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. 2008 Apr;5(2):339–344. doi: 10.1016/j.nurt.2008.01.009

Deep brain stimulation in Tourette’s syndrome

Linda Ackermans 1, Yasin Temel 1, Veerle Visser-Vandewalle 1,✉
PMCID: PMC5084175  PMID: 18394575

Summary

Tourette’s Syndrome (TS) is a neuropsychiatric disorder characterized by motor and vocal tics, often associated with behavioral disorders. Symptoms often disappear before or during adulthood. The pathophysiology of TS is still a matter of considerable debate. Current knowledge of cortico—basal ganglia—thalamocortical circuits provide explanations for the beneficial effects of deep brain stimulation (DBS) on tics. When conservative treatment fails in patients with severe TS, DBS may be a therapeutic option. In 1999, thalamic DBS was introduced for intractable TS. Since then, multiple targets have been used in a small number of patients, including the globus pallidus pars interna and the nucleus accumbens. Inclusion and exclusion criteria have been formulated to identify good candidates for DBS.

Key Words: DBS, Tourette’s syndrome, tics, stimulation, thalamus

References

  • 1.Krämer H, Daniels C. Pioneers of movement disorders: Georges Gilles de la Tourette. J Neural Transm. 2004;111:691–701. doi: 10.1007/s00702-004-0113-3. [DOI] [PubMed] [Google Scholar]
  • 2.Mink JW. Basal ganglia dysfunction in Tourette’s syndrome: a new hypothesis. Pediatr Neurol. 2001;25:190–198. doi: 10.1016/S0887-8994(01)00262-4. [DOI] [PubMed] [Google Scholar]
  • 3.Leckman JF, Bloch MH, Scahill L, King RA. Tourette syndrome: the self under siege. J Child Neurol. 2006;21:642–649. doi: 10.1177/08830738060210081001. [DOI] [PubMed] [Google Scholar]
  • 4.Robertson MM. Tourette syndrome, associated conditions and the complexities of treatment. Brain. 2000;123:425–462. doi: 10.1093/brain/123.3.425. [DOI] [PubMed] [Google Scholar]
  • 5.Lombroso PJ, Mack G, Scahill L, et al. Exacerbation of Gilles de la Tourette’s syndrome associated with thermal stress: a family study. Neurology. 1991;41:1984–1987. doi: 10.1212/wnl.41.12.1984. [DOI] [PubMed] [Google Scholar]
  • 6.Berardelli A, Currà A, Fabbrini G, Gilio F, Manfredi M. Pathophysiology of tics and Tourette syndrome. J Neurol. 2003;250:781–787. doi: 10.1007/s00415-003-1102-4. [DOI] [PubMed] [Google Scholar]
  • 7.Hoekstra PJ, Anderson GM, Limburg PC, Korf J, Kallenberg CG, Minderaa RB. Neurobiology and neuroimmunology of Tourette’s syndrome: an update. Cell Mol Life Sci. 2004;61:886–898. doi: 10.1007/s00018-003-3320-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Riederer F, Stamenkovic M, Schindler SD, Kasper S. Tourette’s syndrome: a review [In German] Nervenarzt. 2002;73:805–819. doi: 10.1007/s00115-002-1270-y. [DOI] [PubMed] [Google Scholar]
  • 9.Leckman JF. Tourette’s syndrome. Lancet. 2002;360:1577–1586. doi: 10.1016/S0140-6736(02)11526-1. [DOI] [PubMed] [Google Scholar]
  • 10.Neimat JS, Patil PG, Lozano AM. Novel surgical therapies for Tourette syndrome. J Child Neurol. 2006;21:715–718. doi: 10.1177/08830738060210080301. [DOI] [PubMed] [Google Scholar]
  • 11.Temel Y, Visser-Vandewalle V. Surgery in Tourette syndrome. Mov Disord. 2004;19:3–14. doi: 10.1002/mds.10649. [DOI] [PubMed] [Google Scholar]
  • 12.Vandewalle V, van der Linden C, Groenewegen HJ, Caemaert J. Stereotactic treatment of Gilles de la Tourette syndrome by high frequency stimulation of thalamus. Lancet. 1999;353:724–724. doi: 10.1016/S0140-6736(98)05964-9. [DOI] [PubMed] [Google Scholar]
  • 13.Hassler R, Dieckmann G. Stereotaxic treatment of tics and inarticulate cries or coprolalia considered as motor obsessional phenomena in Gilles de la Tourette’s disease [In French] Rev Neurol (Paris) 1970;123:89–100. [PubMed] [Google Scholar]
  • 14.Visser-Vandewalle V, Temel Y, Boon P, et al. Chronic bilateral thalamic stimulation: a new therapeutic approach in intractable Tourette syndrome: report of three cases. J Neurosurg. 2003;99:1094–1100. doi: 10.3171/jns.2003.99.6.1094. [DOI] [PubMed] [Google Scholar]
  • 15.Temel Y, van Lankveld JJ, Boon P, Spincemaille GH, van der Linden C, Visser-Vandewalle V. Deep brain stimulation of the thalamus can influence penile erection. Int J Impot Res. 2004;16:91–94. doi: 10.1038/sj.ijir.3901098. [DOI] [PubMed] [Google Scholar]
  • 16.Harris K, Singer HS. Tic disorders: neural circuits, neurochemistry, and neuroimmunology. J Child Neurol. 2006;21:678–689. doi: 10.1177/08830738060210080901. [DOI] [PubMed] [Google Scholar]
  • 17.Singer HS, Minzer K. Neurobiology of Tourette’s syndrome: concepts of neuroanatomic localization and neurochemical abnormalities. Brain Rev. 2003;25(Suppl 1):S70–S84. doi: 10.1016/s0387-7604(03)90012-x. [DOI] [PubMed] [Google Scholar]
  • 18.Peterson BS, Skudlarski P, Anderson AW, et al. A functional magnetic resonance imaging study of tic suppression in Tourette syndrome. Arch Gen Psychiatry. 1998;55:326–333. doi: 10.1001/archpsyc.55.4.326. [DOI] [PubMed] [Google Scholar]
  • 19.Graybiel AM. The basal ganglia. Curr Biol. 2000;10:R509–R511. doi: 10.1016/S0960-9822(00)00593-5. [DOI] [PubMed] [Google Scholar]
  • 20.Groenewegen HJ, van den Heuvel OA, Cath DC, Voorn P, Veltman DJ. Does an imbalance between the dorsal and ventral striatopallidal systems play a role in Tourette’s syndrome? A neuronal circuit approach. Brain Dev. 2003;25(Suppl 1):S3–S14. doi: 10.1016/S0387-7604(03)90001-5. [DOI] [PubMed] [Google Scholar]
  • 21.Peterson BS, Thomas P, Kane MJ, et al. Basal ganglia volumes in patients with Gilles de la Tourette syndrome. Arch Gen Psychiatry. 2003;60:415–424. doi: 10.1001/archpsyc.60.4.415. [DOI] [PubMed] [Google Scholar]
  • 22.Stern E, Silbersweig DA, Chee KY, et al. A functional neuroanatomy of tics in Tourette syndrome. Arch Gen Psychiatry. 2000;57:741–748. doi: 10.1001/archpsyc.57.8.741. [DOI] [PubMed] [Google Scholar]
  • 23.Servello D, Sassi M, Geremia L, Porta M. Bilateral thalamic stimulation for intractable Tourette syndrome. In: Meglio M, editor. Proceedings of the 14th Meeting of the World Society for Stereotactic and Functional Neurosurgery, WSSFN: Rome, Italy, June 14–17, 2005. Bologna: Medimond International Proceedings; 2005. [Google Scholar]
  • 24.Servello D, Porta M, Sassi M, Brambilla A, Robertson MM. Deep brain stimulation in 18 patients with severe Gilles de la Tourette Syndrome refractory to treatment: the surgery and stimulation. J Neurol Neurosurg Psychiatry. 2008;79:136–142. doi: 10.1136/jnnp.2006.104067. [DOI] [PubMed] [Google Scholar]
  • 25.Egidi M, Carrabba G, Priori A, et al. Thalamic DBS in Tourette’s syndrome: case report. In: Meglio M, et al., editors. Proceedings of the 14th Meeting of the World Society for Stereotactic and Functional Neurosurgery, WSSFN: Rome, Italy, June 14–17, 2005. Bologna: Medimond International Proceedings; 2005. [Google Scholar]
  • 26.Bajwa RJ, de Lotbinière AJ, King RA, et al. Deep brain stimulation in Tourette’s syndrome. Mov Disord. 2007;22:1346–1350. doi: 10.1002/mds.21398. [DOI] [PubMed] [Google Scholar]
  • 27.Houeto JL, Karachi C, Mallet L, et al. Tourette’s syndrome and deep brain stimulation. J Neurol Neurosurg Psychiatry. 2005;76:992–995. doi: 10.1136/jnnp.2004.043273. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Van der Linden C, Colle H, Vandewalle V, Alessi G, Rijckaert D, De Waele L. Successful treatment of tics with bilateral internal pallidum (GPi) stimulation in a 27-year-old male patient with Gilles de la Tourette’s syndrome. Mov Disord. 2002;17(Suppl 5):S341–S341. [Google Scholar]
  • 29.Diederich NJ, Bumb A, Mertens E, Kalteis K, Stamenkovic M, Alesch F. Efficient internal segment pallidal stimulation in Gilles de la Tourette syndrome: a case report. Mov Disord. 2004;19(Suppl 9):S440–S440. doi: 10.1002/mds.20551. [DOI] [PubMed] [Google Scholar]
  • 30.Shahed J, Poysky J, Kenney C, Simpson K, Jankovic J. GPi deep brain stimulation for Tourette syndrome improves tics and psychiatric comorbidities. Neurology. 2007;68:159–160. doi: 10.1212/01.wnl.0000250354.81556.90. [DOI] [PubMed] [Google Scholar]
  • 31.Flaherty AW, Williams ZM, Amirnovin R, et al. Deep brain stimulation of the internal capsule for the treatment of Tourette syndrome: technical case report. Neurosurgery. 2005;57:E403–E403. doi: 10.1227/01.NEU.0000176854.24694.95. [DOI] [PubMed] [Google Scholar]
  • 32.Kuhn J, Lenartz D, Mai JK, et al. Deep brain stimulation of the nucleus accumbens and the internal capsule in therapeutically refractory Tourette-syndrome. J Neurol. 2007;254:963–965. doi: 10.1007/s00415-006-0404-8. [DOI] [PubMed] [Google Scholar]
  • 33.Maciunas RJ, Maddux BN, Riley DE, et al. Prospective randomized double-blind trial of bilateral thalamic deep brain stimulation in adults with Tourette syndrome. J Neurosurg. 2007;107:1004–1014. doi: 10.3171/JNS-07/11/1004. [DOI] [PubMed] [Google Scholar]
  • 34.Ackermans L, Temel Y, Bauer NJ, Visser-Vandewalle V, Dutch-Flemish Tourette Surgery Study Group Vertical gaze palsy after thalamic stimulation for Tourette syndrome: case report. Neurosurgery. 2007;61:E1100–E1100. doi: 10.1227/01.neu.0000303208.00242.a6. [DOI] [PubMed] [Google Scholar]
  • 35.Visser-Vandewalle V, Ackermans L, van der Linden C, et al. Deep brain stimulation in Gilles de la Tourette’s syndrome. Neurosurgery. 2006;58:E590–E590. doi: 10.1227/01.NEU.0000207959.53198.D6. [DOI] [PubMed] [Google Scholar]
  • 36.Mink JW, Walkup J, Frey KA, Tourette Syndrome Association, Inc Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome. Mov Disord. 2006;21:1831–1838. doi: 10.1002/mds.21039. [DOI] [PubMed] [Google Scholar]
  • 37.American Psychiatric Association . Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association; 2000. Task Force on DSM-IV. [Google Scholar]
  • 38.Robertson MM, Banerjee S, Kurlan R, et al. The Tourette Syndrome Diagnostic Confidence Index: development and clinical associations. Neurology. 1999;53:2108–2112. doi: 10.1212/wnl.53.9.2108. [DOI] [PubMed] [Google Scholar]
  • 39.Leckman JF, Riddle MA, Hardin MT, et al. The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry. 1989;28:566–573. doi: 10.1097/00004583-198907000-00015. [DOI] [PubMed] [Google Scholar]
  • 40.Goetz CG, Pappert EJ, Louis ED, Raman R, Leurgans S. Advantages of a modified scoring method for the Rush Video-Based Tic Rating Scale. Mov Disord. 1999;14:502–506. doi: 10.1002/1531-8257(199905)14:3<502::AID-MDS1020>3.0.CO;2-G. [DOI] [PubMed] [Google Scholar]
  • 41.Goetz CG, Leurgans S, Chmura TA. Home alone: methods to maximize tic expression for objective videotape assessments in Gilles de la Tourette syndrome. Mov Disord. 2001;16:693–697. doi: 10.1002/mds.1159. [DOI] [PubMed] [Google Scholar]

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