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Zhang C, Deng Z, Pan Y, Zhang J, Zeljic K, Jin H, van der Stelt O, Gong H, Zhan S, Li D, Sun B. Pallidal deep brain stimulation combined with capsulotomy for Tourette's syndrome with psychiatric comorbidity. J Neurosurg 2019; 131:1788-1796. [PMID: 30611137 DOI: 10.3171/2018.8.jns181339] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/09/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE A current challenge is finding an effective and safe treatment for severely disabled patients with Tourette's syndrome (TS) and comorbid psychiatric disorders, in whom conventional treatments have failed. The authors aimed to evaluate the utility of globus pallidus internus deep brain stimulation (GPi-DBS) combined with bilateral anterior capsulotomy in treating these clinically challenging patients. METHODS The authors conducted a retrospective review of the clinical history and outcomes of 10 severely disabled patients with treatment-refractory TS and a psychiatric comorbidity, who had undergone GPi-DBS combined with bilateral anterior capsulotomy in their hospital. At the time of surgery, patients presented mainly with obsessive-compulsive disorder and affective disorders. Clinical outcome assessments of tic and psychiatric symptoms, as well as of general adaptive functioning and quality of life, were performed at the time of surgery and at 6, 12, and between 24 and 96 months postsurgery. RESULTS After surgery, all patients showed significant progressive improvements in tic and psychiatric symptoms, along with improvements in general adaptive functioning and quality of life. Tic alleviation reached 64% at 12 months and 77% at the last follow-up on the Yale Global Tic Severity Scale. At the final follow-up, patients had functionally recovered and displayed no or only mild tic and psychiatric symptoms. All patients tolerated treatment reasonably well, with no serious side effects. CONCLUSIONS GPi-DBS combined with bilateral anterior capsulotomy seems to offer major clinical benefits to severely disabled patients with otherwise treatment-refractory TS and psychiatric comorbidities.
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Affiliation(s)
- Chencheng Zhang
- 1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Zhengdao Deng
- 1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Yixin Pan
- 1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Jing Zhang
- 1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Kristina Zeljic
- 2Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences
- 3University of Chinese Academy of Sciences
| | - Haiyan Jin
- 4Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Hengfen Gong
- 6Department of Psychiatry, Pudong Mental Health Center, Shanghai, China
| | - Shikun Zhan
- 1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Dianyou Li
- 1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
| | - Bomin Sun
- 1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
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102
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Marano M, Migliore S, Squitieri F, Insola A, Scarnati E, Mazzone P. CM-Pf deep brain stimulation and the long term management of motor and psychiatric symptoms in a case of Tourette syndrome. J Clin Neurosci 2019; 62:269-272. [PMID: 30612913 DOI: 10.1016/j.jocn.2018.12.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/23/2018] [Indexed: 11/18/2022]
Abstract
Tourette syndrome is a rare neuropsychiatric disorder affecting the cortico-striato-thalamo-cortical system. The disease manifests in childhood with tics and various psychiatric comorbidities. Cases of refractory Tourette syndrome are valuable candidates for functional neurosurgery. The thalamic centromedian-parafascicular complex is an experimental target that shows a promising role in Tourette syndrome deep brain stimulation, due to pathophysiologic evidences. We have shown on a long term follow-up, that thalamic deep brain stimulation, targeted on the centromedian-parafascicular complex, could modulate motor (i.e. tics) symptoms and owns a putative effect on various psychiatric aspects. Non-responding psychiatric symptoms could be due to the aberrant developmental environment of young Tourette patients more than disease itself. Centromedian-parafascicular complex is intriguingly embedded in motor, associative and limbic pathways and should be further investigated in his role for neuromodulation of human movement and behavior.
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Affiliation(s)
- Massimo Marano
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico of Rome University, Via Alvaro del Portillo, 21, 00128 Rome, Italy.
| | - Simone Migliore
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini, 1, 71013 San Giovanni Rotondo, Italy
| | - Ferdinando Squitieri
- Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini, 1, 71013 San Giovanni Rotondo, Italy
| | | | - Eugenio Scarnati
- Department of Applied Clinical Sciences and Biotechnology, DISCAB, University of l'Aquila, Viale Vetoio Coppito, l'Aquila 67100, Italy
| | - Paolo Mazzone
- Functional Neurosurgery and DBS, Centro Chirurgico Toscano, Via dei Lecci, 22, 52100 Arezzo, Italy
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Neumann WJ, Turner RS, Blankertz B, Mitchell T, Kühn AA, Richardson RM. Toward Electrophysiology-Based Intelligent Adaptive Deep Brain Stimulation for Movement Disorders. Neurotherapeutics 2019; 16:105-118. [PMID: 30607748 PMCID: PMC6361070 DOI: 10.1007/s13311-018-00705-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Deep brain stimulation (DBS) represents one of the major clinical breakthroughs in the age of translational neuroscience. In 1987, Benabid and colleagues demonstrated that high-frequency stimulation can mimic the effects of ablative neurosurgery in Parkinson's disease (PD), while offering two key advantages to previous procedures: adjustability and reversibility. Deep brain stimulation is now an established therapeutic approach that robustly alleviates symptoms in patients with movement disorders, such as Parkinson's disease, essential tremor, and dystonia, who present with inadequate or adverse responses to medication. Currently, stimulation electrodes are implanted in specific target regions of the basal ganglia-thalamic circuit and stimulation pulses are delivered chronically. To achieve optimal therapeutic effect, stimulation frequency, amplitude, and pulse width must be adjusted on a patient-specific basis by a movement disorders specialist. The finding that pathological neural activity can be sampled directly from the target region using the DBS electrode has inspired a novel DBS paradigm: closed-loop adaptive DBS (aDBS). The goal of this strategy is to identify pathological and physiologically normal patterns of neuronal activity that can be used to adapt stimulation parameters to the concurrent therapeutic demand. This review will give detailed insight into potential biomarkers and discuss next-generation strategies, implementing advances in artificial intelligence, to further elevate the therapeutic potential of DBS by capitalizing on its modifiable nature. Development of intelligent aDBS, with an ability to deliver highly personalized treatment regimens and to create symptom-specific therapeutic strategies in real-time, could allow for significant further improvements in the quality of life for movement disorders patients with DBS that ultimately could outperform traditional drug treatment.
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Affiliation(s)
- Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Campus Charite Mitte, Chariteplatz 1, 10117, Berlin, Germany.
| | - Robert S Turner
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Benjamin Blankertz
- Department of Computer Science, Technische Universität Berlin, Berlin, Germany
| | - Tom Mitchell
- Machine Learning Department, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Campus Charite Mitte, Chariteplatz 1, 10117, Berlin, Germany
- Berlin School of Mind and Brain, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Neurocure, Centre of Excellence, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - R Mark Richardson
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Deeb W, Malaty IA, Mathews CA. Tourette disorder and other tic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:123-153. [DOI: 10.1016/b978-0-444-64012-3.00008-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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105
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Doshi PK, Arumugham SS, Bhide A, Vaishya S, Desai A, Singh OP, Math SB, Gautam S, Satyanarayana Rao TS, Mohandas E, Srinivas D, Avasthi A, Grover S, Reddy YCJ. Indian guidelines on neurosurgical interventions in psychiatric disorders. Indian J Psychiatry 2019; 61:13-21. [PMID: 30745649 PMCID: PMC6341921 DOI: 10.4103/psychiatry.indianjpsychiatry_536_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Neurosurgery for psychiatric disorders (NPD) has been practiced for >80 years. However, the interests have waxed and waned, from 1000s of surgeries in 1940-1950s to handful of surgery in 60-80s. This changed with the application of deep brain stimulation surgery, a surgery, considered to be "reversible" there has been a resurgence in interest. The Indian society for stereotactic and functional neurosurgery (ISSFN) and the world society for stereotactic and functional neurosurgery took the note of the past experiences and decided to form the guidelines for NPD. In 2011, an international task force was formed to develop the guidelines, which got published in 2013. In 2018, eminent psychiatrists from India, functional neurosurgeon representing The Neuromodulation Society and ISSFN came-together to deliberate on the current status, need, and legal aspects of NPD. In May 2018, Mental Health Act also came in to force in India, which had laid down the requirements to be fulfilled for NPD. In light of this after taking inputs from all stakeholders and review of the literature, the group has proposed the guidelines for NPD that can help to steer these surgery and its progress in India.
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Affiliation(s)
- Paresh K Doshi
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
| | - Shyam S Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ajit Bhide
- Department of Psychiatry, St. Martha's Hospital, Bengaluru, Karnataka, India
| | - Sandeep Vaishya
- Consultant Neurosurgeon, Department of Neurosurgery, Fortis Hospital, Gurgaon, Haryana, India
| | - Amit Desai
- Department of Psychiatry, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
| | - Om Prakash Singh
- Department of Psychiatry, Nilratan Sirchar Medical College, Kolkata, West Bengal, India
| | - Suresh B Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shiv Gautam
- Consultant Psychiatrist, Gautam Hospital and Research Centre, Civil Lines, Jaipur, Rajasthan, India
| | - T S Satyanarayana Rao
- Department of Psychiatry, J.S.S Medical College and Hospital, J.S.S University, Mysore, Karnataka, India
| | - E Mohandas
- Consultant Psychiatrist, Sun Medical and Research Centre, Trichur, Kerala, India
| | - Dwarkanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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107
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Bryzgalov DV, Kuznetsova IL, Rogaev EI. Enhancement of Declarative Memory: From Genetic Regulation to Non-invasive Stimulation. BIOCHEMISTRY (MOSCOW) 2018; 83:1124-1138. [PMID: 30472951 DOI: 10.1134/s0006297918090146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The problem of memory enhancement is extremely important in intellectual activity areas and therapy of different types of dementia, including Alzheimer's disease (AD). The attempts to solve this problem have come from different research fields. In the first part of our review, we describe the results of targeting certain genes involved in memory-associated molecular pathways. The second part of the review is focused on the deep stimulation of brain structures that can slow down memory loss in AD. The third part describes the results of the use of non-invasive brain stimulation techniques for memory modulation, consolidation, and retrieval in healthy people and animal models. Integration of data from different research fields is essential for the development of efficient strategies for memory enhancement.
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Affiliation(s)
- D V Bryzgalov
- Memory, Oscillations, Brain States (MOBS) Team, Brain Plasticity Unit, CNRS UMR 8249, ESPCI Paris, Paris, France.
| | - I L Kuznetsova
- Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow, 119991, Russia
| | - E I Rogaev
- Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow, 119991, Russia. .,Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA 01605, USA.,Lomonosov Moscow State University, Faculty of Biology, Moscow, 119234, Russia.,Lomonosov Moscow State University, Faculty of Bioengineering and Bioinformatics, Moscow, 119234, Russia
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108
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Coulombe MA, Elkaim LM, Alotaibi NM, Gorman DA, Weil AG, Fallah A, Kalia SK, Lipsman N, Lozano AM, Ibrahim GM. Deep brain stimulation for Gilles de la Tourette syndrome in children and youth: a meta-analysis with individual participant data. J Neurosurg Pediatr 2018; 23:236-246. [PMID: 30497215 DOI: 10.3171/2018.7.peds18300] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/25/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Gilles de la Tourette syndrome (GTS) is a disorder characterized by motor and vocal tics. Although by definition the onset of GTS is before age 18 years, clinical trials of deep brain stimulation (DBS) have been conducted only in adults. Using individual participant data (IPD) meta-analysis methodology, the current study investigated the safety and efficacy of DBS as a treatment for GTS in children and youth. METHODS A systematic review with no date or language restrictions was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Three electronic databases were searched: PubMed, EMBASE, and Web of Science. From 843 articles screened, the IPD of 58 children and youth (ages 12–21 years) extracted from 21 articles were collected and analyzed. A mixed-effects univariable analysis followed by multivariable hierarchical regression was performed using change in the Yale Global Tic Severity Scale (YGTSS) score as the primary outcome and reported measures of comorbidities as secondary outcomes. RESULTS The authors’ results showed an average improvement of 57.5% ± 24.6% across studies on the YGTSS. They also found that comorbid depression and stimulation pulse width each correlated negatively with outcome (p < 0.05). In patients with less severe GTS, greater improvements were evident following thalamic stimulation. More than one-quarter (n = 16, 27.6%) of participants experienced side effects, the majority of which were minor. CONCLUSIONS DBS in the pediatric population may be an effective option with a moderate safety profile for treatment of GTS in carefully selected children and youth. Large, prospective studies with long-term follow-up are necessary to understand how DBS influences tic symptoms and may alter the natural course of GTS in children.
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Affiliation(s)
| | | | - Naif M Alotaibi
- Department of Surgery, University of Toronto.,Division of Neurosurgery, Toronto Western Hospital, Krembil Neuroscience Institute, Toronto; and
| | - Daniel A Gorman
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Ontario
| | - Alexander G Weil
- Faculty of Medicine, Université de Montréal, Quebec.,Division of Neurosurgery, Sainte Justine Hospital, Montreal, Quebec, Canada
| | - Aria Fallah
- Department of Neurosurgery, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Suneil K Kalia
- Department of Surgery, University of Toronto.,Division of Neurosurgery, Toronto Western Hospital, Krembil Neuroscience Institute, Toronto; and
| | - Nir Lipsman
- Department of Surgery, University of Toronto.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto; and
| | - Andres M Lozano
- Department of Surgery, University of Toronto.,Division of Neurosurgery, Toronto Western Hospital, Krembil Neuroscience Institute, Toronto; and
| | - George M Ibrahim
- Department of Surgery, University of Toronto.,Division of Neurosurgery, The Hospital for Sick Children, The Hospital for Sick Children Research Institute, Program in Neuroscience and Mental Health, Toronto, Ontario, Canada
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Perani D, Lalli S, Iaccarino L, Alongi P, Gambini O, Franzini A, Albanese A. Prefrontal Cortical Stimulation in Tourette Disorder: Proof-of-concept Clinical and Neuroimaging Study. Mov Disord Clin Pract 2018; 5:499-505. [PMID: 30515438 DOI: 10.1002/mdc3.12648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 04/04/2018] [Accepted: 04/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background The benefits of neurosurgery in Tourette Syndrome (TS) are still incompletely understood. Prefrontal cortical electrical stimulation offers a less invasive alternative to deep brain stimulation. Objective To perform a pilot assessment on safety and efficacy of prefrontal cortical bilateral electrical stimulation in TS using clinical and brain metabolic assessments. Methods Four adult TS patients underwent tic assessment using the Yale Global Tic Severity Scale and the Rush Video Rating Scale at baseline and 1, 3, 6, and 12-months after implant; whereas FDG-PET scans were acquired at baseline and after 6 and 12 months. Results Tic clinical scores were improved at 6 months after implant, meanwhile they showed a tendency to re-emerge at the 12-month follow-up. There was a correlation between FDG-PET and tics, mainly consisting in a reduction of baseline brain hypermetabolism, which paralleled tic score reduction. Conclusion Epidural stimulation in TS is safe and yields a modulation of tics, paralleled by FDG-PET metabolic modulation.
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Affiliation(s)
- Daniela Perani
- Vita-Salute San Raffaele University Milan Italy.,In vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute Milan Italy.,Nuclear Medicine Unit IRCCS San Raffaele Hospital Milan Italy
| | - Stefania Lalli
- Department of Neurology Catholic University of the Sacred Heart Milan Italy.,Department of Neurology Humanitas Research Hospital Rozzano Milan Italy
| | - Leonardo Iaccarino
- Vita-Salute San Raffaele University Milan Italy.,In vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience IRCCS San Raffaele Scientific Institute Milan Italy
| | | | - Orsola Gambini
- Department of Psychiatry University of Milan Medical School and San Paolo Hospital Milan Italy
| | - Angelo Franzini
- Department of Neurosurgery Istituto Neurologico "C. Besta" Milan Italy
| | - Alberto Albanese
- Department of Neurology Catholic University of the Sacred Heart Milan Italy.,Department of Neurology Humanitas Research Hospital Rozzano Milan Italy
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110
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Efron D, Dale RC. Tics and Tourette syndrome. J Paediatr Child Health 2018; 54:1148-1153. [PMID: 30294996 DOI: 10.1111/jpc.14165] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/04/2018] [Indexed: 12/31/2022]
Abstract
Tourette syndrome is a heterogeneous disorder. The genetic basis is complex, and both in utero and ex utero environmental factors may modify the phenotypic expression of the disorder. Inflammation related to aberrations in immune activation appears to play a pathogenic role in some cases. Multiple neurochemical pathways are involved. Rather than being a pure movement problem, tics are now understood to also have a sensory component. This has resulted in new psychological therapeutic strategies and other potential treatments. Furthermore, comorbidities are common, particularly attention-deficit hyperactivity disorder, anxiety and obsessive-compulsive disorder, and often cause more difficulties than the tics. The approach to treatment is dependent on the degree and types of impairment. For many patients, education, acceptance and understanding are all that is needed. In more severe cases, psychological and/or pharmacological interventions may be indicated. In this article, the clinical features and pathophysiology of Tourette syndrome are reviewed, and a pragmatic management approach is discussed.
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Affiliation(s)
- Daryl Efron
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Russell C Dale
- Department of Paediatric Neurology, University of Sydney, Sydney, New South Wales, Australia.,Department of Neurology, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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111
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Lamothe H, Baleyte JM, Smith P, Pelissolo A, Mallet L. Individualized Immunological Data for Precise Classification of OCD Patients. Brain Sci 2018; 8:E149. [PMID: 30096863 PMCID: PMC6119917 DOI: 10.3390/brainsci8080149] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/01/2018] [Accepted: 08/03/2018] [Indexed: 12/11/2022] Open
Abstract
Obsessive⁻compulsive disorder (OCD) affects about 2% of the general population, for which several etiological factors were identified. Important among these is immunological dysfunction. This review aims to show how immunology can inform specific etiological factors, and how distinguishing between these etiologies is important from a personalized treatment perspective. We found discrepancies concerning cytokines, raising the hypothesis of specific immunological etiological factors. Antibody studies support the existence of a potential autoimmune etiological factor. Infections may also provoke OCD symptoms, and therefore, could be considered as specific etiological factors with specific immunological impairments. Finally, we underline the importance of distinguishing between different etiological factors since some specific treatments already exist in the context of immunological factors for the improvement of classic treatments.
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Affiliation(s)
- Hugues Lamothe
- Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France.
- Institut du Cerveau et de la Moelle Epinière, Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, 75013 Paris, France.
- Fondation FondaMental, 94000 Créteil, France.
| | - Jean-Marc Baleyte
- Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France.
- Fondation FondaMental, 94000 Créteil, France.
| | - Pauline Smith
- Institut du Cerveau et de la Moelle Epinière, Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, 75013 Paris, France.
| | - Antoine Pelissolo
- Fondation FondaMental, 94000 Créteil, France.
- Assistance Publique-Hôpitaux de Paris, Pôle de Psychiatrie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Université Paris-Est Créteil, 94000 Créteil, France.
- INSERM, U955, Team 15, 94000 Créteil, France.
| | - Luc Mallet
- Institut du Cerveau et de la Moelle Epinière, Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, 75013 Paris, France.
- Fondation FondaMental, 94000 Créteil, France.
- Assistance Publique-Hôpitaux de Paris, Pôle de Psychiatrie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Université Paris-Est Créteil, 94000 Créteil, France.
- Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, 1202 Geneva, Switzerland.
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112
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Huh R, Song IU, Chung M. Neuropsychological consequences of pallidal deep brain stimulation altering brain networks. J Clin Neurosci 2018; 54:50-56. [DOI: 10.1016/j.jocn.2018.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/27/2018] [Accepted: 05/17/2018] [Indexed: 02/07/2023]
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113
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Hartmann A, Worbe Y. Tourette syndrome: clinical spectrum, mechanisms and personalized treatments. Curr Opin Neurol 2018; 31:504-509. [DOI: 10.1097/wco.0000000000000575] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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114
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Azimi A, Parvaresh M, Shahidi G, Habibi A, Rohani S, Safdarian M, Fattahi A, Taheri M, Rohani M. Anteromedial GPi deep brain stimulation in Tourette syndrome: The first case series from Iran. Clin Neurol Neurosurg 2018; 172:116-119. [PMID: 29990958 DOI: 10.1016/j.clineuro.2018.06.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 06/27/2018] [Accepted: 06/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Tourette syndrome (TS) is a neuropsychiatric disorder characterized by childhood onset motor and phonic tics. In refractory cases, deep brain stimulation (DBS) with different targets including anteromedial Globus pallidus (AM-GPi) looks promising. PATIENTS AND METHODS Patients with TS diagnosed according to DSM-IV TR criteria with severe medication-recalcitrant disease referred to our DBS clinic, were recruited for this study. They underwent bilateral AM-GPi DBS with Model 3389, Medtronic electrodes. Patients were assessed using Yale Global Tic Severity Scale (YGTSS) and Gilles de la Touretts syndrome-quality of life (GTS-QOL) questionnaire before and one year after DBS. RESULTS Six patients (four men and two women) with severe medication-recalcitrant TS, mean age of 26.33 ± 7.25 years fulfilled the follow up visits. All patients revealed significant improvement in tics severity one year after surgery. Based on YGTSS, total tic severity score decreased from 75.66 ± 16.54 to 28.33 ± 13.95, P-value:0.005. Quality of life improved significantly after DBS (26.66 ± 20.65 before and 70.00 ± 17.88 one year after surgery, P-value:0.02). CONCLUSIONS Results of our study in accordance to previous ones suggest AM-GPi DBS as an effective and well-tolerated therapeutic modality for patients with medication refractory TS.
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Affiliation(s)
- Alireza Azimi
- Department of Neurosurgery, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Parvaresh
- Department of Neurosurgery, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamali Shahidi
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhassan Habibi
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sadra Rohani
- Department of Neurosurgery, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Safdarian
- Cellular and Molecular Research Center, Faculty of Advanced Technologies in Medicine, Iran University of Medicine Sciences, Tehran, Iran
| | - Arash Fattahi
- Department of Neurosurgery, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Taheri
- Department of Neurosurgery, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Rohani
- Cellular and Molecular Research Center, Faculty of Advanced Technologies in Medicine, Iran University of Medicine Sciences, Tehran, Iran.
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115
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Peña CE, Faraji AH, Richardson RM. Deep Brain Stimulation for Tourette Syndrome. Neurosurgery 2018; 83:E13. [DOI: 10.1093/neuros/nyy172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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116
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Abstract
Deep brain stimulation (DBS) has been offered to patients suffering of severe and resistant neuropsychiatric disorders like Obsessive Compulsive Disorder (OCD), Gilles de la Tourette Syndrome (TS) and Major Depression (MDD). Modulation of several targets within the cortico-striato-thalamo-cortical circuits can lead to a decrease of symptom severity in those patients. This review focuses on the recent clinical outcomes in DBS in psychiatric disorders. Studies on OCD and TS are now focusing on the long-term effects of DBS, with encouraging results regarding not only the decrease of symptoms, but also quality of life. They also highlighted efficient adjuvant techniques, like cognitive and behavioural therapy and support programs, to enhance an often-partial response to DBS. The application of DBS for MDD is more recent and, despite encouraging initial open-label studies, two large randomised studies have failed to demonstrate an efficacy of DBS in MDD according to evidence-based medicine criteria. Last years, DBS was also tested in other resistant psychiatric disorders, as anorexia nervosa and addiction, with encouraging preliminary results. However, today, no target – whatever the disease – can meet the criteria for clinical efficacy as recently defined by an international committee for neurosurgery for psychiatric disorders. Consequently, DBS in psychiatric disorders still needs to proceed within the frame of clinical trials.
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Affiliation(s)
- Anne-Hélène Clair
- Sorbonne University, UPMC Paris 06 University, INSERM, CNRS, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - William Haynes
- Sorbonne University, UPMC Paris 06 University, INSERM, CNRS, Institut du Cerveau et de la Moelle épinière, Paris, France.,Neurosurgery department, University Hospital of Montpellier, Montpellier, France
| | - Luc Mallet
- Sorbonne University, UPMC Paris 06 University, INSERM, CNRS, Institut du Cerveau et de la Moelle épinière, Paris, France.,Psychiatry and Addictology Department - Neurosurgery Department, Personalized Neurology & Psychiatry University Department, University Hospitals Henri Mondor - Albert Chenevier, Créteil, France
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Abstract
Gilles de la Tourette syndrome is a chronic and complex tic disorder accompanied by specific behavioral problems in the majority of patients. With its multifaceted interplay between motion and emotion, this condition is a paradigmatic example of the science and art of clinical neuropsychiatry. This review article encompasses the clinical phenomenology of motor and vocal tics and associated sensory experiences (premonitory urges), as well as the behavioral spectrum of the most common comorbidities, including obsessive-compulsive disorder, attention-deficit and hyperactivity disorder, affective symptoms, and impulsivity. Knowledge of the contributions of both tics and behavioral problems to patients' health-related quality of life across the lifespan should assist treating clinicians in formulating a targeted management plan. Although the exact pathophysiology of Gilles de la Tourette syndrome remains elusive, research into therapeutic interventions has expanded the range of available interventions across multiple domains. A thorough understanding of the neurology and psychiatry of this condition is of key importance to meet the needs of this patient population, from the formulation of an accurate diagnosis to the implementation of effective treatment strategies.
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Hartmann A, Millet B. Repetitive movements and behaviors in neurological and psychiatric practice: Distinctions and similarities between Tourette disorder and obsessive–compulsive disorder. Rev Neurol (Paris) 2018; 174:199-202. [DOI: 10.1016/j.neurol.2018.01.364] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 11/26/2022]
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Ethics of Deep Brain Stimulation in Adolescent Patients with Refractory Tourette Syndrome: a Systematic Review and Two Case Discussions. NEUROETHICS-NETH 2018; 11:143-155. [PMID: 29937946 PMCID: PMC5978799 DOI: 10.1007/s12152-018-9359-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/13/2018] [Indexed: 12/15/2022]
Abstract
Introduction Tourette 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 Results We 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. Discussion Specific 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. Conclusion Clinical 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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Doshi PK, Ramdasi R, Thorve S. Deep brain stimulation of anteromedial globus pallidus internus for severe Tourette syndrome. Indian J Psychiatry 2018; 60:138-140. [PMID: 29736078 PMCID: PMC5914244 DOI: 10.4103/psychiatry.indianjpsychiatry_53_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tourette syndrome (TS) is a complex disorder characterized by tics and is associated with behavioral problems. Although its intensity decreases in adolescence and adult life, in some cases it continues to remain severe and refractory to medical treatment. Deep brain stimulation has been offered as a treatment option in such cases. We report two cases of TS treated with of anteromedial globus pallidum internus. Both the cases had good postoperative control of tics and associated obsessive-compulsive behavior.
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Affiliation(s)
- Paresh K Doshi
- Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
| | | | - Smita Thorve
- Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
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Martino D, Pringsheim TM. Tourette syndrome and other chronic tic disorders: an update on clinical management. Expert Rev Neurother 2017; 18:125-137. [PMID: 29219631 DOI: 10.1080/14737175.2018.1413938] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The management of Tourette syndrome (TS) and other chronic tic disorders occurs in multiple stages and begins with comprehensive assessment and complex psychoeducation. Behavioral and pharmacological interventions (second stage) are needed when tics cause physical or psychosocial impairment. Deep brain stimulation surgery or experimental therapies represent the third stage. Areas covered: Discussed are recent advances in assessment and therapy of chronic tic disorders, encompassing the three stages of intervention, with the addition of experimental, non-invasive brain stimulation strategies. A PubMed search was performed using as keywords: 'tic disorders', 'Tourette syndrome', 'assessment', 'rating scales', 'behavioral treatment', 'pharmacological treatment', 'deep brain stimulation', 'transcranial magnetic (or current) stimulation', and 'transcranial current stimulation'. More than 300 peer-reviewed articles were evaluated. The studies discussed have been selected on the basis of novelty and impact. Expert commentary: Comprehensive assessment of tic disorders and psychoeducation are crucial to a correct active management approach. Behavioral treatments represent first line of active interventions, with increasing potential offered by telehealth. Antipsychotics and alpha agonists remain first line pharmacological interventions for tics, although VMAT-2 inhibitors appear promising. Deep brain stimulation is a potential option for medically refractory, severely disabled patients with tics, but age and target selection require further investigation.
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Affiliation(s)
- Davide Martino
- a Department of Clinical Neurosciences , Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute , Calgary , Canada
| | - Tamara M Pringsheim
- a Department of Clinical Neurosciences , Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute , Calgary , Canada.,b Department of Pediatrics , Cumming School of Medicine, University of Calgary , Calgary , Canada.,c Department of Psychiatry , Cumming School of Medicine, University of Calgary , Calgary , Canada
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Abstract
PURPOSE OF REVIEW Describe developments in the etiological understanding of Tourette syndrome. RECENT FINDINGS Tourette syndrome is a complex heterogenous clinical syndrome, which is not a unitary entity. Pathophysiological models describe gamma-aminobutyric acid-ergic-associated disinhibition of cortico-basal ganglia motor, sensory and limbic loops. MRI studies support basal ganglia volume loss, with additional white matter and cerebellar changes. Tourette syndrome cause likely involves multiple vulnerability genes and environmental factors. Only recently have some vulnerability gene findings been replicated, including histidine decarboxylase and neurexin 1, yet these rare variants only explain a small proportion of patients. Planned large genetic studies will improve genetic understanding. The role of inflammation as a contributor to disease expression is now supported by large epidemiological studies showing an association with maternal autoimmunity and childhood infection. Investigation of blood cytokines, blood mRNA and brain mRNA expression support the role of a persistent immune activation, and there are similarities with the immune literature of autistic spectrum disorder. Current treatment is symptomatic, although there is a better appreciation of factors that influence treatment response. SUMMARY At present, therapeutics is focused on symptom-based treatments, yet with improved etiological understanding, we will move toward disease-modifying therapies in the future.
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Neudorfer C, Maarouf M. Neuroanatomical background and functional considerations for stereotactic interventions in the H fields of Forel. Brain Struct Funct 2017; 223:17-30. [DOI: 10.1007/s00429-017-1570-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 11/13/2017] [Indexed: 11/29/2022]
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The colorful spectrum of Tourette syndrome and its medical, surgical and behavioral therapies. Parkinsonism Relat Disord 2017; 46 Suppl 1:S75-S79. [PMID: 28807495 DOI: 10.1016/j.parkreldis.2017.08.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/04/2017] [Accepted: 08/06/2017] [Indexed: 12/17/2022]
Abstract
Tourette syndrome (TS) is a common neuropsychiatric disorder, more common in males than females, with onset before age 18. TS is characterized by multiple motor tics and one or more vocal/phonic tics, persisting for more than a year. Tics are unvoluntary, abrupt, rapid, repetitive, but non-rhythmic movements or sounds (vocalizations). They are preceded by an inner urge. Tics can be temporarily suppressed, but this leads to a powerful re-emergence. The performance of tics results in immediate but transient relief. Motor and vocal tics are classified as simple or complex. Tics emerge many times during the day and display spontaneous fluctuations in frequency, type, severity and complexity. Tics improve during concentration, worsen during relaxation or when under stress and occasionally are persistent in sleep. Psychiatric comorbidities such as attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and others frequently are present. Patients, families and teachers benefit from receiving instruction regarding the character of TS and its specific symptoms and from receiving counseling. Pharmacological treatment is not always necessary. Atypical antipsychotics (e.g. risperidone, ziprasidone, olanzapine, aripiprazole) are often the first-line treatment; typical antipsychotics (e.g. haloperidol, pimozide, fluphenazine), benzodiazepines (clonazepam) and tetrabenazine are employed less frequently. Alpha adrenergic agonists (clonidine, guanfacine), the selective noradrenaline re-uptake inhibitor, atomoxetine, and the amphetamine-like stimulant, methylphenidate, are useful in patients with tics and ADHD; selective serotonin re-uptake inhibitors can be useful in individuals with tics and OCD. Botulinum toxin can be effective in focal tics. In severe, treatment-resistant TS, deep brain stimulation may be beneficial.
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Akbarian-Tefaghi L, Akram H, Johansson J, Zrinzo L, Kefalopoulou Z, Limousin P, Joyce E, Hariz M, Wårdell K, Foltynie T. Refining the Deep Brain Stimulation Target within the Limbic Globus Pallidus Internus for Tourette Syndrome. Stereotact Funct Neurosurg 2017; 95:251-258. [PMID: 28787721 DOI: 10.1159/000478273] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/08/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) in patients with severe, refractory Tourette syndrome (TS) has demonstrated promising but variable results thus far. The thalamus and anteromedial globus pallidus internus (amGPi) have been the most commonly stimulated sites within the cortico-striato thalamic circuit, but an optimal target is yet to be elucidated. OBJECTIVES This study of 15 patients with long-term amGPi DBS for severe TS investigated whether a specific anatomical site within the amGPi correlated with optimal clinical outcome for the measures of tics, obsessive compulsive behaviour (OCB), and mood. METHODS Validated clinical assessments were used to measure tics, OCB, quality of life, anxiety, and depression before DBS and at the latest follow-up (17-82 months). Electric field simulations were created for each patient using information on electrode location and individual stimulation parameters. A subsequent regression analysis correlated these patient-specific simulations to percentage changes in outcome measures in order to identify any significant voxels related to clinical improvement. RESULTS A region within the ventral limbic GPi, specifically on the medial medullary lamina in the pallidum at the level of the AC-PC, was significantly associated with improved tics but not mood or OCB outcome. CONCLUSIONS This study adds further support to the application of DBS in a tic-related network, though factors such as patient sample size and clinical heterogeneity remain as limitations and replication is required.
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Affiliation(s)
- Ladan Akbarian-Tefaghi
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, UK
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Welter ML, Houeto JL, Thobois S, Bataille B, Guenot M, Worbe Y, Hartmann A, Czernecki V, Bardinet E, Yelnik J, du Montcel ST, Agid Y, Vidailhet M, Cornu P, Tanguy A, Ansquer S, Jaafari N, Poulet E, Serra G, Burbaud P, Cuny E, Aouizerate B, Pollak P, Chabardes S, Polosan M, Borg M, Fontaine D, Giordana B, Raoul S, Rouaud T, Sauvaget A, Jalenques I, Karachi C, Mallet L. Anterior pallidal deep brain stimulation for Tourette's syndrome: a randomised, double-blind, controlled trial. Lancet Neurol 2017. [PMID: 28645853 DOI: 10.1016/s1474-4422(17)30160-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) has been proposed to treat patients with severe Tourette's syndrome, and open-label trials and two small double-blind trials have tested DBS of the posterior and the anterior internal globus pallidus (aGPi). We aimed to specifically assess the efficacy of aGPi DBS for severe Tourette's syndrome. METHODS In this randomised, double-blind, controlled trial, we recruited patients aged 18-60 years with severe and medically refractory Tourette's syndrome from eight hospitals specialised in movement disorders in France. Enrolled patients received surgery to implant bilateral electrodes for aGPi DBS; 3 months later they were randomly assigned (1:1 ratio with a block size of eight; computer-generated pairwise randomisation according to order of enrolment) to receive either active or sham stimulation for the subsequent 3 months in a double-blind fashion. All patients then received open-label active stimulation for the subsequent 6 months. Patients and clinicians assessing outcomes were masked to treatment allocation; an unmasked clinician was responsible for stimulation parameter programming, with intensity set below the side-effect threshold. The primary endpoint was difference in Yale Global Tic Severity Scale (YGTSS) score between the beginning and end of the 3 month double-blind period, as assessed with a Mann-Whitney-Wilcoxon test in all randomly allocated patients who received active or sham stimulation during the double-blind period. We assessed safety in all patients who were enrolled and received surgery for aGPi DBS. This trial is registered with ClinicalTrials.gov, number NCT00478842. FINDINGS Between Dec 6, 2007, and Dec 13, 2012, we enrolled 19 patients. We randomly assigned 17 (89%) patients, with 16 completing blinded assessments (seven [44%] in the active stimulation group and nine [56%] in the sham stimulation group). We noted no significant difference in YGTSS score change between the beginning and the end of the 3 month double-blind period between groups (active group median YGTSS score 68·5 [IQR 34·0 to 83·5] at the beginning and 62·5 [51·5 to 72·0] at the end, median change 1·1% [IQR -23·9 to 38·1]; sham group 73·0 [69·0 to 79·0] and 79·0 [59·0 to 81·5], median change 0·0% [-10·6 to 4·8]; p=0·39). 15 serious adverse events (three in patients who withdrew before stimulation and six each in the active and sham stimulation groups) occurred in 13 patients (three who withdrew before randomisation, four in the active group, and six in the sham group), with infections in DBS hardware in four patients (two who withdrew before randomisation, one in the sham stimulation group, and one in the active stimulation group). Other serious adverse events included one electrode misplacement (active stimulation group), one episode of depressive signs (active stimulation group), and three episodes of increased tic severity and anxiety (two in the sham stimulation group and one in the active stimulation group). INTERPRETATION 3 months of aGPi DBS is insufficient to decrease tic severity for patients with Tourette's syndrome. Future research is needed to investigate the efficacy of aGPi DBS for patients over longer periods with optimal stimulation parameters and to identify potential predictors of the therapeutic response. FUNDING French Ministry of Health.
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Affiliation(s)
- Marie-Laure Welter
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Neurology Department, Paris, France; Clinical Investigation Centre, INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie Université Paris 06, Paris, France; Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France.
| | - Jean-Luc Houeto
- Department of Neurology, INSERM-Centre d'Investigation Clinique 1402, University of Poitiers, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
| | - Stéphane Thobois
- Department of Neurology C, Hôpital Neurologique, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; CNRS, Lyon Centre for Neuroscience Research, University Lyon 1, Bron, France
| | - Benoit Bataille
- Department of Neurosurgery, INSERM-Centre d'Investigation Clinique 1402, University of Poitiers, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
| | - Marc Guenot
- Department of Neurosurgery A, Hôpital Neurologique, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Yulia Worbe
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Neurology Department, Paris, France
| | - Andreas Hartmann
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Neurology Department, Paris, France
| | - Virginie Czernecki
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Neurology Department, Paris, France
| | - Eric Bardinet
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Jerome Yelnik
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Sophie Tezenas du Montcel
- AP-HP, Pitié-Salpêtrière Hospital, Biostatistics and Medical Informatics Unit and Clinical Research Unit, Paris, France; Sorbonne Universités, Université Pierre et Marie Curie Université Paris 06, UMR S1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Yves Agid
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Marie Vidailhet
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Philippe Cornu
- Neurosurgery, INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie Université Paris 06, Paris, France
| | - Audrey Tanguy
- AP-HP, Pitié-Salpêtrière Hospital, Biostatistics and Medical Informatics Unit and Clinical Research Unit, Paris, France
| | - Solène Ansquer
- Department of Neurology, INSERM-Centre d'Investigation Clinique 1402, University of Poitiers, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
| | - Nematollah Jaafari
- Department of Psychiatry, INSERM-Centre d'Investigation Clinique 1402, University of Poitiers, Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers, France
| | - Emmanuel Poulet
- PsyR2 Team, U 1028, INSERM and UMR 5292, Centre Hospitalier Le Vinatier, Bron, France
| | - Giulia Serra
- Department of Neurology C, Hôpital Neurologique, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Burbaud
- Department of Neurophysiology, Charles Perrens Hospital, University Bordeaux 2, CNRS UMR 5543, Bordeaux, France
| | - Emmanuel Cuny
- Department of Neurosurgery, Charles Perrens Hospital, University Bordeaux 2, CNRS UMR 5543, Bordeaux, France
| | - Bruno Aouizerate
- Department of Psychiatry, Charles Perrens Hospital, University Bordeaux 2, CNRS UMR 5543, Bordeaux, France
| | - Pierre Pollak
- Department of Neurology, Grenoble Alpes University, CHU Grenoble, Grenoble, France
| | - Stephan Chabardes
- Department of Neurosurgery, Grenoble Alpes University, CHU Grenoble, Grenoble, France
| | - Mircea Polosan
- Department of Psychiatry, Grenoble Alpes University, CHU Grenoble, Grenoble, France
| | - Michel Borg
- Department of Neurology, University Hospital, Nice, France
| | - Denys Fontaine
- Department of Neurosurgery, University Hospital, Nice, France
| | - Bruno Giordana
- Department of Psychiatry, University Hospital, Nice, France
| | - Sylvie Raoul
- Department of Neurosurgery, Nantes University Hospital, Nantes, France
| | - Tiphaine Rouaud
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - Anne Sauvaget
- Department of Psychiatry, Nantes University Hospital, Nantes, France
| | - Isabelle Jalenques
- Department of Psychiatry, CHU Clermont-Ferrand and Clermont Auvergne University, Equipe d'Accueil 7280, Clermont-Ferrand, France
| | - Carine Karachi
- Neurosurgery, INSERM 1127, Sorbonne Universités, Université Pierre et Marie Curie Université Paris 06, Paris, France; Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Luc Mallet
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France; AP-HP, Personalised Neurology and Psychiatry University Department, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Université Paris Est Créteil, Créteil, France; Department of Mental Health and Psychiatry, Geneva University Hospital, University of Geneva, Geneva, Switzerland
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Neudorfer C, El Majdoub F, Hunsche S, Richter K, Sturm V, Maarouf M. Deep Brain Stimulation of the H Fields of Forel Alleviates Tics in Tourette Syndrome. Front Hum Neurosci 2017; 11:308. [PMID: 28659777 PMCID: PMC5468420 DOI: 10.3389/fnhum.2017.00308] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/29/2017] [Indexed: 12/29/2022] Open
Abstract
The current rationale for target selection in Tourette syndrome revolves around the notion of cortico-basal ganglia circuit involvement in the pathophysiology of the disease. However, despite extensive research, the ideal target for deep brain stimulation (DBS) is still under debate, with many structures being neglected and underexplored. Based on clinical observations and taking into account the prevailing hypotheses of network processing in Tourette syndrome, we chose the fields of Forel, namely field H1, as a target for DBS. The fields of Forel constitute the main link between the striatopallidal system and the thalamocortical network, relaying pallidothalamic projections from core anatomical structures to the thalamic ventral nuclear group. In a retrospective study we investigated two patients suffering from chronic, medically intractable Tourette syndrome who underwent bilateral lead implantation in field H1 of Forel. Clinical scales revealed significant alleviation of tics and comorbid symptoms, namely depression and anxiety, in the postoperative course in both patients.
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Affiliation(s)
- Clemens Neudorfer
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
| | - Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
| | - Stefan Hunsche
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
| | - Klaus Richter
- Department of Psychiatry and Psychotherapy, LVR Clinics CologneCologne, Germany
| | - Volker Sturm
- Department of Neurosurgery, University Hospital of WürzburgWürzburg, Germany
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
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Graat I, Figee M, Denys D. The application of deep brain stimulation in the treatment of psychiatric disorders. Int Rev Psychiatry 2017; 29:178-190. [PMID: 28523977 DOI: 10.1080/09540261.2017.1282439] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Deep brain stimulation (DBS) is a last-resort treatment for neurological and psychiatric disorders that are refractory to standard treatment. Over the last decades, the progress of DBS in psychiatry has been slower than in neurology, in part owing to the heterogenic symptomatology and complex neuroanatomy of psychiatric disorders. However, for obsessive-compulsive disorder (OCD) DBS is now an accepted treatment. This study first reviews clinical outcomes and mechanisms of DBS for OCD, and then discusses these results in an overview of current and future psychiatric applications, including DBS for mood disorders, Tourette's syndrome, addiction, anorexia nervosa, autism, schizophrenia, and anxiety disorders. In addition, it will focus on novel techniques that may enhance the application of DBS in psychiatry.
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Affiliation(s)
- Ilse Graat
- a Department of Psychiatry , Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands
| | - Martijn Figee
- a Department of Psychiatry , Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands.,b Amsterdam Brain and Cognition , Amsterdam , Netherlands
| | - Damiaan Denys
- a Department of Psychiatry , Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands.,b Amsterdam Brain and Cognition , Amsterdam , Netherlands.,c Netherlands Institute for Neuroscience , An Institute of the Royal Netherlands Academy of Arts and Sciences , Amsterdam , Netherlands
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Abstract
Gilles de la Tourette syndrome (GTS) is a childhood-onset neurodevelopmental disorder that is characterized by several motor and phonic tics. Tics usually develop before 10 years of age, exhibit a waxing and waning course and typically improve with increasing age. A prevalence of approximately 1% is estimated in children and adolescents. The condition can result in considerable social stigma and poor quality of life, especially when tics are severe (for example, with coprolalia (swearing tics) and self-injurious behaviours) or when GTS is accompanied by attention-deficit/hyperactivity disorder, obsessive-compulsive disorder or another neuropsychiatric disorder. The aetiology is complex and multifactorial. GTS is considered to be polygenic, involving multiple common risk variants combined with rare, inherited or de novo mutations. These as well as non-genetic factors (such as perinatal events and immunological factors) are likely to contribute to the heterogeneity of the clinical phenotype, the structural and functional brain anomalies and the neural circuitry involvement. Management usually includes psychoeducation and reassurance, behavioural methods, pharmacotherapy and, rarely, functional neurosurgery. Future research that integrates clinical and neurobiological data, including neuroimaging and genetics, is expected to reveal the pathogenesis of GTS at the neural circuit level, which may lead to targeted interventions.
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Smeets AYJM, Duits AA, Leentjens AFG, Schruers K, van Kranen-Mastenbroek V, Visser-Vandewalle V, Temel Y, Ackermans L. Thalamic Deep Brain Stimulation for Refractory Tourette Syndrome: Clinical Evidence for Increasing Disbalance of Therapeutic Effects and Side Effects at Long-Term Follow-Up. Neuromodulation 2017; 21:197-202. [PMID: 28102636 DOI: 10.1111/ner.12556] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/24/2016] [Accepted: 10/11/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Thalamic deep brain stimulation (DBS) is effective in reducing tics in patients with refractory Tourette syndrome at the short-term. Here, we report on the long-term outcome. MATERIALS AND METHODS Seven patients underwent bilateral DBS between 2001 and 2008. The target was the centromedian nucleus, substantia periventricularis and nucleus ventro-oralis internus cross point of the thalamus. The effect on tics and side effects were evaluated with a variable follow-up duration of 12 to 78 months. RESULTS Patient 1 and 2 showed good tic improvements of 81.6% (60 months) and 50% (36 months), respectively. However, side effects like reducing levels of energy and visual disturbances increased. In patient 1, the target was changed to the anterior part of the internal pallidum and patient 2 switched the stimulator permanently off. Patient 3 experiences still satisfying results with a tic improvement of 88.9% (78 months). Patient 4 and 7 showed minor tic improvements of 34% (16 months) and 9% (60 months), respectively. In both patients side effects became more severe and the target was changed to the anterior part of the internal pallidum. Patient 5 showed a tic improvement of 27.5% (12 months) and went abroad for stimulation of the external globus pallidus. Patient 6 developed cerebellar atrophy. He experienced several nonstimulation related side effects and turned the stimulator off. CONCLUSIONS There seems to be an increasing disbalance of therapeutic effects and side effects at long-term follow-up, often leading to either switching the stimulator off or new surgery with a different neuro-anatomic target.
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Affiliation(s)
- Anouk Y J M Smeets
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Annelien A Duits
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Albert F G Leentjens
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Koen Schruers
- Mondriaan Zorggroep, Academic Anxiety Centre, Maastricht, The Netherlands
| | | | | | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Linda Ackermans
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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133
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Akbarian-Tefaghi L, Zrinzo L, Foltynie T. The Use of Deep Brain Stimulation in Tourette Syndrome. Brain Sci 2016; 6:brainsci6030035. [PMID: 27548235 PMCID: PMC5039464 DOI: 10.3390/brainsci6030035] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/13/2016] [Accepted: 08/15/2016] [Indexed: 12/16/2022] Open
Abstract
Tourette syndrome (TS) is a childhood neurobehavioural disorder, characterised by the presence of motor and vocal tics, typically starting in childhood but persisting in around 20% of patients into adulthood. In those patients who do not respond to pharmacological or behavioural therapy, deep brain stimulation (DBS) may be a suitable option for potential symptom improvement. This manuscript attempts to summarise the outcomes of DBS at different targets, explore the possible mechanisms of action of DBS in TS, as well as the potential of adaptive DBS. There will also be a focus on the future challenges faced in designing optimized trials.
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Affiliation(s)
- Ladan Akbarian-Tefaghi
- Institute of Neurology, University College London (UCL), Queen Square, London WC1N 3BG, UK.
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience, University College London (UCL) Institute of Neurology, London WC1N 3BG, UK.
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience, University College London (UCL) Institute of Neurology, London WC1N 3BG, UK.
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134
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Basiago A, Binder DK. Effects of Deep Brain Stimulation on Autonomic Function. Brain Sci 2016; 6:brainsci6030033. [PMID: 27537920 PMCID: PMC5039462 DOI: 10.3390/brainsci6030033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 12/22/2022] Open
Abstract
Over the course of the development of deep brain stimulation (DBS) into a well-established therapy for Parkinson's disease, essential tremor, and dystonia, its utility as a potential treatment for autonomic dysfunction has emerged. Dysfunction of autonomic processes is common in neurological diseases. Depending on the specific target in the brain, DBS has been shown to raise or lower blood pressure, normalize the baroreflex, to alter the caliber of bronchioles, and eliminate hyperhidrosis, all through modulation of the sympathetic nervous system. It has also been shown to improve cortical control of the bladder, directly induce or inhibit the micturition reflex, and to improve deglutition and gastric emptying. In this review, we will attempt to summarize the relevant available studies describing these effects of DBS on autonomic function, which vary greatly in character and magnitude with respect to stimulation target.
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Affiliation(s)
- Adam Basiago
- School of Medicine, University of California, Riverside, CA 92521, USA.
| | - Devin K Binder
- Division of Biomedical Sciences, School of Medicine, University of California, 1247 Webber Hall, Riverside, CA 92521, USA.
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135
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Haense C, Müller-Vahl KR, Wilke F, Schrader C, Capelle HH, Geworski L, Bengel FM, Krauss JK, Berding G. Effect of Deep Brain Stimulation on Regional Cerebral Blood Flow in Patients with Medically Refractory Tourette Syndrome. Front Psychiatry 2016; 7:118. [PMID: 27458389 PMCID: PMC4932098 DOI: 10.3389/fpsyt.2016.00118] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 06/15/2016] [Indexed: 11/22/2022] Open
Abstract
In this study, alterations in brain perfusion have been investigated in patients with Tourette syndrome (TS) compared with control subjects. In addition, we investigated the effects of deep brain stimulation (DBS) in both globus pallidus internus (GPi) and centromedian-parafascicular/ventralis oralis internus nuclei of the thalamus (CM/Voi) and sham (SHAM) stimulation on cerebral blood flow. In a prospective controlled, randomized, double-blind setting, five severely affected adult patients with TS with predominant motor or vocal tics (mean total tic score on the Yale Global Tic Severity Scale: 39) underwent serial brain perfusion single photon emission computed tomography with (99m)Tc-ECD. Results were compared with data from six age-matched control subjects. All patients were investigated at four different time points: once before DBS implantation (preOP) and three times postoperatively. Postoperative scans were performed in a randomized order, each after 3 months of either GPi, CM/Voi, or SHAM stimulation. At each investigation, patients were injected at rest while awake, but scanned during anesthesia. This procedure ensured that neither anesthesia nor movement artifacts influenced our results. Control subjects were investigated only once at baseline (without DBS or anesthesia). At baseline, cerebral blood flow was significantly reduced in patients with TS (preOP) compared with controls in the central region, frontal, and parietal lobe, specifically in Brodmann areas 1, 4-9, 30, 31, and 40. Significantly increased perfusion was found in the cerebellum. When comparing SHAM stimulation to preOP condition, we found significantly decreased perfusion in basal ganglia and thalamus, but increased perfusion in different parts of the frontal cortex. Compared with SHAM condition both GPi and thalamic stimulation resulted in a significant decrease in cerebral blood flow in basal ganglia and cerebellum, while perfusion in the frontal cortex was significantly increased. Our results provide substantial evidence that, in TS, brain perfusion is altered in the frontal cortex and the cerebellum and that these changes can be reversed by both GPi and CM/Voi DBS.
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Affiliation(s)
- Cathleen Haense
- Department of Nuclear Medicine, Hannover Medical School , Hannover , Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School , Hannover , Germany
| | - Florian Wilke
- Department of Radiation Protection and Medical Physics, Hannover Medical School , Hannover , Germany
| | | | - Holger H Capelle
- Department of Neurosurgery, Hannover Medical School , Hannover , Germany
| | - Lilli Geworski
- Department of Radiation Protection and Medical Physics, Hannover Medical School , Hannover , Germany
| | - Frank M Bengel
- Department of Nuclear Medicine, Hannover Medical School , Hannover , Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School , Hannover , Germany
| | - Georg Berding
- Department of Nuclear Medicine, Hannover Medical School , Hannover , Germany
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