Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome

Martínez-Ramírez, Daniel; Jimenez-Shahed, Joohi; Leckman, James F.; Porta, Mauro; Servello, Domenico; Meng, Fan Gang; Kuhn, Jens; Huys, Daniel; Baldermann, Juan Carlos; Foltynie, Thomas; Hariz, Marwan; Joyce, Eileen M.; Zrinzo, Ludvic; Kefalopoulou, Zinovia; Silburn, Peter A.; Coyne, Terry; Mogilner, Alon Y.; Pourfar, Michael; Khandhar, Suketu M.; Auyeung, Man; Ostrem, Jill L.; Visser‐Vandewalle, Veerle; Welter, Marie Laure; Mallet, Luc; Karachi, Carine; Houeto, Jean Luc; Klassen, Bryan T.; Ackermans, Linda; Kaido, Toshimi; Temel, Yasin; Gross, Robert E.; Walker, Harrison C.; Lozano, Andrés M.; Walter, Benjamin L.; Mari, Zoltán; Anderson, William S.; Changizi, Barbara Kelly; Moro, Elena; Zauber, S. Elizabeth; Schrock, Lauren E.; Zhang, Jian Guo; Hu, Wei; Rizer, Kyle; Monari, Erin H.; Foote, Kelly D.; Malaty, Irene A.; Deeb, Wissam; Gündüz, Ayşegül; Okun, Michael S.

doi:10.1001/jamaneurol.2017.4317

Cited by 206 publications

(52 citation statements)

References 17 publications

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“…Our meta-analysis suggests that DBS may be superior to medication and behavioral therapy at reducing TS symptoms for chronic, adult TS patients. Our mean DBS symptomatic improvement was also in agreement with a recent analysis of aggregate data from the TS registry [21]. DBS may also result in greater improvement over time (Fig.…”

Section: Discussionsupporting

confidence: 91%

Deep Brain Stimulation Results in Greater Symptomatic Improvement in Tourette Syndrome than Conservative Measures: A Meta-Analysis

Mahajan

Purger

Mantovani

et al. 2020

Stereotact Funct Neurosurg

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Introduction: Deep brain stimulation (DBS) has emerged as a safe and effective therapy for refractory Tourette syndrome (TS). Recent studies have identified several neural targets as effective in reducing TS symptoms with DBS, but, to our knowledge, none has compared the effectiveness of DBS with conservative therapy. Methods: A literature review was performed to identify studies investigating adult patient outcomes reported as Yale Global Tic Severity Scale (YGTSS) scores after DBS surgery, pharmacotherapy, and psychotherapy. Data were pooled using a random-effects model of inverse variance-weighted meta-analysis (n = 168 for DBS, n = 131 for medications, and n = 154 for behavioral therapy). Results: DBS resulted in a significantly greater reduction in YGTSS total score (49.9 ± 17.5%) than pharmacotherapy (22.5 ± 15.2%, p = 0.001) or psychotherapy (20.0 ± 11.3%, p < 0.001), with a complication (adverse effect) rate of 0.15/ case, 1.13/case, and 0.60/case, respectively. Conclusion: Our data suggest that adult patients with refractory TS undergoing DBS experience greater symptomatic improvement with surprisingly low morbidity than can be obtained with pharmacotherapy or psychotherapy.

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Section: Discussionsupporting

confidence: 91%

Deep Brain Stimulation Results in Greater Symptomatic Improvement in Tourette Syndrome than Conservative Measures: A Meta-Analysis

Mahajan

Purger

Mantovani

et al. 2020

Stereotact Funct Neurosurg

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“…Our findings on the networks involved in tic suppression and release may also have therapeutic implications. For GTS patients with severe and medically refractory tics, deep brain stimulation (DBS) is considered a therapeutic option and proven effective ( Martinez-Ramirez et al, 2018 ). Based on the phenotype of the most problematic tic a target for stimulation is chosen, which could be the thalamus, globus pallidus, anterior limb of the internal capsule or nucleus accumbens.…”

Section: Discussionmentioning

confidence: 99%

Distinctive tics suppression network in Gilles de la Tourette syndrome distinguished from suppression of natural urges using multimodal imaging

Salm

Meer

Cath

et al. 2018

NeuroImage: Clinical

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Background and objectivesGilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder characterized by tics. A hallmark of GTS is the ability to voluntarily suppress tics. Our aim was to distinguish the neural circuits involved in the voluntary suppression of ocular tics in GTS patients from blink suppression in healthy subjects.MethodsFifteen GTS patients and 22 healthy control subjects were included in a multimodal study using eye-tracker recordings during functional MRI (fMRI). The ability to suppress tics/blinks was compared both on subjective (self-rating) and objective (eye-tracker) performance. For fMRI analysis we used a novel designed performance-adapted block design analysis of tic/blink suppression and release based on eye-tracker monitoring.ResultsWe found that the subjective self-reported ability to suppress tics or blinks showed no significant correlation with objective task performance. In GTS during successful suppression of tics, the dorsal anterior cingulate cortex and associated limbic areas showed increased activation. During successful suppression of eye blinks in healthy subjects, the right ventrolateral prefrontal cortex and supplementary and cingulate motor areas showed increased activation.ConclusionsThese findings demonstrate that GTS patients use a characteristic limbic suppression strategy. In contrast, control subjects use the voluntary sensorimotor circuits and the classical ‘stop’ network to suppress natural urges. The employment of different neural suppression networks provides support for cognitive behavioral therapy in GTS.

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“…These advantages of sEEG combined with the relative low risk profile (Cardinale et al, 2012;Hader et al, 2013;Mullin et al, 2016) associated with the small burr holes (diameter of 1.2 mm) as opposed to the full craniotomy necessary for ECoG, make sEEG a desirable modality for electrophysiological investigations. The leads employed in sEEG and the associated surgery are akin to those used for Deep Brain Stimulation (DBS) procedures, which is widely-used as a treatment for tremors, dystonia and Parkinson's Disease, with more recent application to obsessive-compulsive disorder (Greenberg et al, 2006), Tourette's syndrome (Martinez-Ramirez et al, 2018), and epilepsy (Pycroft et al, 2018). While DBS electrodes are primarily used for electric stimulation of the brain, the demonstrated longterm efficacy of chronic DBS electrodes suggests the possibility of chronic sEEG for BCI applications.…”

Section: Stereotactic Eegmentioning

confidence: 99%

The Potential of Stereotactic-EEG for Brain-Computer Interfaces: Current Progress and Future Directions

2020

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Stereotactic electroencephalogaphy (sEEG) utilizes localized, penetrating depth electrodes to measure electrophysiological brain activity. It is most commonly used in the identification of epileptogenic zones in cases of refractory epilepsy. The implanted electrodes generally provide a sparse sampling of a unique set of brain regions including deeper brain structures such as hippocampus, amygdala and insula that cannot be captured by superficial measurement modalities such as electrocorticography (ECoG). Despite the overlapping clinical application and recent progress in decoding of ECoG for Brain-Computer Interfaces (BCIs), sEEG has thus far received comparatively little attention for BCI decoding. Additionally, the success of the related deep-brain stimulation (DBS) implants bodes well for the potential for chronic sEEG applications. This article provides an overview of sEEG technology, BCI-related research, and prospective future directions of sEEG for long-term BCI applications.

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Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome

Abstract: IMPORTANCECollective evidence has strongly suggested that deep brain stimulation (DBS) is a promising therapy for Tourette syndrome.OBJECTIVE To assess the efficacy and safety of DBS in a multinational cohort of patients with Tourette syndrome.

Cited by 206 publications

References 17 publications

Deep Brain Stimulation Results in Greater Symptomatic Improvement in Tourette Syndrome than Conservative Measures: A Meta-Analysis

Deep Brain Stimulation Results in Greater Symptomatic Improvement in Tourette Syndrome than Conservative Measures: A Meta-Analysis

Distinctive tics suppression network in Gilles de la Tourette syndrome distinguished from suppression of natural urges using multimodal imaging

The Potential of Stereotactic-EEG for Brain-Computer Interfaces: Current Progress and Future Directions

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