Basal Ganglia Pathways Associated With Therapeutic Pallidal Deep Brain Stimulation for Tourette Syndrome

Johnson, Kara A.; Duffley, Gordon; Foltynie, Thomas; Hariz, Marwan; Zrinzo, Ludvic; Joyce, Eileen M.; Akram, Harith; Servello, Domenico; Galbiati, Tommaso Francesco; Bona, Alberto; Porta, Mauro; Meng, Fangang; Leentjens, Albert F.G.; Gündüz, Ayşegül; Hu, Wei; Foote, Kelly D.; Okun, Michael S.; Butson, Christopher R.

doi:10.1016/j.bpsc.2020.11.005

Cited by 20 publications

(29 citation statements)

References 86 publications

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“…Second, connectomic studies for DBS strongly depend on the validity of the modelled white matter pathways and how activation hereof is determined which is again subject to relevant limitations. In case of OCD, many studies relied on a similar whole-brain normative connectome and fiber filtering approach based on isotropic electric field models (1,28,(32)(33)(34). More complex biophysical field modeling methods have been developed that may lead to more detailed insights and superior results when predicting clinical effects, in the future (66)(67)(68).…”

Section: Limitations and Methodological Considerationsmentioning

confidence: 99%

“…This tract again graphically matched the pathway identified in ( 29) with a slightly more ventral course and overlap with the originally published tract (29) positively correlated with clinical outcomes to a similar degree -albeit not significantly (figure 3). Lastly, a recent investigation of 28 patients with Tourette Syndrome treated with DBS of the anterior globus pallidus internus (GPi) showed that modulation of the pathway published by ( 29) was a significant predictor of improvement in obsessive and compulsive symptoms in these patients (34). This observation is remarkable since it suggests that DBS for OCD might act via symptom-specific rather than diseasespecific networks.…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

“…While some of the aforementioned studies agreed on the critical role of the same fiber bundle published as a three-dimensional dataset (1,28,29,(32)(33)(34), others revealed seeming heterogeneity about which pathway would be critical to modulate for successful DBS in OCD. Namely, the study by J o u r n a l P r e -p r o o f Liebrand et al suggested that the MFB, connecting the PFC with the ventral tegmental area, would be associated with a beneficial response (26) whereas other studies highlighted streamlines within the ALIC as being critical for OCD-DBS (28,32,42).…”

Section: Anatomical Considerationsmentioning

confidence: 99%

“…ventral and dorsal frontostriatal loops, fronto-midbrain connections) and respective changes in symptom dimensions will further contribute to specific therapeutic outcomes (9). This is reflected by the fact that although a common pathway could be derived from connectomic studies in OCD DBS, there are evidently subjects in which this pathway was not modulated but who still profited from DBS (29,32,34), implying that additional circuits will be relevant to consider. As an example (see supplemental figure S1), DBS for OCD is capable of changing affective states (i.e.…”

Section: Further Pathways and Factors Relevant For Neuromodulation In Ocdmentioning

confidence: 99%

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Connectomic Deep Brain Stimulation for Obsessive-Compulsive Disorder

Baldermann

Schüller

Kohl

et al. 2021

Biological Psychiatry

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Limitations and Methodological Considerationsmentioning

confidence: 99%

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Section: Anatomical Considerationsmentioning

confidence: 99%

Section: Further Pathways and Factors Relevant For Neuromodulation In Ocdmentioning

confidence: 99%

See 2 more Smart Citations

Connectomic Deep Brain Stimulation for Obsessive-Compulsive Disorder

Baldermann

Schüller

Kohl

et al. 2021

Biological Psychiatry

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“…Given its anatomical connections to sensorimotor regions, the modulation of these fibers seem like a probable mechanism of action for pvlGPi DBS (28,32). However, stimulation of projections from pvlGPi to sensorimotor networks was found to correlate negatively or not at all with tic improvement (31,131). The amGPi was previously thought to be a particularly effective target for TS patients with comorbid OCD symptoms, but according to the present results, it may also play an equally important role in tic reduction (30).…”

Section: Interpretation Of Main Findingsmentioning

confidence: 50%

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

et al. 2021

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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.

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European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part IV: deep brain stimulation

Szejko

Worbe

Hartmann

et al. 2021

Eur Child Adolesc Psychiatry

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In 2011 the European Society for the Study of Tourette Syndrome (ESSTS) published its first European clinical guidelines for the treatment of Tourette Syndrome (TS) with part IV on deep brain stimulation (DBS). Here, we present a revised version of these guidelines with updated recommendations based on the current literature covering the last decade as well as a survey among ESSTS experts. Currently, data from the International Tourette DBS Registry and Database, two meta-analyses, and eight randomized controlled trials (RCTs) are available. Interpretation of outcomes is limited by small sample sizes and short follow-up periods. Compared to open uncontrolled case studies, RCTs report less favorable outcomes with conflicting results. This could be related to several different aspects including methodological issues, but also substantial placebo effects. These guidelines, therefore, not only present currently available data from open and controlled studies, but also include expert knowledge. Although the overall database has increased in size since 2011, definite conclusions regarding the efficacy and tolerability of DBS in TS are still open to debate. Therefore, we continue to consider DBS for TS as an experimental treatment that should be used only in carefully selected, severely affected and otherwise treatment-resistant patients.

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Basal Ganglia Pathways Associated With Therapeutic Pallidal Deep Brain Stimulation for Tourette Syndrome

Cited by 20 publications

References 86 publications

Connectomic Deep Brain Stimulation for Obsessive-Compulsive Disorder

Connectomic Deep Brain Stimulation for Obsessive-Compulsive Disorder

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

European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part IV: deep brain stimulation

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