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Deep brain stimulation for Tourette syndrome.

V Visser-Vandewalle1, J Kuhn

  • 1Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands.

Handbook of Clinical Neurology
|October 12, 2013
PubMed
Summary

Deep brain stimulation (DBS) offers a surgical option for severe Tourette syndrome (TS) cases. Research explores various brain targets to improve tic reduction in patients with intractable symptoms.

Keywords:
DBSTourette syndromeglobus pallidus externusglobus pallidus internusinternal capsule/nucleus accumbensstimulationthalamustics

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Area of Science:

  • Neuroscience
  • Neurosurgery
  • Psychiatry

Background:

  • Tourette syndrome (TS) is a neuropsychiatric disorder presenting with motor and vocal tics, typically starting in childhood.
  • While many TS patients experience symptom improvement or respond to behavioral therapy/medication, a subset requires advanced interventions.
  • Deep brain stimulation (DBS) emerged in 1999 as a surgical option for intractable Tourette syndrome.

Purpose of the Study:

  • To review the evolution and current understanding of deep brain stimulation (DBS) for Tourette syndrome (TS).
  • To discuss the various brain targets utilized for DBS in TS patients.
  • To highlight the need for standardized multicenter trials to optimize DBS efficacy in Tourette syndrome.

Main Methods:

  • Review of existing literature and clinical practices regarding DBS for Tourette syndrome.
  • Analysis of different anatomical targets within the thalamus, globus pallidus, and internal capsule/nucleus accumbens.
  • Discussion of inclusion/exclusion criteria for identifying suitable DBS candidates.

Main Results:

  • Multiple DBS targets have been explored, including the medial thalamus, globus pallidus internus/externus, and internal capsule/nucleus accumbens.
  • Understanding of cortical-basal ganglia-thalamocortical circuits aids in explaining DBS's beneficial effects on tics.
  • Established criteria exist for selecting patients for DBS, though refinement is ongoing.

Conclusions:

  • Deep brain stimulation (DBS) is a viable treatment for a select group of patients with severe Tourette syndrome.
  • Further research into optimal DBS targets and precise targeting is warranted.
  • There is a critical need for multicenter, double-blind trials with standardized protocols to advance DBS therapy for Tourette syndrome.