Abstract
In patients with severe, treatment-refractory Gilles de la Tourette syndrome (GTS), deep brain stimulation (DBS) of various targets has been increasingly explored over the past 15 years. The multiplicity of surgical targets is intriguing and may be partly due to the complexity of GTS, specifically the various and frequent associated psychiatric comorbidities in this disorder. Thus, the target choice may not only be aimed at reducing tics but also comorbidities. While this approach is laudable, it also carries the risk to increase confounding factors in DBS trials and patient evaluation. Moreover, I question whether DBS should really be expected to alleviate multiple symptoms at a time. Rather, I argue that tic reduction should remain our primary objective in severe GTS patients and that this intervention may subsequently allow an improved psychotherapeutic and/or pharmacological treatment of comorbidities. Thus, I consider DBS in GTS not as a single solution for all our patients' ailments but as a stepping stone to improved holistic care made possible by tic reduction.
Highlights
In patients with severe, treatment-refractory Gilles de la Tourette syndrome (GTS), deep brain stimulation (DBS) of various targets has been increasingly explored over the past 15 years
Why so many potential targets in GTS? One of the main reasons appears to be the wish to diminish tics and comorbidities (obsessive-compulsive disorder (OCD), impulsivity, attention deficit hyperactivity disorder (ADHD), anxiety, depression and others) which are present in almost 90% of patients meeting DSM criteria for GTS (Hirschtritt et al, 2015)
We chose the surgical target which we believe will be best suited to counter the main burden on the patient’s quality of life. This may mean that a patient with severe tics but even more severe OCD might be operated predominantly for the latter, targeting the subthalamic nucleus, for instance, which is not a usual target in GTS (Mallet et al, 2008)
Summary
Treatment-refractory Gilles de la Tourette syndrome (GTS), deep brain stimulation (DBS) of various targets has been increasingly explored over the past 15 years. Black , Washington University in St. Louis, St. Louis, USA Shan Siddiqi, Washington University School of Medicine, St Louis, USA Deep brain stimulation (DBS) has been used for over 15 years to treat severe forms of Gilles de la Tourette syndrome (GTS) refractory to pharmacological and, more recently, cognitive-behavioral therapies (CBT) (Schrock et al, 2015).
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
