Deep brain stimulation of the globus pallidus internus and Gilles de la Tourette syndrome: Toward multiple networks modulation

Abstract

Background:Gilles de la Tourette's syndrome (GTS) is a complex neuropsychiatric disorder characterized by disabling motor and vocal tics. The pathophysiology of GTS remains poorly understood. Conventional treatment consists in pharmacological and behavioral treatment. For patients suffering severe adverse effects or not responding to pharmacological treatment, deep brain stimulation (DBS) presents an alternative treatment. However, the optimal target choice in DBS for GTS remains a divisive issue.Methods:A PubMed search from 1999 to 2012 was conducted. Thirty-three research articles reporting on DBS in patients with GTS were selected and analyzed.Results:Eighty-eight patients with Tourette's syndrome were treated since 1999 with DBS. The majority of patients received thalamic stimulation. Significantly fewer patients were treated with globus pallidus internus stimulation. Occasionally, the anterior limb of the internal capsule and the nucleus accumbens were implanted. The subthalamic nucleus was selected once. All targets were reported with positive results, but of variable extent. Only 14 patients exhibited level 1 evidence.Conclusion:In light of the wide spectrum of associated behavioral co-morbidities in GTS, multiple networks modulation may result in the most efficacious treatment strategy. The optimal locations for DBS within the cortico-basal ganglia-thalamocortical circuits remain to be established. However, at the current stage, comparison between targets should be done with great caution. Significant disparity between number of patients treated per target, methodological variability, and quality of reporting renders a meaningful comparison between targets difficult. Randomized controlled trials with larger cohorts and standardization of procedures are urgently needed.

Temporary deep brain stimulation in Gilles de la Tourette syndrome: A feasible approach?

“…[ 1 ] For 41 GTS patients treated since 1999 with thalamic DBS a significant mean YGTSS decrease of 58% (standard deviation [SD] =15) was reported. [ 9 ] Several guidelines have been published for DBS in GTS. One of the main decisive topics in these guidelines is the age of inclusion.…”

Efficacy of deep brain stimulation of the anterior-medial globus pallidus internus in tic and non-tic related symptomatology in refractory Tourette syndrome

“…Macroelectrode stimulation (MES) was performed 4 mm above, 2 mm above and at target to check for side-effects within the therapeutic range up to the supramaximal level (0–5 mA; 60 μsec and 130 Hz). A passive tip lead with four electrodes (3389 model [15] ; Medtronic, Minneapolis, MN, USA) was implanted under intra-operative fluoroscopy guidance and after verification, a burr hole cover functioning as a lead locking device was affixed. Post-operative CT fused with the pre-operative MRI for audit of lead location was done in patients 1–4.…”

Effectiveness of deep brain stimulation on refractory aggression in pediatric patients with autism and severe intellectual disability: meta-analytic review

“…It seems that the application of DBS in both records was used as a last therapeutic measure to relieve the disabling stereotypies. What is certain is that the results of stimulation in GPi and ALIC have yielded variable results (120,121).…”