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.
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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.
Members of the ESSTS Guidelines Group: Christos Androutsos, Harald Aschauer, Gillian Baird, Netty Bos-Veneman, Ariana Brambilla, Francesco Cardona, Danielle C. Cath, Andrea E. Cavanna, Virginie Czernecki, Sandra Dehning, Alan Eapter, Luca Farkas, Julia Gadaros, Andreas Hartmann, Elizabeth Hauser, Isabel Heyman, Tammy Hedderly, Pieter J. Hoekstra, Anne Korsgaard, Georgina M. Jackson, Linnea Larsson, Andrea G. Ludolph, Davide Martino, Claudia Menghetti, Nanette Mol Debes, Norbert Muller, Kirsten Muller-Vahl, Alexander Munchau, Tara Murphy, Richard Musil, Peter Nagy, Judith Nurnberger, Ben Oostra, Perry Paschou, Massimo Pasquini, Kirsten J. Plessen, Mauro Porta, Hugh Rickards, Renata Rizzo, Mary M. Robertson, Veit Roessner, Aribert Rothenberger, Domenico Servello, Liselotte Skov, Jeremy S. Stern, Gerd Strand, Zsannett Tarnok, Cristiano Termine, Jolande Van der Griendt, Cara Verdellen, Veerle Visser-Vandewalle, Ebba Wannag, Tomas Wolanczyck.
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Müller-Vahl, K.R., Cath, D.C., Cavanna, A.E. et al. European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: deep brain stimulation. Eur Child Adolesc Psychiatry 20, 209–217 (2011). https://doi.org/10.1007/s00787-011-0166-4
- Deep brain stimulation