Therapy‐refractory tourette syndrome: Beneficial outcome with globus pallidus internus deep brain stimulation

Dehning, Sandra; Mehrkens, Jan-Hinnerk; Müller, Norbert; Bötzel, Kai

doi:10.1002/mds.21930

Cited by 104 publications

(64 citation statements)

References 15 publications

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“…A case report detailing the 47% reduction in YGTSS associated with stimulation at the GPi for TS was published in 2005. 55 Multiple case reports 50,56,59,79,258 and small case series 49,185 followed, with the largest series reporting a mean decrease in YGTSS of 50%. 39 The only Class III evidence supporting use of GPi in TS comes from 2 single-subject, blinded cross-over trials comparing stimulation at the CM-PF to that of the GPi in patients implanted at both sites.…”

Section: Globus Pallidusmentioning

confidence: 99%

Deep brain stimulation for psychiatric disorders: where we are now

Cleary

Ozpinar

Raslan

et al. 2015

FOC

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Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned. Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry. This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.

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Section: Globus Pallidusmentioning

confidence: 99%

Deep brain stimulation for psychiatric disorders: where we are now

Cleary

Ozpinar

Raslan

et al. 2015

FOC

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“…Typically, the therapy is used for conditions, such as Parkinson's disease and dystonia (Krauss et al, 1999;Starr et al, 2004;Rodriguez-Oroz et al, 2005;Bronstein et al, 2011), yet recently it has also been tried experimentally for treating BG-mediated hyperkinetic motor disorders, such as motor tics and Tourette syndrome (TS) (Vandewalle et al, 1999;van der Linden et al, 2002;Houeto et al, 2005;Shahed et al, 2007;Dehning et al, 2008;Dueck et al, 2009;MartinezTorres et al, 2009;Welter et al, 2010;Azoulay-Zyss et al, 2011;Martinez-Fernandez et al, 2011;Piedimonte et al, 2012). The emerging clinical data with respect to HF-DBS for TS is also supported by positive responses to stimulation in animal models of tourettism McCairn et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation Reduces Tic-Related Neural Activity via Temporal Locking with Stimulus Pulses

2013

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A neurosurgical intervention that has shown potential for treating basal ganglia (BG) mediated motor tics involves high-frequency deep brain stimulation (HF-DBS) targeted to the output nucleus of the BG: the globus pallidus internus (GPi). This study used a nonhuman primate (Macaca fuscata) model of BG-meditated motor tics, and investigated the short-term neuronal mechanism that might underlie the beneficial effects of GPi-HF-DBS. In parallel with behavioral tic expressions, phasic alterations of neuronal activity emerged in the pallidum following focal disinhibition of the striatum with bicuculline. We delivered HF-DBS in the GPi in such a way that on-stimulation and off-stimulation conditions alternated every 30 s. Analysis of electromyographic (EMG) records showed that during on-stimulation, there were significant reductions in tic-related EMG amplitude. Analysis of pallidal activity showed that GPi-HF-DBS induced both sustained and transient patterns of excitation and inhibition in both segments of the GP. Population-scale firing rates were initially raised relative to baseline, but were not significantly different by the time stimulation ceased. Modulation of behavior and neuronal firing rates were associated with the reduction of tic-related phasic activity in pallidal cells. Examination of short-latency responses showed that firing rate changes were strongly associated with locking of the cells' activity with the HF-DBS pulse. This temporal locking often induced multiphasic changes of firing rates in individual cells, which dynamically changed across the stimulation period. These results support clinical studies that reported success in treating motor tics with GPi-HF-DBS, and demonstrate that the underlying local mechanism within the GP is suppression of tic-related activity through temporal locking with the stimulation pulse.

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“…Multiple targets have been successful on a case-by-case basis, with the largest number of patients treated with bilateral implantation in the centromedian-parafascicular complex and ventralis oralis of the thalamus. 21 Other DBS targets, including the internal segment of the globus pallidus, 5,6,16 anterior limb of the internal capsule, 7,14 and nucleus accumbens, 14,17 have demonstrated a successful reduction in tic severity and comorbid obsessive-compulsive symptoms, a common clinical finding in patients with TS. 15 A reported case of TS with severe comorbid OCD and self-mutilation responded dramatically to DBS in the nucleus accumbens.…”

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confidence: 99%

Deep brain stimulation for the obsessive-compulsive and Tourette-like symptoms of Kleefstra syndrome

Segar

Chodakiewitz

Torabi

et al. 2015

FOC

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Deep brain stimulation (DBS) has been reported to have beneficial effects in severe, treatment-refractory cases of obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). In this report, the authors present the first case in which DBS was used to treat the neuropsychiatric symptoms of Kleefstra syndrome, a rare genetic disorder characterized by childhood hypotonia, intellectual disability, distinctive facial features, and myriad psychiatric and behavioral disturbances. A 24-year-old female patient with childhood hypotonia, developmental delay, and diagnoses of autism spectrum disorder, OCD, and TS refractory to medical management underwent the placement of bilateral ventral capsule/ventral striatum (VC/VS) DBS leads, with clinical improvement. Medical providers and family observed gradual and progressive improvement in the patient's compulsive behaviors, coprolalia, speech, and social interaction. Symptoms recurred when both DBS electrodes failed because of lead fracture and dislodgement, although the clinical benefits were restored by lead replacement. The symptomatic and functional improvements observed in this case of VC/VS DBS for Kleefstra syndrome suggest a novel indication for DBS worthy of further investigation.

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Therapy‐refractory tourette syndrome: Beneficial outcome with globus pallidus internus deep brain stimulation

Abstract: We report on a female patient with Tourette syndrome and a 12-month follow-up after chronic deep brain stimulation in the globus pallidus internus which resulted in excellent remission of motor and vocal tics.

Cited by 104 publications

References 15 publications

Deep brain stimulation for psychiatric disorders: where we are now

Deep brain stimulation for psychiatric disorders: where we are now

Deep Brain Stimulation Reduces Tic-Related Neural Activity via Temporal Locking with Stimulus Pulses

Deep brain stimulation for the obsessive-compulsive and Tourette-like symptoms of Kleefstra syndrome

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