Abstract
Background: Extended research has pointed to the efficacy of deep brain stimulation (DBS) in treatment of patients with treatment-refractory Tourette syndrome (TS). The four most commonly used DBS targets for TS include the centromedian nucleus–nucleus ventrooralis internus (CM-Voi) and the centromedian nucleus–parafascicular (CM-Pf) complexes of the thalamus, and the posteroventrolateral (pvIGPi) and the anteromedial portion of the globus pallidus internus (amGPi). Differences and commonalities between those targets need to be compared systematically.Objective: Therefore, we evaluated whether DBS is effective in reducing TS symptoms and target-specific differences.Methods: A PubMed literature search was conducted according to the PRISMA guidelines. Eligible literature was used to conduct a systematic review and meta-analysis.Results: In total, 65 studies with 376 patients were included. Overall, Yale Global Tic Severity Scale (YGTSS) scores were reduced by more than 50 in 69% of the patients. DBS also resulted in significant reductions of secondary outcome measures, including the total YGTSS, modified Rush Video-Based Tic Rating Scale (mRVRS), Yale-Brown Obsessive Compulsive Scale (YBOCS), and Becks Depression Inventory (BDI). All targets resulted in significant reductions of YGTSS scores and, with the exception of the CM-Pf, also in reduced YBOCS scores. Interestingly, DBS of pallidal targets showed increased YGTSS and YBOCS reductions compared to thalamic targets. Also, the meta-analysis including six randomized controlled and double-blinded trials demonstrated clinical efficacy of DBS for TS, that remained significant for GPi but not thalamic stimulation in two separate meta-analyses.Conclusion: We conclude that DBS is a clinically effective treatment option for patients with treatment-refractory TS, with all targets showing comparable improvement rates. Future research might focus on personalized and symptom-specific target selection.
Highlights
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by motor and vocal tics
Considering the time course of symptom improvement after deep brain stimulation (DBS)-surgery, our results show that global YGTSS scores were already reduced after 6 months
Based on the present results, we suggest that DBS is capable of reducing TS symptomatology in patients with treatmentrefractory TS, which is in line with previous research [36, 37, 123]
Summary
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by motor and vocal tics. A majority of patients experience reduced symptoms by late adolescence or early adulthood. Around 20% of patients continue to experience persistent, distressing, and even painful tics throughout adulthood [2]. Tics can have a great influence on the patient’s overall health and well-being, as they may disrupt daily functioning and adversely affect the quality of life [3, 4]. Comorbid disorders are associated with increased social problems and reduced quality of life [15]. An alternative and safe treatment option for those treatment-refractory patients constitutes deep brain stimulation (DBS) [20]. Extended research has pointed to the efficacy of deep brain stimulation (DBS) in treatment of patients with treatment-refractory Tourette syndrome (TS). Differences and commonalities between those targets need to be compared systematically
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