Deep brain stimulation for Tourette's syndrome

Abstract

Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder characterized by the presence of multiple motor and vocal tics. TS usually co-occurs with one or multiple psychiatric disorders. Although behavioral and pharmacological treatments for TS are available, some patients do not respond to the available treatments. For these patients, TS is a severe, chronic, and disabling disorder. In recent years, deep brain stimulation (DBS) of basal ganglia-thalamocortical networks has emerged as a promising intervention for refractory TS with or without psychiatric comorbidities. Three major challenges need to be addressed to move the field of DBS treatment for TS forward: (1) patient and DBS target selection, (2) ethical concerns with treating pediatric patients, and (3) DBS treatment optimization and improvement of individual patient outcomes (motor and phonic tics, as well as functioning and quality of life). The Tourette Association of America and the American Academy of Neurology have recently released their recommendations regarding surgical treatment for refractory TS. Here, we describe the challenges, advancements, and promises of the use of DBS in the treatment of TS. We summarize the results of clinical studies and discuss the ethical issues involved in treating pediatric patients. Our aim is to provide a better understanding of the feasibility, safety, selection process, and clinical effectiveness of DBS treatment for select cases of severe and medically intractable TS.

Keywords: Adaptive close loop; Capsulotomy; Connectivity; Deep brain stimulation; Tourette syndrome.

Fig. 1

Quantitative susceptibility map of targets proposed for DBS in Tourette’s syndrome Abbreviations: ALIC, anterior limb of internal capsule; amGPi, anteromedial or limbic GPi; CM-Pf, centromedian-parafascicular complex; GPe, Globus Pallidus externus; NAc, Nucleus Accumbens; pvGPi, posteroventral GPi.