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Embedded Human Closed-Loop Deep Brain Stimulation for Tourette Syndrome: A Nonrandomized Controlled Trial.

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Closed-loop deep brain stimulation (DBS) is a safe and feasible treatment for Tourette syndrome (TS), showing comparable tic reduction to conventional DBS. This on-demand stimulation offers a promising alternative for managing TS symptoms.

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Area of Science:

  • Neurology
  • Neurosurgery
  • Biomedical Engineering

Background:

  • Tourette syndrome (TS) is a neurological disorder characterized by paroxysmal tics.
  • Conventional deep brain stimulation (DBS) offers symptomatic relief but is continuously applied.
  • On-demand stimulation targeting neural signatures of tics is a potential therapeutic strategy.

Purpose of the Study:

  • To evaluate the feasibility, safety, and clinical effectiveness of closed-loop DBS in the centromedian-parafascicular complex thalamus for medication-refractory TS.
  • To compare closed-loop DBS with conventional DBS in reducing tic severity.

Main Methods:

  • A single-center, double-blinded safety and feasibility trial involving individuals with TS.
  • Bilateral centromedian-parafascicular complex thalamic closed-loop DBS implantation.
  • Assessment of tic severity using the Yale Global Tic Severity Scale (YGTSS) and Modified Rush Videotape Rating Scale for Tic at 6 months.

Main Results:

  • Closed-loop DBS was found to be feasible and safe in 4 participants with TS.
  • Two out of four participants achieved the primary efficacy target of a 40% reduction in YGTSS scores.
  • No statistical difference in tic severity reduction was observed between closed-loop and conventional DBS compared to baseline.

Conclusions:

  • Embedded closed-loop DBS is a feasible and safe therapeutic option for Tourette syndrome.
  • Closed-loop DBS demonstrates comparable effectiveness to conventional DBS in managing tic symptoms.
  • This on-demand stimulation approach holds promise for personalized TS treatment.