williams DK, Garcia-Rill E (2012) Gamma band activity in the developing parafascicular nucleus. J Neurophysiol 107:772–784

    Article  CAS  PubMed  Google Scholar 

  • Krämer H, Daniels C (2004) Pioneers of movement disorders: Georges Gilles de la Tourette. J Neural Transm 111:691–701

    Article  PubMed  Google Scholar 

  • Kuhn J, Lenartz D, Mai JK, Huff W, Lee SH, Koulousakis A et al (2007) Deep brain stimulation of the nucleus accumbens and the internal capsule in therapeutically refractory Tourette-syndrome. J Neurol 254:963–965

    Article  PubMed  Google Scholar 

  • Leckman JF, Zhang H, Vitale A, Lahnin F, Lynch K, Bondi C et al (1998) Course of tic severity in Tourette syndrome: the first two decades. Pediatrics 102:14–19

    Article  CAS  PubMed  Google Scholar 

  • Leckman JF, Bloch MH, Scahill L, King RA (2006) Tourette syndrome: the self under siege. J Child Neurol 21:642–649

    Article  PubMed  Google Scholar 

  • Little S, Pogosyan A, Neal S, Zavala B, Zrinzo L, Hariz M et al (2013) Adaptive deep brain stimulation in advanced Parkinson disease. Ann Neurol 74:449–457

    Article  PubMed  PubMed Central  Google Scholar 

  • Little S, Beudel M, Zrinzo L, Foltynie T, Limousin P, Hariz M et al (2015) Bilateral adaptive deep brain stimulation is effective in Parkinson’s disease. J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp-2015-310972

    PubMed  PubMed Central  Google Scholar 

  • Maciunas RJ, Maddux BN, Riley DE, Whitney CM, Schoenberg MR, Ogrocki PJ et al (2007) Prospective randomized double-blind trial of bilateral thalamic deep brain stimulation in adults with Tourette syndrome. J Neurosurg 107:1004–1014

    Article  PubMed  Google Scholar 

  • Maling N, Hashemiyoon R, Foote KD, Okun MS, Sanchez JC (2012) Increased thalamic gamma band activity correlates with symptom relief following deep brain stimulation in humans with Tourette’s syndrome. PLoS One 7:e44215

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Martinez-Torres I, Hariz MI, Zrinzo L, Foltynie T, Limousin P (2009) Improvement of tics after subthalamic nucleus deep brain stimulation. Neurology 72:1787–1789

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mink JW, Walkup J, Frey KA, Como P, Cath D, Delong MR et al (2006) Tourette Syndrome Association, Inc., Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome. Mov Disord 21:1831–1838

    Article  PubMed  Google Scholar 

  • Okun MS, Foote KD, Wu SS, Ward HE, Bowers D, Rodriguez RL et al (2013) A trial of scheduled deep brain stimulation for Tourette syndrome: moving away from continuous deep brain stimulation paradigms. JAMA Neurol 70(1):85–94

    Article  PubMed  Google Scholar 

  • Pierre JM (2005) Extrapyramidal symptoms with atypical antipsychotics: incidence, prevention and management. Drug Saf 28:191–208

    Article  CAS  PubMed  Google Scholar 

  • Robertson MM (2000) Tourette syndrome, associated conditions and the complexities of treatment. Brain 123:425–462

    Article  PubMed  Google Scholar 

  • Robertson MM (2011) Gilles de la Tourette syndrome: the complexities of phenotype and treatment. Br J Hosp Med (Lond) 72:100–107

    Article  Google Scholar 

  • Roessner V, Plessen KJ, Rothenberger A, Ludolph AG, Rizzo R, Skov L et al (2011) European clinical guidelines for Tourette syndrome and other tic disorders. Part II: Pharmacological treatment. Eur Child Adolesc Psychiatry 20:173–196

    Article  PubMed  PubMed Central  Google Scholar 

  • Schrock LE, Mink JW, Woods DW, Porta M, Servello D, Visser-Vandewalle V et al (2015) Tourette syndrome deep brain stimulation: a review and updated recommendations. Mov Disord 30:448–471

    Article  PubMed  Google Scholar 

  • Servello D, Porta M, Sassi M, Brambilla A, Robertson MM (2008) Deep brain stimulation in 18 patients with severe Gilles de la Tourette syndrome refractory to treatment; the surgery and stimulation. J Neurol Neurosurg Psychiatry 79:136–142

    Article  CAS  PubMed  Google Scholar 

  • Shields DC, Cheng ML, Flaherty AW, Gale JT, Eskandar EN (2008) Microelectrode-guided deep brain stimulation for Tourette syndrome: within-subject comparison of different stimulation sites. Stereotact Funct Neurosurg 86:87–91

    Article  PubMed  Google Scholar 

  • Steriade M, McCormick DA, Sejnowski TJ (1993) Thalamocortical oscillations in the sleeping and aroused brain. Science 262:679–685

    Article  CAS  PubMed  Google Scholar 

  • Temel Y, Visser-Vandewalle V (2004) Surgery in Tourette syndrome. Mov Disord 19:3–14

    Article  PubMed  Google Scholar 

  • Temel Y, van Lankveld JJ, Boon P, Spincemaille GH, van der Linden C, Visser-Vandewalle V (2004) Deep brain stimulation of the thalamus can influence penile erection. Int J Impot Res 16:91–94

    Article  CAS  PubMed  Google Scholar 

  • Van der Linden C, Colle H, Vandewalle V, Alessi G, Rijckaert D, De Waele L et al (2002) Successful treatment of tics with bilateral internal pallidum (GPi) stimulation in a 27-year-old male patient with Gilles de la Tourette’s syndrome. Mov Disord 17:S341

    Google Scholar 

  • Vandewalle V, van der Linden C, Groenewegen HJ, Caemaert J (1999) Stereotactic treatment of Gilles de la Tourette syndrome by high frequency stimulation of thalamus. Lancet 353:724

    Article  CAS  PubMed  Google Scholar 

  • Vilela Filho O, Ragazzo PC, Souza JT, Silva D, Oliveira P, Piedimonte F et al (2010) Bilateral GPE-DBS for Tourette syndrome: a double-blind prospective controlled study of seven patients. In: Abstract book of the ASSFN (American Society for Stereotactic and Functional Neurosurgery) 2010 biennial meeting. Bridging the Future of Neurosurgery, New York

  • Visser-Vandewalle V, Temel Y, Boon P, Vreeling F, Colle H, Hoogland G et al (2003) Chronic bilateral thalamic stimulation: a new therapeutic approach in intractable Tourette syndrome. Report of three cases. J Neurosurg 99:1094–1100

    Article  PubMed  Google Scholar 

  • Visser-Vandewalle V, Ackermans L, van der Linden C, Temel Y, Tijssen MA, Schruers KR et al (2006) Deep brain stimulation in Gilles de la Tourette’s syndrome. Neurosurgery 58:E590

    Article  PubMed  Google Scholar 

  • Viswanathan A, Jimenez-Shahed J, Baizabal Carvallo JF, Jankovic J (2012) Deep brain stimulation for Tourette syndrome: target selection. Stereotact Funct Neurosurg 90:213–224

    Article  PubMed  Google Scholar 

  • Welter ML, Mallet L, Houeto JL, Karachi C, Czernecki V, Cornu P et al (2008) Internal pallidal and thalamic stimulation in patients with Tourette syndrome. Arch Neurol 65:952–957

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Stereotactic and Functional Neurosurgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Pablo Andrade & Veerle Visser-Vandewalle

  2. Department of Neurosurgery, University of Cologne, Cologne, Germany

    Pablo Andrade

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  1. Pablo Andrade
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  2. Veerle Visser-Vandewalle
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Correspondence to Veerle Visser-Vandewalle.

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Andrade, P., Visser-Vandewalle, V. DBS in Tourette syndrome: where are we standing now?. J Neural Transm 123, 791–796 (2016). https://doi.org/10.1007/s00702-016-1569-7

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  • DOI: https://doi.org/10.1007/s00702-016-1569-7

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