Robust clinical benefit of multi-target deep brain stimulation for treatment of Gilles de la Tourette syndrome and its comorbidities

Kakusa, Bina; Saluja, Sabir; Tate, William J.; Espil, Flint M.; Halpern, Casey H.; Williams, Nolan

doi:10.1016/j.brs.2019.02.026

Cited by 20 publications

(7 citation statements)

References 9 publications

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“…DBS modulates several networks that underlie tic and obsessivecompulsive behaviors, as well as mood and cognition; thus, it is likely that alleviating one aspect of impairment will have complimentary effects on other aspects. Indeed, several TS patients with comorbid OCD/obsessive-compulsive behavior achieved suppression of both conditions from DBS targeted for TS [202,203,209,211,213,215,219].…”

Section: Other Clinical Management Considerationsmentioning

confidence: 99%

Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review

et al. 2021

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Invasive and noninvasive neurostimulation therapies for obsessive-compulsive and related disorders (OCRD) were systematically reviewed with the aim of assessing clinical characteristics, methodologies, neuroanatomical substrates, and varied stimulation parameters. Previous reviews have focused on a narrow scope, statistical rather than clinical significance, grouped together heterogenous protocols, and proposed inconclusive outcomes and directions. Herein, a comprehensive and transdiagnostic evaluation of all clinically relevant determinants is presented with translational clinical recommendations and novel response rates. Electroconvulsive therapy (ECT) studies were limited in number and quality but demonstrated greater efficacy than previously identified. Targeting the pre-SMA/SMA is recommended for transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). TMS yielded superior outcomes, although polarity findings were conflicting, and refinement of frontal/cognitive control protocols may optimize outcomes. For both techniques, standardization of polarity, more treatment sessions (>20), and targeting multiple structures are encouraged. A deep brain stimulation (DBS) ‘sweet spot’ of the striatum for OCD was proposed, and CBT is strongly encouraged. Tourette’s patients showed less variance and reliance on treatment optimization. Several DBS targets achieved consistent, rapid, and sustained clinical response. Analysis of fiber connectivity, as opposed to precise neural regions, should be implemented for target selection. Standardization of protocols is necessary to achieve translational outcomes.

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Section: Other Clinical Management Considerationsmentioning

confidence: 99%

Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review

et al. 2021

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“…Nonetheless, variation in efficacy may exist within investigations targeting the NAc and ventral striatum overall, as the location of anatomical subregions remains controversial in humans (44). Importantly, both the NAc and hypothalamus may be useful targets, and one trial is investigating dual targeting of both regions (NCT03650309), as multitarget DBS has been efficacious for other disorders (45).…”

Section: Ta B L E 1 Adverse Event/complication Incidences and Utilitiesmentioning

confidence: 99%

Can responsive deep brain stimulation be a cost‐effective treatment for severe obesity?

Mahajan

Ojukwu

Azagury

et al. 2022

Obesity

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The global obesity epidemic has an undeniably high economic burden, with its associated annual medical spending in the US alone totaling $150 billion in 2010 (1). The financial cost per patient with obesity is similarly high in other nations, including in low-and middle-income countries (2). At the turn of the 21st century, obesity accounted for up to 3% of a country's total health expenditures (3). In the years following, both the global prevalence of obesity and disease burden related to high BMI have steadily increased within every sociodemographic quintile (4). Most recently, the societal safety measures imposed during the COVID-19 pandemic will likely have long-term negative effects on the obesity epidemic (5).Notably, the relationship between BMI and health care costs is nonlinear, i.e., health care costs rise exponentially for the few individuals with the most severe obesity (6). Indeed, the 10% of the population of individuals with overweight/obesity with the highest BMI account for more than 60% of the global disease burden related to obesity (7). Therefore, it becomes critical to identify, examine, and provide cost-effective treatments for individuals with severe obesity. Bariatric surgery is an established treatment for severe obesity, shown to be cost-effective in the US (8), Europe (9), Asia (10), South America (11), and Australia (12). However, in patients with severe

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“…Specifically, the global severity of YGTSS was decreased by 46% three months after the second surgery compared with that at baseline [ 28 ]. Furthermore, results from a study conducted by Kakusa B et al revealed that bilateral, dual-target DBS to the CM and ventral capsule/ventral striatum (VC/VS) effectively treated motor and non-motor complications of severe, intractable TS and its comorbidities, including OCD, major depressive disorder, chronic pain, and substance abuse [ 29 ]. Case studies regarding NAc stimulation with or without ALIC involvement have also been reported.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Surgery for Treating Intractable Tourette Syndrome: A Single-Center Pilot Study

Wang

et al. 2022

Brain Sciences

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To evaluate the potential effect of radiofrequency ablation and deep brain stimulation in patients with treatment-refractory Tourette syndrome (TS), this study enrolled thirteen patients with TS who were admitted to our hospital between August 2002 and September 2018. Four patients received a single- or multi-target radiofrequency ablation after local, potentiated, or general anesthesia; eight patients underwent deep brain stimulation (DBS) surgery; and one patient underwent both ablation and DBS surgery. The severity of tics and obsessive compulsive disorder symptoms and the quality of life were evaluated using the Yale Global Tic Severity Scale (YGTSS), Yale–Brown Obsessive Compulsive Scale (YBOCS), and Gilles de la Tourette Syndrome Quality of Life scale (GTS-QOL), respectively, before surgery, one month after surgery, and at the final follow-up after surgery, which was conducted in December 2018. A paired-sample t test and a multiple linear regression analysis were performed to analyze the data. All patients underwent the operation successfully without any severe complications. Overall, the YGTSS total scores at one month post-surgery (44.1 ± 22.3) and at the final visit (35.1 ± 23.7) were significantly decreased compared with those at baseline (75.1 ± 6.2; both p < 0.05). Additionally, the YBOCS scores at one month post-surgery (16.5 ± 10.1) and at the final visit (12.0 ± 9.5) were significantly decreased compared with those at baseline (22.5 ± 13.1; both p < 0.05). Furthermore, the GTS-QOL scores at one month post-surgery (44.0 ± 12.8) and at the final visit (31.0 ± 17.8) were significantly decreased compared with those at baseline (58.4 ± 14.2; both p < 0.05). Results from a multiple linear regression analysis revealed that the improvement in the YGTSS total score was independently associated with the improvement in the GTS-QOL score at one month post-surgery (standardized β = 0.716, p = 0.023) and at the final visit (standardized β = 1.064, p = 0.000). Conversely, changes in YBOCS scores did not correlate with changes in GTS-QOL scores (p > 0.05). Our results demonstrate that tics, psychiatric symptoms, and the quality of life in patients with intractable TS may be relieved by stereotactic ablation surgery and deep brain stimulation. Furthermore, it appears that the improvement in tics contributes more to the post-operative quality of life of patients than does the improvement in obsessive compulsive symptoms.

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Robust clinical benefit of multi-target deep brain stimulation for treatment of Gilles de la Tourette syndrome and its comorbidities

Cited by 20 publications

References 9 publications

Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review

Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review

Can responsive deep brain stimulation be a cost‐effective treatment for severe obesity?

Stereotactic Surgery for Treating Intractable Tourette Syndrome: A Single-Center Pilot Study

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