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.
Highlights
Surgical treatment In this review, we consider Tourette syndrome (TS) in terms of the diagnostic criteria of the DSM-V
We evaluate the results of clinical studies and discuss several methodological and ethical issues involved in deep brain stimulation (DBS) treatment of pediatric patients
A retrospective study of several patients with refractory TS and psychiatric comorbidities reported that DBS of the thalamic centromedian-parafascicular (CM-Pf) complex was associated with a 46% improvement in motor tics and 52% improvement in phonic tics, as measured by the Yale Global Tic Severity YGTSS Yale Global Tic Severity Scale (Scale) (YGTSS) at follow-up [34]
Summary
Tourette syndrome (TS) is a relatively common neuropsychiatric disorder characterized by sudden, rapid, repetitive, non-rhythmic, and stereotyped movements and/ or vocalizations. TS is frequently complicated by the presence of one or more comorbid psychiatric disorders, attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), impulse. Both DBS and ablative neurosurgical procedures have been utilized in an effort to manage refractory symptoms in TS patients [18,19,20,21]. In order to move the field of DBS treatment for TS forward and to improve individual patient outcomes, at least three major challenges need to be addressed: [1] patient and target selection, [2] ethical issues involved in treating pediatric patients, and [3] optimization of DBS, such as motor and vocal tics, mental health, daily functioning, and quality of life. The aim of this review is to provide a better understanding of the feasibility, safety, and effectiveness of DBS treatment for carefully selected cases of severe and intractable TS
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