Deep brain stimulation for Gilles de la Tourette syndrome

Gilles de la Tourette syndrome (GTS) is a childhood-onset neurodevelopmental disorder characterized by motor and vocal tics and commonly associated with comorbid psychiatric and behavioral symptoms. Medication or behavioral therapies are effective for treating GTS in most cases; however, a proportion of individuals experience treatment-refractory tics. Deep brain stimulation (DBS) is an invasive surgical therapy reserved for select individuals with severe, treatment-refractory GTS. DBS has been targeted to several brain regions involved in the basal ganglia-thalamo-cortical networks implicated in GTS pathophysiology, including medial thalamic regions, the anteromedial (limbic) globus pallidus internus, and the posteroventrolateral (sensorimotor) globus pallidus internus, among others. Evidence from case studies, open-label studies, randomized controlled trials, and multicenter retrospective studies has suggested that DBS can be effective for improving tics, comorbidities, and quality of life. However, outcomes have been variable across individuals, and challenges remain regarding selecting individuals who are most likely to benefit from DBS, identifying effective target(s) for each individual, and determining optimal postoperative stimulation strategies. Progress has been made toward addressing these challenges through multicenter collaborations, neuroimaging, and neurophysiology; however, further prospective studies, clinical trials, and regulatory approvals will be needed to advance DBS as a more widely adopted therapy for treatment-refractory GTS.