Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: June 02, 2014
Accepted:
May 14,
2014
Received in revised form:
April 24,
2014
Received:
October 30,
2013
Identification
Copyright
© Society of Biological Psychiatry, 2014.
ScienceDirect
Access this article on ScienceDirectLinked Article
- 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.
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