Neuropsychiatric Outcome of an Adolescent Who Received Deep Brain Stimulation for Tourette's Syndrome

Pullen, Samuel J.; Wall, Christopher A.; Lee, K. H.; Stead, S. Matt; Klassen, Bryan T.; Brown, Tanya M.

doi:10.1155/2011/209467

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…The incidence of complications associated with DBS generally exceeds 25%, and 4%–6% of these complications are permanent. [ 13 ] In our study, a total of three patients encountered long-term postoperative surgical complications, which correspond to 12.5% of the participant group. The case of mild sexual dysfunction (reduced sexual drive) in one patient requires further investigation.…”

Section: Discussionmentioning

confidence: 86%

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Deep Brain Stimulation of the Globus Pallidus Internus in Patients with Intractable Tourette Syndrome

Zhang

et al. 2016

Chinese Medical Journal

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Background:Deep brain stimulation (DBS) has been a promising treatment for patients with refractory Tourette syndrome (TS) for more than a decade. Despite successful DBS treatment of TS in more than 100 patients worldwide, studies with a large patient sample and long-term follow-up assessments are still scarce. Accordingly, we investigated the clinical efficacy and safety of globus pallidus internus (GPi) DBS in the treatment of intractable TS in 24 patients with a 1-year follow-up assessment.Methods:Bilateral/unilateral GPi-DBS was performed in 24 patients with TS. We evaluated symptoms of tics and obsessive-compulsive disorder (OCD) through the Yale Global Tic Severity Scale (YGTSS) and Yale-Brown Obsessive-compulsive Scale (Y-BOCS). We used the Wechsler Adult Intelligence Scale-Revised in China (WAIS-RC) to evaluate the safety of the treatment. We conducted follow-up assessments of all patients for at least 12 months (12–99 months).Results:Symptoms of tics and OCD were significantly relieved at a 12-month follow-up assessment. The mean YGTSS score was 74.04 ± 11.52, 49.83 ± 10.91, 32.58 ± 7.97, and 31.21 ± 8.87 at baseline, 3, 6, and 12 months, respectively. The mean YGTSS scores obtained at the follow-up assessments were significantly different from the baseline (P < 0.05). The improvement in motor tics was superior to that in phonic tics. The mean Y-BOCS scores were 21.61 ± 4.97, 18 ± 4.58, 14.39 ± 3.99, and 13.78 ± 4.56 at baseline, 3, 6, and 12 months, respectively (P < 0.05). We observed a remarkable improvement in psychiatric comorbidities, such as OCD and attention-deficit hyperactivity disorder, after the procedure. WAIS-RC scores were comparable before and after the operation. There were no severe postoperative complications.Conclusion:GPi-DBS appears to comprehensively alleviate tic symptoms and psychiatric comorbidities in patients with TS, thus significantly improving patients’ quality of life.

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Section: Discussionmentioning

confidence: 86%

“…According to the literature, more than 100 TS patients have been treated with DBS to date. [ 3 6 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 ]…”

Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation of the Globus Pallidus Internus in Patients with Intractable Tourette Syndrome

Zhang

et al. 2016

Chinese Medical Journal

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“…The most common reasons for operating on these young patients were the severity and intractability of the disease, the considerable influence on daily functioning (e.g. not able to go to school or work, avoiding social activities, not able to develop friendships, and low self-esteem), and severe motor tics causing self-injurious behaviour [ 20 – 22 , 34 – 37 , 39 , 41 , 42 ]. None of these reports discussed the ethical aspects of DBS in adolescent patients.…”

Section: Methods and Resultsmentioning

confidence: 99%

Ethics of Deep Brain Stimulation in Adolescent Patients with Refractory Tourette Syndrome: a Systematic Review and Two Case Discussions

et al. 2018

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IntroductionTourette Syndrome (TS) is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation (DBS) may be considered.Methods and ResultsWe discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects.DiscussionSpecific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication.ConclusionClinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals.

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“…Since 1999, reports of DBS for refractory TS have continued to surface, but are sparse, and the procedure is still considered experimental. Based on the developing pathophysiology of TS, 5 DBS targets have been identi-fied: the medial thalamus, 1,2,4,26,33,45,46,[51][52][53]55,60,61 GPi, 9,13-15, 23,36,54,59,62 globus pallidus externus (GPe), 44 anterior limb of the internal capsule (ALIC)/nucleus accumbens (NA), 17,29,41,49,63 and the subthalamic nucleus. 37 While the medial thalamus has been the most widely reported DBS target, there is still much debate over which target provides optimal results.…”

Section: Deep Brain Stimulation Targetsmentioning

confidence: 99%

“…Pullen et al 46 described a 17-year-old patient with worsening intractable TS, OCD, and ADHD, who received bilateral stimulation of CM-Pf complex. The surgery resulted in a significant improvement in tic severity and psychosocial functioning at the 18-month followup.…”

Section: Medial Thalamusmentioning

confidence: 99%

The use of deep brain stimulation in Tourette's syndrome

Rotsides

Mammis²

2013

FOC

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Tourette's syndrome (TS) is a childhood neuropsychiatric disorder characterized by multiple involuntary motor and vocal tics. It is commonly associated with other behavioral disorders including attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, anxiety, depression, and self-injurious behaviors. Tourette's syndrome can be effectively managed with psychobehavioral and pharmacological treatments, and many patients experience an improvement in tics in adulthood. However, symptoms may persist and cause severe impairment in a small subset of patients despite available therapies. In recent years, deep brain stimulation (DBS) has been shown to be a promising treatment option for such patients. Since the advent of its use in 1999, multiple targets have been identified in DBS for TS, including the medial thalamus, globus pallidus internus, globus pallidus externus, anterior limb of the internal capsule/nucleus accumbens, and subthalamic nucleus. While the medial thalamus is the most commonly reported trajectory, the optimal surgical target for TS is still a topic of much debate. This paper provides a review of the available literature regarding the use of DBS for TS.

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Neuropsychiatric Outcome of an Adolescent Who Received Deep Brain Stimulation for Tourette's Syndrome

Cited by 6 publications

References 9 publications

Deep Brain Stimulation of the Globus Pallidus Internus in Patients with Intractable Tourette Syndrome

Deep Brain Stimulation of the Globus Pallidus Internus in Patients with Intractable Tourette Syndrome

Ethics of Deep Brain Stimulation in Adolescent Patients with Refractory Tourette Syndrome: a Systematic Review and Two Case Discussions

The use of deep brain stimulation in Tourette's syndrome

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