1
|
Li Y, Yan JJ, Cui YH. Clinical characteristics of pediatric patients with treatment-refractory Tourette syndrome: An evidence-based survey in a Chinese population. World J Psychiatry 2022; 12:958-969. [PMID: 36051602 PMCID: PMC9331451 DOI: 10.5498/wjp.v12.i7.958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/06/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tourette syndrome (TS) is a complex neurodevelopmental condition marked by tics, as well as a variety of psychiatric comorbidities, such as obsessive-compulsive disorders (OCDs), attention deficit hyperactivity disorder (ADHD), anxiety, and self-injurious behavior. TS might progress to treatment-refractory Tourette syndrome (TRTS) in some patients. However, there is no confirmed evidence in pediatric patients with TRTS.
AIM To investigate the clinical characteristics of TRTS in a Chinese pediatric sample.
METHODS A total of 126 pediatric patients aged 6-12 years with TS were identified, including 64 TRTS and 62 non-TRTS patients. The Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), and Child Behavior Checklist (CBCL) were used to assess these two groups and compared the difference between the TRTS and non-TRTS patients.
RESULTS When compared with the non-TRTS group, we found that the age of onset for TRTS was younger (P < 0.001), and the duration of illness was longer (P < 0.001). TRTS was more often caused by psychosocial (P < 0.001) than physiological factors, and coprolalia and inappropriate parenting style were more often present in the TRTS group (P < 0.001). The TRTS group showed a higher level of premonitory urge (P < 0.001), a lower intelligence quotient (IQ) (P < 0.001), and a higher percentage of family history of TS. The TRTS patients demonstrated more problems (P < 0.01) in the “Uncommunicative”, “Obsessive-Compulsive”, “Social-Withdrawal”, “Hyperactive”, “Aggressive”, and “Delinquent” subscales in the boys group, and “Social-Withdrawal” (P = 0.02) subscale in the girls group.
CONCLUSION Pediatric TRTS might show an earlier age of onset age, longer duration of illness, lower IQ, higher premonitory urge, and higher comorbidities with ADHD-related symptoms and OCD-related symptoms. We need to pay more attention to the social communication deficits of TRTS.
Collapse
Affiliation(s)
- Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Beijing 100045, China
| | - Jun-Juan Yan
- Department of Psychiatry, Beijing Children's Hospital, Beijing 100045, China
| | - Yong-Hua Cui
- Department of Psychiatry, Beijing Children's Hospital, Beijing 100045, China
| |
Collapse
|
2
|
Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets. Brain Sci 2020; 10:brainsci10050301. [PMID: 32429219 PMCID: PMC7287742 DOI: 10.3390/brainsci10050301] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 01/01/2023] Open
Abstract
Gilles de la Tourette syndrome (GTS) is a complex neurodevelopmental disorder characterized by tics and, frequently, psychiatric and behavioral comorbidities. Above all, obsessive compulsive disorder/behavior (OCD/OCB) influences the clinical picture and has a severe impact on quality of life, eventually more than the tics themselves. Deep brain stimulation (DBS) is an effective therapy in selected, refractory cases. Clinical response to DBS may vary according to the clinical picture, comorbidities, and to the anatomical target. This retrospective study compares the results obtained from DBS in the ventralis oralis/centromedian-parascicular nucleus of the thalamus (Voi-Cm/Pf) (41 patients) and antero-medial Globus Pallidus internus (am-GPi) (14 patients), evaluating clinical response over time by means of Yale Global Tic Severity Scale (YGTSS) and Yale–Brown Obsessive-Compulsive Scale (YBOCS) scores over a period of 48 months. A significant and stable improvement in the YGTSS and YBOCS has been obtained in both groups (p < 0.001). There was a significant difference in YBOCS improvement over time between the am-GPi group and the Voi-Cm/Pf group, indicating a better and faster control of OCD/OCB symptoms in the former group. The ratio of hardware removal was 23% and limited to 13 patients in the Voi-Cm/Pf group. These results confirm that DBS is an effective therapy in treating GTS and suggest that the am-GPi might be superior to Voi-Cm/Pf in alleviating comorbid OCD/OCB.
Collapse
|
3
|
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]
|
4
|
Kious BM, Jimenez-Shahed J, Shprecher DR. Treatment-refractory Tourette Syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:227-36. [PMID: 26875502 DOI: 10.1016/j.pnpbp.2016.02.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/02/2016] [Accepted: 02/08/2016] [Indexed: 12/27/2022]
Abstract
Tourette Syndrome (TS) is a complex neurodevelopmental condition marked by tics and frequently associated with psychiatric comorbidities. While most cases are mild and improve with age, some are treatment-refractory. Here, we review strategies for the management of this population. We begin by examining the diagnosis of TS and routine management strategies. We then consider emerging treatments for refractory cases, including deep brain stimulation (DBS), electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and novel pharmacological approaches such as new vesicular monoamine transporter type 2 inhibitors, cannabinoids, and anti-glutamatergic drugs.
Collapse
Affiliation(s)
- Brent M Kious
- University of Utah, Department of Psychiatry, 501 Chipeta Way, Salt Lake City, UT 84108, United States.
| | - Joohi Jimenez-Shahed
- Baylor College of Medicine, Department of Neurology, 7200 Cambridge, Suite 9a/MS: BCM 609, Houston, TX 77030, United States
| | - David R Shprecher
- University of Utah, Department of Neurology, 729 Arapeen Drive, Salt Lake City, UT 84108, United States; Banner Sun Health Research Institute, 10515 W. Santa Fe Drive, Sun City, AZ 85351, United States
| |
Collapse
|
5
|
Servello D, Zekaj E, Saleh C, Lange N, Porta M. Deep Brain Stimulation in Gilles de la Tourette Syndrome: What Does the Future Hold? A Cohort of 48 Patients. Neurosurgery 2016; 78:91-100. [PMID: 26348012 DOI: 10.1227/neu.0000000000001004] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gilles de la Tourette syndrome (GTS) is a severe neuropsychiatric disorder with childhood onset, characterized by disabling motor and vocal tics lasting for more than 1 year and associated with a wide range of psychiatric comorbidities. Pharmacological treatment is indicated for moderate to severe GTS patients. However, when GTS is refractory to conventional medical and behavioral treatments, deep brain stimulation (DBS) can be considered as a last resort therapeutic avenue. OBJECTIVE To evaluate the efficacy of DBS and its comorbidities in the largest pool of GTS patients to date. METHODS Our cohort study was based on 48 patients' refractory to conventional treatment who underwent DBS for GTS at Galeazzi Institute, Milan, Italy. An exhaustive preoperative and a follow-up battery of tests was performed including the Yale Global Tic Severity Rating Scale, the Yale-Brown Obsessive Compulsive Scale, the Beck Depression Inventory, the State Trait Anxiety Inventory, and the Subjective Social Impairment on a 10-point Visual Analogue Scale tests. RESULTS Eleven patients in whom the device was removed for inflammatory complications or for poor compliance were excluded from final analysis. Twenty-seven of the remaining 37 patients had a Yale Global Tic Severity Rating Scale score at the last follow-up that was less than 35. Of the 37 patients, in 29 cases (78%) a reduction of more than 50% of the Yale Global Tic Severity Rating Scale score was observed. CONCLUSION The clinical efficacy of DBS in GTS is promising. Although DBS is associated with risks, as is any surgical intervention, DBS should be considered as a last resort therapeutic option in carefully selected GTS patients.
Collapse
Affiliation(s)
- Domenico Servello
- *Departments of Neurosurgery and Neurology, IRCCS Galeazzi, Milan, Italy;‡Department of Psychiatry, Harvard Medical School, Neurostatistics Laboratory, Belmont, Massachusetts
| | | | | | | | | |
Collapse
|
6
|
Macerollo A, Martino D, Cavanna AE, Gulisano M, Hartmann A, Hoekstra PJ, Hedderly T, Debes NM, Muller-Vahl K, Neuner I, Porta M, Rickards H, Rizzo R, Cardona F, Roessner V. Refractoriness to pharmacological treatment for tics: A multicentre European audit. J Neurol Sci 2016; 366:136-138. [PMID: 27288792 DOI: 10.1016/j.jns.2016.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 04/05/2016] [Accepted: 05/02/2016] [Indexed: 11/17/2022]
Affiliation(s)
- A Macerollo
- Sobell Department of Motor Neuroscience and Movement Disorders, The National Hospital of Neurology and Neurosurgery, Institute of Neurology, University College London, London, United Kingdom
| | - D Martino
- International Parkinson's Centre of Excellence, King's College and King's College Hospital, Denmark Hill Campus, London, United Kingdom; Queen Elizabeth Hospital, Woolwich, Lewisham & Greenwich NHS Trust, London, United Kingdom.
| | - A E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, United Kingdom
| | - M Gulisano
- Section of Child Neuropsichiatry, Dipartimento di Scienze Mediche e Pediatriche, Catania University, Catania, Italy
| | - A Hartmann
- Centre de Référence National Maladie Rare: Syndrome Gilles de la Tourette, Département de Neurologie, Pôle des Maladies du Système Nerveux, France
| | - P J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T Hedderly
- TANDeM Clinic-Evelina London Children's Hospital at Guys and St. Thomas', Kings Health Partners AHSC, London, United Kingdom
| | - N M Debes
- Pediatric Department, Glostrup University Hospital, Glostrup, Denmark
| | - K Muller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Street 1, D-30625 Hannover, Germany
| | - I Neuner
- Institute of Neuroscience and Medicine 4, (INM 4), Forschungszentrum, Jülich, Jülich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, JARA-BRAIN - Translational Medicine, Germany
| | - M Porta
- Departments of Neurosurgery and Neurology, IRCCS Galeazzi, Milan, Italy
| | - H Rickards
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, United Kingdom
| | - R Rizzo
- Section of Child Neuropsichiatry, Dipartimento di Scienze Mediche e Pediatriche, Catania University, Catania, Italy
| | - F Cardona
- Department of Psychology, University of Rome, La Sapienza, Rome, Italy
| | - V Roessner
- Klinik und Poliklinikfür Kinder- und Jugendpsychiatrie und -psychotherapie, TechnischeUniversität Dresden, Germany
| |
Collapse
|
7
|
Porta M, Saleh C, Zekaj E, Zanaboni Dina C, Bona AR, Servello D. Why so many deep brain stimulation targets in Tourette’s syndrome? Toward a broadening of the definition of the syndrome. J Neural Transm (Vienna) 2016; 123:785-790. [DOI: 10.1007/s00702-015-1494-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/30/2015] [Indexed: 12/01/2022]
|
8
|
Kuhn KW, Cambron J. Chiropractic management using a brain-based model of care for a 15-year-old adolescent boy with migraine headaches and behavioral and learning difficulties: a case report. J Chiropr Med 2014; 12:274-80. [PMID: 24396330 DOI: 10.1016/j.jcm.2013.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 06/23/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The purpose of this report is to describe chiropractic management, using a brain-based model of care, of a teen who had migraine headaches and several social and learning difficulties. CLINICAL FEATURES A 15-year-old adolescent boy with a chronic history of migraines and more than 10 years of learning and behavioral difficulties, including attention-deficit/hyperactivity disorder, obsessive compulsive disorder, and Tourette syndrome, presented for chiropractic care. INTERVENTION AND OUTCOME The patient received spinal manipulation and was given home physical coordination activities that were contralateral to the side of the involved basal ganglia and ipsilateral to the involved cerebellum, along with interactive metronome training. Quantitative changes were noted in neurological soft signs, tests of variables of attention Conners' Parent Rating Scale, the California Achievement Test, grade point, and reduction of medications. The patient reported qualitative improvements in tics, attention, reading, vision, health, relationships with his peers and his family, and self-esteem. CONCLUSION The patient with migraine headaches and learning difficulties responded well to the course of chiropractic care. This study suggests that there may be value in a brain-based model of care in the chiropractic management of conditions that are beyond musculoskeletal in nature.
Collapse
Affiliation(s)
| | - Jerrilyn Cambron
- Professor, Research, Basic and Clinical Science, National University of Health Sciences, Lombard, IL
| |
Collapse
|
9
|
Motlagh MG, Smith ME, Landeros-Weisenberger A, Kobets AJ, King RA, Miravite J, de Lotbinière ACJ, Alterman RL, Mogilner AY, Pourfar MH, Okun MS, Leckman JF. Lessons Learned from Open-label Deep Brain Stimulation for Tourette Syndrome: Eight Cases over 7 Years. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2013; 3. [PMID: 24255802 PMCID: PMC3822402 DOI: 10.7916/d8m32tgm] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/23/2013] [Indexed: 12/26/2022]
Abstract
Background Deep brain stimulation (DBS) remains an experimental but promising treatment for patients with severe refractory Gilles de la Tourette syndrome (TS). Controversial issues include the selection of patients (age and clinical presentation), the choice of brain targets to obtain optimal patient-specific outcomes, and the risk of surgery- and stimulation-related serious adverse events. Methods This report describes our open-label experience with eight patients with severe refractory malignant TS treated with DBS. The electrodes were placed in the midline thalamic nuclei or globus pallidus, pars internus, or both. Tics were clinically assessed in all patients pre- and postoperatively using the Modified Rush Video Protocol and the Yale Global Tic Severity Scale (YGTSS). Results Although three patients had marked postoperative improvement in their tics (>50% improvement on the YGTSS), the majority did not reach this level of clinical improvement. Two patients had to have their DBS leads removed (one because of postoperative infection and another because of lack of benefit). Discussion Our clinical experience supports the urgent need for more data and refinements in interventions and outcome measurements for severe, malignant, and medication-refractory TS. Because TS is not an etiologically homogenous clinical entity, the inclusion criteria for DBS patients and the choice of brain targets will require more refinement.
Collapse
Affiliation(s)
- Maria G Motlagh
- Child Study Center, Yale University, New Haven, Connecticut, United States of America
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Williams NR, Okun MS. Deep brain stimulation (DBS) at the interface of neurology and psychiatry. J Clin Invest 2013; 123:4546-56. [PMID: 24177464 DOI: 10.1172/jci68341] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Deep brain stimulation (DBS) is an emerging interventional therapy for well-screened patients with specific treatment-resistant neuropsychiatric diseases. Some neuropsychiatric conditions, such as Parkinson disease, have available and reasonable guideline and efficacy data, while other conditions, such as major depressive disorder and Tourette syndrome, have more limited, but promising results. This review summarizes both the efficacy and the neuroanatomical targets for DBS in four common neuropsychiatric conditions: Parkinson disease, Tourette syndrome, major depressive disorder, and obsessive-compulsive disorder. Based on emerging new research, we summarize novel approaches to optimization of stimulation for each neuropsychiatric disease and we review the potential positive and negative effects that may be observed following DBS. Finally, we summarize the likely future innovations in the field of electrical neural-network modulation.
Collapse
|
11
|
Servello D, Zekaj E, Sassi M, Menghetti C, Porta M. Submuscular Submammarian Internal Pulse Generator Implantation in a Patient with Tourette's Syndrome and Obsessive Compulsive Behavior. Neuromodulation 2013; 17:96-7. [DOI: 10.1111/ner.12025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 11/27/2022]
Affiliation(s)
| | - Edvin Zekaj
- Functional Neurosurgical Unit; IRCCS Galeazzi Milano; Milan Italy
| | - Marco Sassi
- Functional Neurosurgical Unit; IRCCS Galeazzi Milano; Milan Italy
| | | | - Mauro Porta
- Functional Neurosurgical Unit; IRCCS Galeazzi Milano; Milan Italy
| |
Collapse
|
12
|
Porta M, Servello D, Zanaboni C, Anasetti F, Menghetti C, Sassi M, Robertson MM. Deep brain stimulation for treatment of refractory Tourette syndrome: long-term follow-up. Acta Neurochir (Wien) 2012; 154:2029-41. [PMID: 22961243 DOI: 10.1007/s00701-012-1497-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 08/23/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Eighteen patients with severe and refractory Tourette Syndrome underwent bilateral thalamic deep brain stimulation. The surgical procedures and stimulation processes of the cohort were reported in 2008; the 2 year follow-up was reported in 2009. The aim of the research is the assessment of long-term outcome (5-6 years) on tics, obsessional behaviours, anxiety, mood, and on the overall general health of the patients and their general satisfaction. METHOD In this study, all 18 of the original patients will be discussed, pre- and post-DBS, according to our protocol using standardized objective schedules, as well as the clinical impressions of both clinicians and patients. As there were no substantial nor statistical differences on measures of cognitive functioning between pre-DBS and 2 year follow-up, we decided not to continue this aspect of the formal assessment, particularly as there were also no clinical indications. RESULTS At 5-6 year follow-up, there was a significant reduction in tic severity (p < 0.001), and significant improvements in obsessive compulsive behaviours (p = 0.003), anxiety (p < 0.001) and depressive (p < 0.001) symptoms. Patients, in general, required less medication for tics, co-morbid conditions and/or co-existent psychopathologies. The long-term outcome/satisfaction were not unanimous between patients and the medical team. CONCLUSIONS At long-term follow-up, DBS was very successful in terms of a significant improvement in tics and also a significant reduction in the potentially disabling symptoms of obsessionality, anxiety and depression. However, compared with our more positive overall results at 2 years, these later results demonstrate long-term difficulties as follows: non-compliance, long-term complications , and the differences in the opinions between the (a) medical, (b) the surgical teams and (c) the post-DBS patients as to their outcome/satisfaction with the procedures. Our experience highlights the need for controlled studies, for long-term follow up, and the need to improve the selection of patients for DBS.
Collapse
Affiliation(s)
- M Porta
- Tourette Center- IRCCS Galeazzi Hospital, via R. Galeazzi 4, 20161, Milano, Italy.
| | | | | | | | | | | | | |
Collapse
|
13
|
Müller-Vahl KR. Surgical treatment of Tourette syndrome. Neurosci Biobehav Rev 2012; 37:1178-85. [PMID: 23041074 DOI: 10.1016/j.neubiorev.2012.09.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 09/19/2012] [Accepted: 09/26/2012] [Indexed: 11/15/2022]
Abstract
In severely affected, treatment resistant patients with Tourette syndrome (TS) new therapeutic strategies are urgently needed. Since 1999, 34 studies including more than 90 patients have been performed to investigate the efficacy and safety of deep brain stimulation (DBS) in the treatment of tics resulting in the vast majority of patients in an improvement of tics and in some patients even of comorbidities. Both surgery-related (e.g., bleeding, infection) and stimulation-related adverse events (e.g., loss of energy, blurred vision) seem to occur only in a minority of patients and not to cause significant impairment, respectively. Since randomized controlled studies including a larger number of patients are still lacking, up to now, no definite conclusion can be drawn. Therefore, at present time DBS is recommended only in adult, treatment resistant, and severely affected patients. However, most experts have no doubt that DBS is indeed effective in the treatment of tics. Future studies should aim to identify which target in which patient is optimal depending on the individual symptomatology.
Collapse
Affiliation(s)
- Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
| |
Collapse
|