Article

Gilles de la Tourette syndrome and deep brain stimulation

Unit of Functional Neurosurgery, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
European Journal of Neuroscience (Impact Factor: 3.18). 10/2010; 32(7):1128-34. DOI: 10.1111/j.1460-9568.2010.07415.x
Source: PubMed

ABSTRACT

Gilles de la Tourette Syndrome (GTS) is characterized by multiple motor and one or more vocal/phonic tics. Psychopathology and co-morbidity occur in approximately 80-90% of clinical cohorts. The most common psychopathologies are attention deficit hyperactivity disorder, obsessive-compulsive behaviours, obsessive-compulsive disorder, depression, anxiety and certain behavioural disorders. In severe GTS patients who are refractory to medication and other therapies, deep brain stimulation (DBS) is investigated. To date there have been some 50-55 patients who have received DBS in 19 centres worldwide. Nine different brain targets in the thalamus, the pallidum, and the ventral caudate and anterior internal capsule have been stimulated. This paper reviews critically and in detail all studies published to date. Only two studies on just a few patients fulfil some of the evidence-based criteria. DBS for GTS is therefore still highly experimental.

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    • "Animal models directly linking basal ganglia dysfunction and motor tics indicated that local disinhibition within the basal ganglia input structure, the striatum, induces the appearance of motor tics in rats and monkeys (McCairn et al., 2009). That tics are generated by the basal ganglia is also supported by studies based on deep brain stimulation of the internal globus pallidus or the thalamus (Hariz & Robertson, 2010). Three tic disorders are included in the DSM-5: Tourette's disorder (also called Tourette syndrome (TS), persistent (also called chronic) motor or vocal tic disorder, and provisional tic disorder (American Psychiatric Association, 2013). "
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    ABSTRACT: Hyperkinetic movement disorders are manifested by abnormal, uncontrollable, and unwanted movements and include six main phenotypic categories: tremor, chorea, tics, myoclonus, dystonia, and stereotypies. Tremor is an involuntary, rhythmic oscillation of a body region about a joint axis, usually produced by alternating or synchronous contractions of reciprocally innervated agonistic and antagonistic muscles. Tics are repeated, individually recognizable, intermittent movements, almost always briefly suppressible and usually associated with the awareness of an urge to perform the movement. Tourette syndrome is a neurological disorder manifested by motor and phonic tics usually starting during childhood and often accompanied by obsessive–compulsive disorder, attention-deficit/hyperactivity disorder, and other comorbid behaviors.
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    • "). Third, these disorders share symptomatology, showing considerable overlap in the core and associated symptoms , that is, issues with attention, impulsivity, repetitive behaviors , impairments in socialization and communication, anxiety, sleep disturbance, obsessive compulsive behaviors, sensory processing abnormalities, depression, and ritualistic behaviors, such as counting, repeating, or ordering and arranging (see Table 1 for a comparison of the shared symptomatology) (Grzadzinski et al., 2011; Hariz and Robertson, 2010; Hattori et al., 2006; Taylor, 2009; Terband et al., 2014; Tourette Syndrome Fact Sheet, 2013). Fourth, these disorders share neuropathology. "
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    • "Significant symptomatic improvements of motor dysfunctions were reported in these studies, but the stimulation parameters were not communicated. Since then, impressive reductions in tic frequency and severity, perhaps with greater effectiveness against motor than vocal tics, have been reported, although the number of TS patients treated with CM/Pf DBS remains small (Visser-Vandewalle et al., 2003, 2004, 2006; Temel and Visser-Vandewalle, 2004; Houeto et al., 2005; Ackermans et al., 2006, 2008, 2010, 2011; Bajwa et al., 2007; Maciunas et al., 2007; Servello et al., 2008, 2010; Shields et al., 2008; Porta et al., 2009; Hariz and Robertson, 2010; Sassi et al., 2011; Maling et al., 2012; Savica et al., 2012; Visser-Vandewalle and Kuhn, 2013). The time course of tic improvement varies between individuals, ranging from immediate effects (Visser-Vandewalle et al., 2003; Maciunas et al., 2007) to a more protracted time course (Maciunas et al., 2007; Servello et al., 2008). "
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