European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: deep brain stimulation
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Ten years ago deep brain stimulation (DBS) has been introduced as an alternative and promising treatment option for patients suffering from severe Tourette syndrome (TS). It seemed timely to develop a European guideline on DBS by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). For a narrative review a systematic literature search was conducted and expert opinions of the guidelines group contributed also to the suggestions. Of 63 patients reported so far in the literature 59 had a beneficial outcome following DBS with moderate to marked tic improvement. However, randomized controlled studies including a larger number of patients are still lacking. Although persistent serious adverse effects (AEs) have hardly been reported, surgery-related (e.g., bleeding, infection) as well as stimulation-related AEs (e.g., sedation, anxiety, altered mood, changes in sexual function) may occur. At present time, DBS in TS is still in its infancy. Due to both different legality and practical facilities in different European countries these guidelines, therefore, have to be understood as recommendations of experts. However, among the ESSTS working group on DBS in TS there is general agreement that, at present time, DBS should only be used in adult, treatment resistant, and severely affected patients. It is highly recommended to perform DBS in the context of controlled trials.
KeywordsTics Tourette Deep brain stimulation Treatment Guidelines
Conflict of interest
Commercial firms and governmental organisations did not play a role in, or fund, the development of these guidelines. Kirsten R. Müller-Vahl, Danielle C. Cath, Andrea E. Cavanna, Sandra Dehning, Veerle Visser-Vandewalle declare that they have no conflict of interest. Potential conflicts of interest: Mauro Porta: scientific advisory board of Lundbeck, the Netherlands; Mary Robertson has recently received a grant from the Tourette’s Action-UK (Grant to support Dr AE Cavanna), she has also received honoraria from Janssen-Cilag, Eli Lilly, and has received Royalties for books from Blackwells Science, David Fulton/Granada/Taylor Francis, Oxford University Press and also Jessica Kingsley Publishers, she also sits on the Medical Advisory Board for the Italian Tourette Syndrome Association and The Tourette Syndrome Foundation of Canada; Davide Martino: honoraria for symposia from UCB Pharma, Chiesi Pharmaceuticals, Novartis, and Boehringer-Ingelheim.
- 13.Foltynie T, Martinez-Torres I, Zrinzo L, Joyce E, Cavanna A, Jahanshahi M, Limousin P, Hariz M (2009) Improvement in vocal and motor tics following DBS of motor GPi for Tourette syndrome, not accompanied by subjective improvement in quality of life—a case report. Mov Disord 24(Suppl 1):S497–S498Google Scholar
- 20.van der Linden C, Colle H, Vandewalle V, Alessi G, Rijckaert D, de Waele L (2002) Successful treatment of tics with bilateral internal pallidum (GPi) stimulation in a 27-year-old male patient with Gilles de la Tourette’s syndrome (GTS). Mov Disord 17:P1130Google Scholar
- 23.Mink JW (2009) Clinical review of DBS for Tourette syndrome. Front Biosci 1:72–76Google Scholar
- 24.Mink JW, Walkup J, Frey KA, Como P, Cath D, Delong, Erenberg G, Jankovic J, Juncos J, Leckman JF, Swerdlow N, Visser-Vandewalle V, Vitek JL, Tourette Syndrome Association, Inc (2006) Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome. Mov Disord 21:1831–1838PubMedCrossRefGoogle Scholar
- 33.Roessner V, Plessen K, Rizzo R, Skov L, Strand G, Stern J, Termine C, Hoekstra P; the ESSTS Guidelines Group. European clinical guidelines for Tourette syndrome and other chronic tic disorders. Part II: pharmacological treatment. Eur Child Adolesc PsychiatryGoogle Scholar
- 40.Verdellen C, van de Griendt J, Hartmann A, Murphy T; the ESSTS Guidelines Group. European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions. Eur Child Adolesc PsychiatryGoogle Scholar
- 41.Vilela Filho O, Ragazzo P, Silva D, Souza J, Oliveira P, Ribeiro T (2008) Bilateral GPe-DBS for Tourette’s syndrome (Abstr.). Neurotarget 3:65Google Scholar
- 42.Vilela Filho O, Ragazzo P, Souza J, Silva D, Oliveira P, Piedimonte F, Ribeiro T (2010) Bilateral GPe-DBS for Tourette syndrome: a double-blind prospective controlled study of seven patients (Abstr.). In: Abstract book of the ASSFN (American Society for Stereotactic and Functional Neurosurgery), 2010 biennial meeting. Bridging the Future of Neurosurgery, New YorkGoogle Scholar