Evidence for the role of the dorsal ventral lateral posterior thalamic nucleus connectivity in deep brain stimulation for Gilles de la Tourette syndrome

Kakusa, Bina; Saluja, Sabir; Barbosa, Daniel A. N.; Cartmell, Sam; Espil, Flint M.; Williams, Nolan; McNab, Jennifer A.; Halpern, Casey H.

doi:10.1016/j.jpsychires.2020.09.024

Cited by 9 publications

(6 citation statements)

References 41 publications

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“…Previous studies reported that the sweet spot could be the anterior border of the CM nucleus and the medial area of the ventral lateral nucleus as the optimal stimulation area in other studies. 2,6,28 This study further supports this possibility. Furthermore, the normative connectome associated with the microlesion effect has components common to the connectome associated with the volume of tissue activated (VTA) of the therapeutic stimulation area; therefore, we consider that the presumed microlesion area in this study may include the sweet spot.…”

Section: Stereotactic Precision and Connectome Imagessupporting

confidence: 84%

Precision Mapping of Thalamic Deep Brain Stimulation Lead Positions Associated With the Microlesion Effect in Tourette Syndrome

et al. 2023

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BACKGROUND: The microlesion effect refers to the improvement of clinical symptoms after deep brain stimulation (DBS) lead placement and is suggested to indicate optimal lead placement. Very few studies have reported its implications in neuropsychiatric disorders. OBJECTIVE: To evaluate the magnitude of the microlesion effect in Tourette syndrome and the relationship between the microlesion effect and the anatomic location of implanted DBS leads. METHODS: Six male patients were included. Their median age at surgery and follow-up period were 25 years (range, 18-47) and 12 months (range, 6-24), respectively. All patients were videotaped pre- and postoperatively, and tic frequencies were counted. We also analyzed the precision of lead placement and evaluated the normative connectome associated with the microlesion area. RESULTS: The microlesion effect was observed as an improvement in tic symptoms in all patients, and the long-term clinical outcomes were favorable. The median motor tic frequency was 20.2 tics/min (range, 9.7-60) at baseline and decreased to 3.2 tics/min (1.2-11.3) in patients on postoperative day 1 (P = .043) and to 5.7 tics/min (range, 1.9-16.6) in patients on postoperative day 7 (P = .028). Phonic tic tended to improve immediately after surgery although the changes were not significant. Image analyses revealed that the precise position of the electrode was directed toward the anteromedial centromedian nucleus. Normative connectome analysis demonstrated connections between improvement-related areas and wide areas of the prefrontal cortex. CONCLUSION: This study shows that the microlesion effect may seem as an immediate improvement after optimal DBS lead placement in patients with Tourette syndrome.

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Section: Stereotactic Precision and Connectome Imagessupporting

confidence: 84%

Precision Mapping of Thalamic Deep Brain Stimulation Lead Positions Associated With the Microlesion Effect in Tourette Syndrome

et al. 2023

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“…Whether the GPi and thalamic nuclei form an interconnected common network in terms of a network-modulation involved in symptom improvement of TS is currently under investigation. From preliminary experimental studies a new approach has been suggested by selecting individual targets based on the identification of patterns of connectivity [ 38 , 71 , 125 ].…”

Section: Review Of the Literature (Based On Search Of Studies On Dbs ...mentioning

confidence: 99%

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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“…The microlesion effect may even persist 6 months after surgery 8,9 and, in some cases, symptoms may be completely abolished without stimulation. 24 The long-lasting microlesion effect may partly explain why the tic frequency in the off-DBS condition in our cases was lower than the baseline level even after 24 h of stimulation washout (Figure 2), although it is possible that neuroplasticity may have been induced by chronic electrical stimulation.…”

Section: Discussionmentioning

confidence: 77%

Precision Mapping of Thalamic Deep Brain Stimulation Lead Positions Associated with the Microlesion Effect in Tourette Syndrome

Morishita

Iida

Yoshimura

et al. 2022

Preprint

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Objectives: The microlesion effect is refers to the improvement of clinical symptoms after deep brain stimulation (DBS) lead placement and is suggested to indicate optimal lead placement. This phenomenon is well known for movement disorders, such as essential tremors and Parkinson disease, but very few studies have reported its implications in neuropsychiatric disorders. Our aim was to evaluate the magnitude of the microlesion effect in Tourette syndrome (TS) and the relationship between the microlesion effect and the anatomical location of implanted DBS leads. Methods: This study included 6 consecutive patients who underwent DBS for severe TS. All patients were male and their mean age was 28.5 years. All patients were videotaped at baseline and on postoperative day (POD) 7, and motor and phonic tic frequencies were recorded. We also analyzed the precision of lead placement in normalized brain space and evaluated the normative connectome associated with precise electrode positions for improvement of tics. Results: The microlesion effect was observed as an improvement in tic symptoms in all patients. The median motor tic frequency was 20.2 tics/min (range, 9.7-60) at baseline and decreased to 3.2 tics/min (1.2-11.3) on POD 1 (z = -2.20, p = 0.028) and 5.7 tics/min (range, 1.9-16.6) on POD 7 (z = -2.20, p = 0.028). The median phonic tic frequency was 10.5 tics/min (range, 2.0-58.7) at baseline and decreased to 0.7 tics/min (range, 0-14.4) on POD 1 (z = -1.78, p = 0.075) and 2.25 tics/min (range, 1.3-13.7) on POD 7 (z = -1.57, p = 0.116). Image analyses revealed that the precise position of the electrode was directed toward the anteromedial centromedian nucleus. Normative connectome analysis demonstrated connections between improvement-related areas and wide areas of the prefrontal cortex. Conclusion: This study shows that the microlesion effect may appear as an immediate improvement following DBS lead placement even in patients with TS. Our results support the existence of a sweet spot for tic suppression in patients with severe TS, and clinicians should pay attention to this phenomenon in the postoperative evaluation of the lead position.

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Evidence for the role of the dorsal ventral lateral posterior thalamic nucleus connectivity in deep brain stimulation for Gilles de la Tourette syndrome

Cited by 9 publications

References 41 publications

Precision Mapping of Thalamic Deep Brain Stimulation Lead Positions Associated With the Microlesion Effect in Tourette Syndrome

Precision Mapping of Thalamic Deep Brain Stimulation Lead Positions Associated With the Microlesion Effect in Tourette Syndrome

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

Precision Mapping of Thalamic Deep Brain Stimulation Lead Positions Associated with the Microlesion Effect in Tourette Syndrome

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