Selection of Patients with Tourette Syndrome for Deep Brain Stimulation Surgery (original) (raw)
Related papers
Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome
Movement Disorders, 2006
In response to recent publicity regarding the potential use of deep brain stimulation (DBS) for reducing tic severity in Tourette's syndrome (TS), the Tourette Syndrome Association convened a group of TS and DBS experts to develop recommendations to guide the early use and potential clinical trials of DBS for TS and other tic disorders. The goals of these recommendations are to ensure that all surgical candidates are (1) fully informed about the risks, benefits, and alternative treatments available; (2) receive a comprehensive evaluation before surgery to ensure that DBS is clearly the appropriate clinical treatment choice; and (3) that early clinical experience will be documented publicly to facilitate rational decisionmaking for both clinical care and future clinical trials.
British Journal of Neurosurgery, 2011
Deep brain stimulation (DBS) is an emerging therapeutic option for severe, treatment-resistant Tourette Syndrome (TS), with about 40 cases reported in the scientific literature over the last decade. Despite the production of clinical guidelines for this procedure from both European and USA centres, a number of unresolved issues still persist, mainly in relation to eligibility criteria and brain targets. The present article illustrates the UK perspective on DBS in TS and proposes consensusbased recommendations for double-blind controlled trials.
The 5 Pillars in Tourette Syndrome Deep Brain Stimulation Patient Selection
Neurology, 2021
The selection of patients with Tourette syndrome (TS) for deep brain stimulation (DBS) surgery rests on 5 fundamental pillars. However, the operationalization of the multidisciplinary screening process to evaluate these pillars remains highly diverse, especially across sites. High tic severity and tic-related impact on quality of life (first 2 pillars) require confirmation from objective, validated measures, but malignant features of TS should per se suffice to fulfill this pillar. Failure of behavioral and pharmacologic therapies (third pillar) should be assessed taking into account refractoriness through objective and subjective measures supporting lack of efficacy of all interventions of proven efficacy, as well as true lack of tolerability, adherence, or access. Educational interventions and use of remote delivery formats (for behavioral therapies) play a role in preventing misjudgment of treatment failure. Stability of comorbid psychiatric disorders for 6 months (fourth pillar)...
Tourette syndrome deep brain stimulation: A review and updated recommendations
Movement disorders : official journal of the Movement Disorder Society, 2014
Deep brain stimulation (DBS) may improve disabling tics in severely affected medication and behaviorally resistant Tourette syndrome (TS). Here we review all reported cases of TS DBS and provide updated recommendations for selection, assessment, and management of potential TS DBS cases based on the literature and implantation experience. Candidates should have a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) diagnosis of TS with severe motor and vocal tics, which despite exhaustive medical and behavioral treatment trials result in significant impairment. Deep brain stimulation should be offered to patients only by experienced DBS centers after evaluation by a multidisciplinary team. Rigorous preoperative and postoperative outcome measures of tics and associated comorbidities should be used. Tics and comorbid neuropsychiatric conditions should be optimally treated per current expert standards, and tics should be the major cause of disability. Psychogenic...
Issues Related to Deep Brain Stimulation for Treatment-Refractory Tourette’s Syndrome
European Neurology, 2009
plex pre-, peri-and postoperative issues. Future studies should include establishment of consistent inclusion criteria and specific practical requirements for clinical trials, evaluation of the impact of DBS on non-tic symptoms and their influence on outcome, social impairment and quality of life, and the identification of optimum neurophysiologically based DBS targets for improved efficacy in specific patient subtypes.
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. 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). 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 bec...
Issues related to deep brain stimulation for treatment-refractory Tourette's syndrome
European …, 2009
plex pre-, peri-and postoperative issues. Future studies should include establishment of consistent inclusion criteria and specific practical requirements for clinical trials, evaluation of the impact of DBS on non-tic symptoms and their influence on outcome, social impairment and quality of life, and the identification of optimum neurophysiologically based DBS targets for improved efficacy in specific patient subtypes.
Exploring the clinical outcomes after deep brain stimulation in Tourette syndrome
Journal of the Neurological Sciences, 2019
Introduction: Deep brain stimulation (DBS) of the thalamic centromedianparafascicular (CM-Pf) region is the most common target to treat refractory Tourette syndrome (TS), but the improvement among the patients is quite variable. This study describes the outcomes of stimulation in TS patients and attempts to determine whether the volume of tissue activated (VTA) inside the thalamus or the structural connectivity
Deep brain stimulation therapy for treatment-refractory Tourette’s syndrome
Acta Neurochirurgica, 2011
Tourette's syndrome is a chronic neurobehavioral disorder that can demonstrate refractoriness to conservative treatments, or to invasive nonsurgical treatments such as botulinum toxin infiltration, or to psychobehavioral treatments. In these cases, the surgical option is often proposed, either with lesional interventions, or more recently with deep brain stimulation (DBS). This latter modality is currently preferred because of its reversibility and modularity. Some relevant issues, however, still persist in terms of appropriate indication to treatment, selection of target, and follow-up evaluation.
Temporary deep brain stimulation in Gilles de la Tourette syndrome: A feasible approach?
Surgical Neurology International, 2015
Background: Gilles de la Tourette Syndrome (GTS) is a complex neuropsychiatric disorder, characterized by chronic motor and vocal tics, associated in 50-90% of cases with psychiatric comorbidities. Patients with moderate and severe clinical picture are treated with psychotherapy and pharmacological therapy. Deep brain stimulation (DBS) is reserved for pharmacological refractory GTS patients. As GTS tends to improve with time and potentially resolves in the second decade of life, the major concern of DBS in GTS is the age at which the patient undergoes surgical procedure. Some authors suggest performing DBS after 18 years, others after 25 years of age. Case Description: We present a 25-year-old patient with GTS, who was aged 17 years and was treated with thalamic DBS. DBS resulted in progressive and sustained improvement of tics and co-morbidities. After 6 years of DBS treatment, it was noted that the clinical improvement was maintained also in OFF stimulation setting, so it was decided to keep it off. After 2 years in offsetting and stable clinical picture the entire DBS device was removed. Six months after DBS device removal the patient remained symptom-free. Conclusions: DBS is a therapeutic option reserved for severe and refractory GTS cases. In our opinion DBS might be considered as a temporary application in GTS.