The Need for a Proper Definition of a “Treatment Refractoriness” in Tourette Syndrome

Porta, Mauro; Sassi, Marco; Menghetti, Claudia; Servello, Domenico

doi:10.3389/fnint.2011.00022

Cited by 18 publications

(7 citation statements)

References 26 publications

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“…Although in most cases GTS is "benign" and responds to therapy or spontaneously resolves in adulthood, in some cases, it might have more severe characteristic, causing a severe impact on patients' lives [22]. Despite the severity of this condition, therapeutic options are limited.…”

Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets

et al. 2020

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Gilles de la Tourette syndrome (GTS) is a complex neurodevelopmental disorder characterized by tics and, frequently, psychiatric and behavioral comorbidities. Above all, obsessive compulsive disorder/behavior (OCD/OCB) influences the clinical picture and has a severe impact on quality of life, eventually more than the tics themselves. Deep brain stimulation (DBS) is an effective therapy in selected, refractory cases. Clinical response to DBS may vary according to the clinical picture, comorbidities, and to the anatomical target. This retrospective study compares the results obtained from DBS in the ventralis oralis/centromedian-parascicular nucleus of the thalamus (Voi-Cm/Pf) (41 patients) and antero-medial Globus Pallidus internus (am-GPi) (14 patients), evaluating clinical response over time by means of Yale Global Tic Severity Scale (YGTSS) and Yale–Brown Obsessive-Compulsive Scale (YBOCS) scores over a period of 48 months. A significant and stable improvement in the YGTSS and YBOCS has been obtained in both groups (p < 0.001). There was a significant difference in YBOCS improvement over time between the am-GPi group and the Voi-Cm/Pf group, indicating a better and faster control of OCD/OCB symptoms in the former group. The ratio of hardware removal was 23% and limited to 13 patients in the Voi-Cm/Pf group. These results confirm that DBS is an effective therapy in treating GTS and suggest that the am-GPi might be superior to Voi-Cm/Pf in alleviating comorbid OCD/OCB.

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Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets

et al. 2020

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“…These include the optimal target, the best indications for surgery, the optimal stimulation parameters, the optimal approach to assess social status, and the potential for social reintegration postsurgery. 41,43,44,[56][57][58]…”

Section: Discussionmentioning

confidence: 99%

Lessons Learned from Open-label Deep Brain Stimulation for Tourette Syndrome: Eight Cases over 7 Years

Motlagh

Smith

Landeros-Weisenberger

et al. 2013

Tremor and Other Hyperkinetic Movements

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Background: Deep brain stimulation (DBS) remains an experimental but promising treatment for patients with severe refractory Gilles de la Tourette syndrome (TS). Controversial issues include the selection of patients (age and clinical presentation), the choice of brain targets to obtain optimal patient-specific outcomes, and the risk of surgery-and stimulation-related serious adverse events.Methods: This report describes our open-label experience with eight patients with severe refractory malignant TS treated with DBS. The electrodes were placed in the midline thalamic nuclei or globus pallidus, pars internus, or both. Tics were clinically assessed in all patients pre-and postoperatively using the Modified Rush Video Protocol and the Yale Global Tic Severity Scale (YGTSS).Results: Although three patients had marked postoperative improvement in their tics (.50% improvement on the YGTSS), the majority did not reach this level of clinical improvement. Two patients had to have their DBS leads removed (one because of postoperative infection and another because of lack of benefit).Discussion: Our clinical experience supports the urgent need for more data and refinements in interventions and outcome measurements for severe, malignant, and medication-refractory TS. Because TS is not an etiologically homogenous clinical entity, the inclusion criteria for DBS patients and the choice of brain targets will require more refinement.

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“…A standardized definition of refractoriness to pharmacological treatment of tics in TD (chronic tic disorders including Tourette Syndrome) would aid decisions on drug switch, psychological treatment or access to invasive treatments like functional surgery [2,3]. We conducted a European audit survey in order to: i) explore the main features that would define refractoriness of tics to pharmacological treatment, and ii) assess how consistently these features are taken into account in routine clinical practice.…”

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confidence: 99%

Refractoriness to pharmacological treatment for tics: A multicentre European audit

Macerollo

Martino

Cavanna

et al. 2016

Journal of the Neurological Sciences

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The Need for a Proper Definition of a “Treatment Refractoriness” in Tourette Syndrome

Cited by 18 publications

References 26 publications

Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets

Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets

Lessons Learned from Open-label Deep Brain Stimulation for Tourette Syndrome: Eight Cases over 7 Years

Refractoriness to pharmacological treatment for tics: A multicentre European audit

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