Since its first application in 1999, the potential benefit of deep brain stimulation (DBS) in reducing symptoms of otherwise treatment-refractory Tourette syndrome (TS) has been documented in several publications. However, uncertainty regarding the ideal neural targets remains, and the eventuality of so far undocumented but possible negative long-term effects on personality fuels the debate about the ethical implications of DBS.
In this prospective open-label trial, eight patients (three female, five male) 19–56 years old with severe and medically intractable TS were treated with high-frequency DBS of the ventral anterior and ventrolateral motor part of the thalamus. To assess the course of TS, its clinical comorbidities, personality parameters, and self-perceived quality of life, patients underwent repeated psychiatric assessments at baseline and 6 and 12 months after DBS onset.
Analysis indicated a strongly significant and beneficial effect of DBS on TS symptoms, trait anxiety, quality of life, and global functioning with an apparently low side-effect profile. In addition, presurgical compulsivity, anxiety, emotional dysregulation, and inhibition appeared to be significant predictors of surgery outcome.
Trading off motor effects and desirable side effects against surgery-related risks and negative implications, stimulation of the ventral anterior and ventrolateral motor part of the thalamus seems to be a valuable option when considering DBS for TS.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Biological Psychiatry
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Mood disorders and Gilles de la Tourette’s syndrome: An update on prevalence, etiology, comorbidity, clinical associations, and implications.J Psychosom Res. 2006; 61: 349-358
- Clinical features and associated psychopathology in a Tourette syndrome cohort.Acta Neurol Scand. 2004; 109: 255-260
- Quality of life in adults with Gilles de la Tourette syndrome.BMC Psychiatry. 2012; 12: 109
- Health-related quality of life in patients with Gilles de la Tourette’s syndrome.Mov Disord. 2010; 25: 309-314
- A controlled study of personality and affect in Tourette syndrome.Compr Psychiatry. 2013; 54: 105-110
- Deep brain stimulation for psychiatric disorders.Dtsch Arztebl Int. 2010; 107: 105-113
- Stereotactic treatment of Gilles de la Tourette syndrome by high frequency stimulation of thalamus.Lancet. 1999; 353: 724
- Surgery for Tourette syndrome.World Neurosurg. 2013; 80: e15-22
- Parallel organization of functionally segregated circuits linking basal ganglia and cortex.Annu Rev Neurosci. 1986; 9: 357-381
- Circuits and circuit disorders of the basal ganglia.Arch Neurol. 2007; 64: 20-24
World Health Organization (1992): ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization.
American Psychiatric Association (2000): Diagnostic and Statistical Manual of Mental Disorders, 4th ed rev (DSM IV-TR). Washington, DC: American Psychiatric Association
- The Tourette Syndrome Diagnostic Confidence Index: Development and clinical associations.Neurology. 1999; 53: 2108-2112
- European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: Deep brain stimulation.Eur Child Adolesc Psychiatry. 2011; 20: 209-217
- Clinical effectiveness of unilateral deep brain stimulation in Tourette syndrome.Transl Psychiatry. 2011; 1: e52
- 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
- Advantages of a modified scoring method for the Rush Video-Based Tic Rating Scale.Mov Disord. 1999; 14: 502-506
- The Yale-Brown Obsessive Compulsive Scale. II. Validity.Arch Gen Psychiatry. 1989; 46: 1012-1016
- Beck Depression Inventory Manual. The Psychological Corporation, San Antonio1988
- Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press, Palo Alto, CA1983
- Manual for the Dimensional Assessment of Personality Pathology–Basic Questionnaire (DAPP-BQ). Sigma Press, Port Huron2002
- Quality of life in psychiatry: A systematic contribution to construct validation and the development of the integrative assessment tool “modular system for quality of life.”.Eur Arch Psychiatry Clin Neurosci. 2000; 250: 120-132
- Atlas of the Human Brain, 3rd ed. Academic Press, San Diego2007
- Motor thalamic circuits in primates with emphasis on the area targeted in treatment of movement disorders.Mov Disord. 2002; 17: S9-S14
- Thalamus.The Human Nervous System. Academic Press, San Diego2011: 620-679
- Stimulating personality: Ethical criteria for deep brain stimulation in psychiatric patients and for enhancement purposes.Biotechnol J. 2008; 3: 1511-1520
- The Collaborative Longitudinal Personality Disorders Study (CLPS): Overview and implications.J Pers Disord. 2005; 19: 487-504
- Examining cortisol rhythmicity and responsivity to stress in children with Tourette syndrome.Psychoneuroendocrinology. 2008; 33: 810-820
- Lack of benefit of accumbens/capsular deep brain stimulation in a patient with both tics and obsessive-compulsive disorder.Neurocase. 2010; 16: 321-330
- Pallidal versus subthalamic deep-brain stimulation for Parkinson’s disease.N Engl J Med. 2010; 362: 2077-2091
- Double-blind clinical trial of thalamic stimulation in patients with Tourette syndrome.Brain. 2011; 134: 832-844
- In vivo evidence of deep brain stimulation-induced dopaminergic modulation in Tourette’s syndrome.Biol Psychiatry. 2012; 71: e11-e13
- A three-dimensional histological atlas of the human basal ganglia. II. Atlas deformation strategy and evaluation in deep brain stimulation for Parkinson disease.J Neurosurg. 2009; 110: 208-219
- CranialVault and its CRAVE tools: A clinical computer assistance system for deep brain stimulation (DBS) therapy.Med Image Anal. 2012; 16: 744-753
Published online: June 02, 2014
Accepted: May 14, 2014
Received in revised form: April 24, 2014
Received: October 30, 2013
© Society of Biological Psychiatry, 2014.
ScienceDirectAccess this article on ScienceDirect
- Deep Brain Stimulation for Tourette Syndrome: Lessons Learned and Future DirectionsBiological PsychiatryVol. 79Issue 5
- PreviewTourette syndrome (TS) is a childhood-onset neuropsychiatric disorder that affects neural circuits involved in sensory and motor processing as well as cognitive control. Tics consist of repetitive, unwanted, non–goal-directed muscle contractions involving discrete muscle groups, which are associated with preceding sensory phenomena (urges) and are variably suppressible by volition (1). Most individuals with TS experience improvement of their tics in late adolescence or early adulthood. However, a few individuals have severe and self-injurious tics that are refractory to currently available behavioral and pharmacologic interventions.