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Zhang A, Liu T, Xu J, Zhao Q, Wang X, Jiang Z, Liang S, Cui Y, Li Y. Efficacy of deep brain stimulation for Tourette syndrome and its comorbidities: A meta-analysis. Neurotherapeutics 2024; 21:e00360. [PMID: 38688785 DOI: 10.1016/j.neurot.2024.e00360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024] Open
Abstract
Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by multiple motor and vocal tics, often accompanied by comorbid disorders. Optional treatments for patients with TS include behavioral therapy, pharmacotherapy, and neurostimulation techniques. Deep brain stimulation (DBS) has been considered a therapeutic approach for refractory TS and its comorbid symptoms. However, systematic comparison is necessary to understand the therapeutic effect of DBS among patients with TS with various comorbid symptoms, demographic characteristics, or stimulation targets. Consequently, our research aimed to assess the clinical efficacy of DBS in alleviating the symptoms of TS and its comorbidities. A systematic literature search was conducted across five databases: PubMed, Web of Science, MEDLINE, Embase, and PsycINFO. The primary outcome was the mean change in the global score of the Yale Global Tic Severity Scale (YGTSS), which assesses the severity of tics. The secondary outcomes included mean improvement of comorbid symptoms, such as obsessive-compulsive behaviors (OCB), depression symptoms and anxiety symptoms. In total, 51 studies with 673 participants were included in this meta-analysis. Overall, the DBS led to a significant improvement in tic symptoms (p < 0.001), as well as the comorbid obsessive-compulsive, depression, and anxiety symptoms with effect sizes of 1.88, 0.88, 1.04, and 0.76 accordingly. In the subgroup analysis, we found that striatum stimulation led to a more significant improvement in OCB in patients with TS compared to that observed with thalamic stimulation (p = 0.017). The relationship between sex, age, and target with the improvement of tics, depression, and anxiety was not statistically significant (p = 0.923, 0.438, 0.591 for different male proportions; p = 0.463, 0.425, 0.105 for different age groups; p = 0.619, 0.113, 0.053 for different targets). In conclusion, DBS is an efficient treatment option for TS, as well as the comorbid OCB, depression symptoms, and anxiety symptoms. It is important to highlight that stimulating the striatum is more effective in managing obsessive-compulsive symptoms compared to stimulating the thalamus.
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Affiliation(s)
- Anyi Zhang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Tinghong Liu
- Functional Neurosurgery Department, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jinshan Xu
- Functional Neurosurgery Department, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qing Zhao
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Xianbin Wang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Zhongliang Jiang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China
| | - Shuli Liang
- Functional Neurosurgery Department, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China.
| | - Ying Li
- Department of Psychosomatic Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
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Trau SP, Singer HS. Tourette Syndrome and Tic Disorders. Pediatr Rev 2024; 45:85-95. [PMID: 38296781 DOI: 10.1542/pir.2023-006014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Steven P Trau
- Division of Child Neurology, Department of Neurology, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC
| | - Harvey S Singer
- Department of Neurology, Johns Hopkins Hospital and the Kennedy Krieger Institute, Baltimore, MD
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Wang X, Hu X. Quantitative risk assessment of college campus considering risk interactions. Heliyon 2023; 9:e13674. [PMID: 36873159 PMCID: PMC9975098 DOI: 10.1016/j.heliyon.2023.e13674] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Abstract
Because of the more emerging risks and stronger risk interactions, the risk of college campuses as well as students and staff received more and more attention. Current works on campus risk mostly focus on single-category factors, and few of them considered risk interactions. Therefore, an integrated model for assessing comprehensive risks on the campus is proposed to put forward risk reduction strategies. First, a comprehensive risk identification of the college campus is conducted by integrating the modified egg model and the fault tree. Then, DEMATEL (Decision-Making Trial and Evaluation Laboratory) is applied to quantify the complex risk interactions and determine the influential causes for further modelling. Finally, the Bayesian network is established for cause diagnosis, consequence prediction, and risk reduction. The identified most sensitive cause is alcohol use. In the case of the four sensitive causes simultaneously occurring, the probability of high campus risk will increase from 21.9% of the original to 39.4%. Moreover, an efficiency analysis of different risk reduction strategies is performed to determine the most efficient risk reduction strategy. The results indicate that the proposed methodology may of great significance for the risk reduction of the college campus in the changing age.
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Affiliation(s)
- Xinan Wang
- Guanghua School of Management, Peking University, Beijing 100871, China
| | - Xiaofeng Hu
- School of Information Technology and Cybersecurity, People's Public Security University of China, Beijing 100038, China
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