Deep brain stimulation in 18 patients with severe Gilles de la Tourette syndrome refractory to treatment: the surgery and stimulation

Servello, Domenico; Porta, Mauro; Sassi, Marco; Brambilla, Arianna; Robertson, Mary M.

doi:10.1136/jnnp.2006.104067

Cited by 308 publications

(235 citation statements)

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“…136 The Vim nucleus of the thalamus continues to be the primary target for essential tremor, 137 although stimulation near the STN may also improve essential tremor and both STN and GPi DBS improve the tremor associated with PD. 61,138 At least three regions have been targeted for Tourette syndrome, including the centromedian-parafascicular nucleus, 113,139,140 anterior GPi, 113,141,142 and anterior limb of the internal capsule. 143 Given the multiplicity of effective stimulation targets, the question naturally arises whether the therapeutic mechanisms are the same.…”

Section: Why So Many Targets?mentioning

confidence: 99%

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

et al. 2008

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Summary:Chronic electrical stimulation of the brain, known as deep brain stimulation (DBS), has become a preferred surgical treatment for medication-refractory movement disorders. Despite its remarkable clinical success, the therapeutic mechanisms of DBS are still not completely understood, limiting opportunities to improve treatment efficacy and simplify selection of stimulation parameters. This review addresses three questions essential to understanding the mechanisms of DBS. 1) How does DBS affect neuronal tissue in the vicinity of the active electrode or electrodes? 2) How do these changes translate into therapeutic benefit on motor symptoms? 3) How do these effects depend on the particular site of stimulation? Early hypotheses proposed that stimulation inhibited neuronal activity at the site of stimulation, mimicking the outcome of ablative surgeries. Recent studies have challenged that view, suggesting that although somatic activity near the DBS electrode may exhibit substantial inhibition or complex modulation patterns, the output from the stimulated nucleus follows the DBS pulse train by direct axonal excitation. The intrinsic activity is thus replaced by high-frequency activity that is time-locked to the stimulus and more regular in pattern. These changes in firing pattern are thought to prevent transmission of pathologic bursting and oscillatory activity, resulting in the reduction of disease symptoms through compensatory processing of sensorimotor information. Although promising, this theory does not entirely explain why DBS improves motor symptoms at different latencies. Understanding these processes on a physiological level will be critically important if we are to reach the full potential of this powerful tool.

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Section: Why So Many Targets?mentioning

confidence: 99%

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

et al. 2008

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“…The results of double-blind, cross-over (with stimulation on or off) trials involving thalamic stimulation indicate that some patients can achieve substantial benefit [26,27]. However, the best patient selection criteria and the optimal location for the electrodes (thalamus, globus pallidus interna, putamen, subthalamic nucleus and other areas have been used) in TS have not been established [28].…”

Section: Deep Brain Stimulation Surgery For Ticsmentioning

confidence: 99%

Treatment of Tourette Syndrome

Kurlan

2014

Neurotherapeutics

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Tourette's syndrome (TS) consists of chronic motor and phonic tics and characteristically begins in childhood. The tics can be disabling and commonly associated behavioral comorbities such as attention deficit hyperactivity disorder (ADHD) and obsessivecompulsive disorder (OCD), can also cause problems in daily functioning. The underlying etiology and neurobiology of TS remain unknown although genetic factors appear to be important, cortical control of basal ganglia motor function appears to be disturbed and neurochemical abnormalities, particularly involving dopamine neurotransmission, are likely present. The treatment of TS involves appropriate education and support. Tics can be treated with habit reversal cognitive behavioral therapy, medications (most commonly alpha agonists and antipsychotics), local intramuscular injections of botulinum toxin and some severe, refractory cases have responded to deep brain stimulation surgery (DBS). It is important to appropriately diagnose and treat comorbid behavioral disorders that are disrupting function. OCD can be treated with cognitive behavioral therapy, selective serotonin reuptake inhibitors, and atypical antipsychotics. DBS has become a treatment option for patients with disabling OCD despite other therapies. ADHD is treated with appropriate classroom accommodations, behavioral therapy, alpha agonists, atomoxetine or methylphenidate-containing stimulant drugs.

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“…DBS involves inserting microelectrodes into specific regions of the brain and modulating neural activity by applying an electrical current. It was first used to treat movement disorders in Parkinson's disease (Benabid et al, 1993), but is now being investigated to treat intractable psychiatric disorders, such as Tourette's syndrome (Servello, Porta, Sassi, Brambilla, & Robertson, 2008), obsessive compulsive disorder (FDA, 2009;Lipsman, Neimat, & Lozano, 2007), and depression (Schlaepfer et al, 2008).…”

Section: Reconciling Competing Views Of Addictionmentioning

confidence: 99%

Anticipating possible policy uses of addiction neuroscience research

Hall

Carter

2013

Drugs: Education, Prevention and Policy

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Neuroscience research on animals has identified the neurochemical circuitry on which psychoactive drugs of dependence act and produced models of the development of tolerance, elicitation of withdrawal symptoms, and the rapid reinstatement of drug use after abstinence. Human neuroimaging studies have provided support for the hypothesis that similar neurobiological processes are at work in addicted humans. Leading proponents of neurobiological addiction research have argued that it provides strong support for the view that addiction is a chronic brain disease. They also argue that broad acceptance of the model will improve societal attitudes and policies towards addicted persons. We briefly examine the research evidence for the claim that addiction is a chronic relapsing brain disease and discuss the promised advantages of the brain disease model of addiction and the likelihood of their realization. We also discuss the potential costs of social policies advocated on the basis of addiction neuroscience research, namely, advocacy of 'high risk' social policies that are congenial to legal industries that promote the use of addictive commodities; renewed advocacy of legally coerced addiction treatment; and the promotion of research into expensive, high technology, biomedical interventions that aim to treat addiction by directly intervening in 'addicted brains'.

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Deep brain stimulation in 18 patients with severe Gilles de la Tourette syndrome refractory to treatment: the surgery and stimulation

Abstract: DBS is a useful and safe treatment for severe GTS. The results of ours and previous DBS reports suggest that the CM-Pfc and ventralis oralis complex of the thalamus may be a good DBS target for GTS.

Cited by 308 publications

References 33 publications

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

Treatment of Tourette Syndrome

Anticipating possible policy uses of addiction neuroscience research

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