Exploring the clinical outcomes after deep brain stimulation in Tourette syndrome

Brito, Manuelina; Teixeira, Manoel Jacobsen; Mendes, Matheus Miranda; França, Carina; Iglesio, Ricardo; Barbosa, Egberto Reis; Cury, Rubens Gisbert

doi:10.1016/j.jns.2019.05.011

Cited by 21 publications

(20 citation statements)

References 13 publications

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“…Comparable clinical results have been reported in up to four different targets within the CM thalamic region [12], however anatomical differences between these nuclei should be taken into consideration. A recent study with a similar setting, in this case targeting the CM-Pf (parafascicular) region, showed a high variability between the clinical outcome and the connectivity [38]. In this report, the cortical projections associated with better clinical responses were the right frontal middle gyrus, the left frontal superior sulci region and the left cingulate sulci region.…”

Section: Discussionsupporting

confidence: 50%

Modulation of Fibers to Motor Cortex during Thalamic DBS in Tourette Patients Correlates with Tic Reduction

et al. 2020

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Probabilistic tractography in Tourette syndrome (TS) patients have shown an alteration in the connectivity of the primary motor cortex and supplementary motor area with the striatum and thalamus, suggesting an abnormal connectivity of the cortico-striatum-thalamocortical-pathways in TS. Deep brain stimulation (DBS) of the centromedian nucleus–nucleus ventrooralis internus (CM-Voi complex) in the thalamus is an effective treatment for refractory TS patients. We investigated the connectivity of activated fibers from CM-Voi to the motor cortex and its correlation between these projections and their clinical outcome. Seven patients with TS underwent CM-Voi-DBS surgery and were clinically evaluated preoperatively and six months postoperatively. We performed diffusion tensor imaging to display the activated fibers projecting from the CM-Voi to the different motor cortex regions of interest. These analyses showed that the extent of tic reduction during DBS is associated with the degree of stimulation-dependent connectivity between CM-Voi and the motor cortex, and in particular, an increased density of projections to the presupplementary motor area (preSMA). Non-responder patients displayed the largest amount of active fibers projecting into cortical areas other than motor cortex compared to responder patients. These findings support the notion that an abnormal connectivity of thalamocortical pathways underlies TS, and that modulation of these circuits through DBS could restore the function and reduce symptoms.

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Section: Discussionsupporting

confidence: 50%

Modulation of Fibers to Motor Cortex during Thalamic DBS in Tourette Patients Correlates with Tic Reduction

et al. 2020

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“…A common target for deep brain stimulation in Tourette patients is the thalamic centromedian-parafascicular (CM-Pf) region (Mink, 2006; Britoa et al, 2019). According to our approach, the thalamus is a critical element of the shortcut, and indeed Tourette patients had increased basal ganglia-cortical and thalamo-cortical connectivity in a recent fMRI study (Ramkiran et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Enhanced habit formation in Tourette syndrome: dopamine release and striatal disinhibition modulate shortcut connections in a hierarchical model of cortico-basal ganglia loops

Scholl

Baladron

Vitay

et al. 2021

Preprint

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In the Gilles de la Tourette syndrome, tics are often considered as habitual responses towards unwanted premonitory urges. Support for the relationship between tics and habits comes from devaluation protocols, which reveal that unmedicated Tourette patients show an increased tendency towards responses to devalued outcomes. We use a neuro-computational model of hierarchically organized cortico-basal ganglia-thalamo-cortical loops to shed more light on enhanced habit formation of Tourette patients. In our model, habitual behavior emerges from cortico-thalamic shortcut connections, where enhanced habit formation can be linked to faster plasticity in the shortcut or to a stronger feedback from the shortcut to the basal ganglia. Abnormal activity in such shortcut connections may have different pathophysiological origins. Based on our model, we explore decreased local striatal inhibition, which may correspond to a loss of inhibitory interneurons, and increased dopaminergic modulation of striatal medium spiny neurons as causes for abnormal shortcut plasticity or activation. Both lead to higher rates of response towards devalued outcomes in our model, similar to what is observed in Tourette patients. Our results support the view of tics in Tourette syndrome as maladaptive habits. We suggest to reveal more shortcuts between cortico-basal ganglia-thalamo-cortical loops in the human brain and study their potential role in the development of the Tourette syndrome.

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“…The functional profile was defined in terms of connection between the volumes of tissue activated (VTAs) of the active DBS contact and the cortical areas. The results showed that responders had VTAs that were closely linked to the right frontal middle gyrus, the left frontal superior sulci region, and the left cingulate sulci region, whereas poor responders had VTAs that were only loosely related to these regions [94]. Although this study was limited by small sample size (n = 5 patients), the results indicate that the assessment of VTA-based functional connectivity profiles could help in predicting the patient's clinical response to CM-Pf DBS.…”

Section: Functional Connectivity Profilesmentioning

confidence: 98%

“…In another study, the functional connectivity profile of TS patients who showed a good clinical response to CM-Pf DBS were compared with that of patients who displayed a poor clinical response [94]. The functional profile was defined in terms of connection between the volumes of tissue activated (VTAs) of the active DBS contact and the cortical areas.…”

Section: Functional Connectivity Profilesmentioning

confidence: 99%

Deep brain stimulation for Tourette’s syndrome

Zhang

Deeb

et al. 2020

Transl Neurodegener

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Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder characterized by the presence of multiple motor and vocal tics. TS usually co-occurs with one or multiple psychiatric disorders. Although behavioral and pharmacological treatments for TS are available, some patients do not respond to the available treatments. For these patients, TS is a severe, chronic, and disabling disorder. In recent years, deep brain stimulation (DBS) of basal ganglia-thalamocortical networks has emerged as a promising intervention for refractory TS with or without psychiatric comorbidities. Three major challenges need to be addressed to move the field of DBS treatment for TS forward: (1) patient and DBS target selection, (2) ethical concerns with treating pediatric patients, and (3) DBS treatment optimization and improvement of individual patient outcomes (motor and phonic tics, as well as functioning and quality of life). The Tourette Association of America and the American Academy of Neurology have recently released their recommendations regarding surgical treatment for refractory TS. Here, we describe the challenges, advancements, and promises of the use of DBS in the treatment of TS. We summarize the results of clinical studies and discuss the ethical issues involved in treating pediatric patients. Our aim is to provide a better understanding of the feasibility, safety, selection process, and clinical effectiveness of DBS treatment for select cases of severe and medically intractable TS.

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Exploring the clinical outcomes after deep brain stimulation in Tourette syndrome

Cited by 21 publications

References 13 publications

Modulation of Fibers to Motor Cortex during Thalamic DBS in Tourette Patients Correlates with Tic Reduction

Modulation of Fibers to Motor Cortex during Thalamic DBS in Tourette Patients Correlates with Tic Reduction

Enhanced habit formation in Tourette syndrome: dopamine release and striatal disinhibition modulate shortcut connections in a hierarchical model of cortico-basal ganglia loops

Deep brain stimulation for Tourette’s syndrome

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