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Operative Neuromodulation pp 215–222Cite as

DBS in Tourette syndrome: rationale, current status and future prospects

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Part of the book series: Acta Neurochirurgica Supplements ((NEUROCHIRURGICA,volume 97/2))

Abstract

Tourette syndrome is a neuropsychiatric disorder with onset in early childhood and characterized by tics, often associated with behavioural abnormalities. Symptoms often disappear before or during adulthood. Treatment consists of psychotherapy or pharmacotherapy. A small percentage of patients is treatment refractory. After the introduction of deep brain stimulation (DBS) of the thalamus as a new therapeutical approach in 1999, several other brain nuclei have been targeted in a small number of patients, like the globus pallidus internus, anteromedial and ventroposterolateral part, and the nucleus accumbens. In the published reports, a tic reduction rate of at least 66% is described. The effects of DBS on associated behavioural disorders are more variable. The number of treated patients is small and it is unclear whether the effects of DBS are dependent on the target nucleus. The pathophysiology of Tourette syndrome is not well understood. On the basis of our current knowledge of cortico-basal ganglia-thalamocortical circuits, an explanation for the beneficial effects of DBS on tics is proposed. It is concluded that a meticulous evaluation of the electrode position, and a blinded assessment of the clinical effects on tics and behavioural disorders, is absolutely mandatory in order to identify the best target of DBS for Tourette syndrome.

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References

  1. Berardelli A, Curra A, Fabbrini G, Gilio F, Manfredi M (2003) Pathophysiology of tics and Tourette syndrome. J Neurol 250: 781–787

    Article  PubMed  Google Scholar 

  2. Brito GN (1997) A neurobiological model for Tourette syndrome centered on the nucleus accumbens. Med Hypotheses 49: 133–142

    Article  PubMed  CAS  Google Scholar 

  3. Diederich NJ, Bumb A, Mertens E, Kalteis K, Stamenkovic M, Alesch F (2004) Efficient internal segment pallidal stimulation in Gilles de la Tourette syndrome: a case report. Mov Disord 19Suppl 9: S440

    Google Scholar 

  4. DSM-IV task force: Tic Disorders (1994) In: Frances A, Pincus HA, First MB (eds) American Psychiatric Association, Washington DC, pp 100–105

    Google Scholar 

  5. Egidi M, Carrabba G, Priori A, Rampini P, Locatelli M, Bossi B, Cogiamanian F, Mrakic-Sposta S, Prada F, Tamma F, Caputo E, Gaini SM (2005) Thalamic DBS in Tourette’s syndrome: case report. Proceedings of the 14th meeting of the WSSFN Rome, Italy, June 13–17, 2005

    Google Scholar 

  6. Follett KA (2004) Comparison of pallidal and subthalamic deep brain stimulation for the treatment of levodopa-induced dyskinesias. Neurosurg Focus 17(1): E3

    PubMed  Google Scholar 

  7. Graybiel AM (2000) The basal ganglia. Curr Biol 10: R509–R511

    Article  PubMed  CAS  Google Scholar 

  8. Groenewegen HJ, van den Heuvel OA, Cath DC, Voorn P, Veltman DJ (2003) Does an imbalance between the dorsal and ventral striatopallidal systems play a role in Tourette’s syndrome? A neuronal circuit approach. Brain Dev 25Suppl 1: S3–S14

    Article  PubMed  Google Scholar 

  9. Hassler R, Dieckmann G (1970) Traitement stereotaxique des tics et cris inarticulés ou coprolaliques considérés comme phénomène d’obsession motrice au cours de la maladie de Gilles de la Tourette. Rev Neurol Paris 123: 89–100

    PubMed  CAS  Google Scholar 

  10. Hoekstra PJ, Anderson GM, Limburg PC, Korf J, Kallenberg CG, Minderaa RB (2004) Neurobiology and neuroimmunology of Tourette’s syndrome: an update. Cell Mol Life Sci 61: 886–898

    Article  PubMed  CAS  Google Scholar 

  11. Hornse H, Banerjee S, Zeitlin H, Robertson M (2001) The prevalence of Tourette syndrome in 13–14-year-olds in mainstream schools. J Child Psychol Psychiatry 42: 1035–1039

    Article  PubMed  CAS  Google Scholar 

  12. Houeto JL, Karachi C, Mallet L, Pillon B, Yelnik J, Mesnage V, Welter ML, Navarro S, Pelissolo A, Damier P, Pidoux B, Dormont D, Cornu P, Agid Y (2005) Tourette’s syndrome and deep brain stimulation. J Neurol Neurosurg Psychiatry 76: 904

    Article  Google Scholar 

  13. Johannes S, Wieringa BM, Nager W, Rada D, Muller-Vahl KR, Emrich HM, Dengler R, Munte TF, Dietrich D (2003) Tourette syndrome and obsessive-compulsive disorder: event-related brain potentials show similar mechanisms [correction of mechanisms] of frontal inhibition but dissimilar target evaluation processes. Behav Neurol 14: 9–17

    PubMed  Google Scholar 

  14. Krause M, Fogel W, Kloss M, Rasche D, Volkmann J, Tronnier V (2004) Pallidal stimulation for dystonia. Neurosurgery 55: 1361–1368

    Article  PubMed  Google Scholar 

  15. Leckman JF (2002) Tourette’s syndrome. Lancet 360: 1577–1586

    Article  PubMed  Google Scholar 

  16. Leckman JF, Riddle MA, Hardin MT, Ort SI, Swartz KL, Stevenson J, Cohen DJ (1989) The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 28: 566–573

    Article  PubMed  CAS  Google Scholar 

  17. Lozano AM, Mahant N (2004) Deep brain stimulation surgery for Parkinson’s disease: mechanisms and consequences. Parkinsonism Relat Disord 10Suppl 1: S49–S57

    Article  PubMed  Google Scholar 

  18. Mink JW (2001) Basal ganglia dysfunction in Tourette’s syndrome: a new hypothesis. Pediatric Neurology 25: 190–198

    Article  PubMed  CAS  Google Scholar 

  19. Mink JW, Walkup J, Frey KA, Como P, Cath D, DeLong MR, Erenberg G, Juncos J, Leckman JF, Swerdlow N, Visser-Vandewalle V, Vitek JL for the Tourette Syndrome Association, Inc. (2005) Recommended guidelines for deep brain stimulation in Tourette syndrome. Mov Dis 21(11): 1831–1838

    Article  Google Scholar 

  20. Peterson BS, Skudlarski P, Anderson AW, Zhang H, Gatenby JC, Lacadie CM, Leckman JF, Gore JC (1998) A functional magnetic resonance imaging study of tic suppression in Tourette syndrome. Arch Gen Psychiatry 55: 326–333

    Article  PubMed  CAS  Google Scholar 

  21. Peterson BS, Thomas P, Kane MJ, Scahill L, Zhang H, Bronen R, King RA, Leckman JF, Staib L (2003) Basal Ganglia volumes in patients with Gilles de la Tourette syndrome. Arch Gen Psychiatry 60: 415–424

    Article  PubMed  Google Scholar 

  22. Rezai AR, Finelli D, Nyenhuis JA, Hrdlicka G, Tkach J, Sharan A, Rugieri P, Stypulkowski PH, Shellock FG (2002) Neurostimulation systems for deep brain stimulation: in vitro evaluation of magnetic resonance imaging-related heating at 1.5 Tesla. J Magn Reson Imaging 15: 241–250

    Article  PubMed  Google Scholar 

  23. Riederer F, Stamenkovic M, Schindler SD, Kasper S (2002) Tourette’s syndrome — a review. Nervenarzt 73: 805–819

    Article  PubMed  CAS  Google Scholar 

  24. Robertson MM (2000) Tourette syndrome, associated conditions and the complexities of treatment. Brain 123 (Pt 3): 425–462

    Article  PubMed  Google Scholar 

  25. Schaltenbrand G, Wahren W (1977) Atlas for stereotaxy of the human brain, 2nd edn Thieme, Stuttgart

    Google Scholar 

  26. Servello D, Sassi M, Geremia L, Porta M (2005) Bilateral thalamic stimulation for intractable Tourette syndrome. Proceedings of the 14th meeting of the WSSFN, Rome, Italy, June 13–17, 2005

    Google Scholar 

  27. Silay YS, Jankovic J (2005) Emerging drugs in Tourette syndrome Expert Opin Emerg Drugs. 2005 May 10: 365–380

    Article  PubMed  CAS  Google Scholar 

  28. Singer HS, Szymanski S, Giuliano J, Yokoi F, Dogan AS, Brasic JR, Zhou Y, Grace AA, Wong DF (2002) Elevated intrasynaptic dopamine release in Tourette’s syndrome measured by PET. Am J Psychiatry 159: 1329–1336

    Article  PubMed  Google Scholar 

  29. Stern E, Silbersweig DA, Chee KY, Holmes A, Robertson MM, Trimble M, Frith CD, Frackowiak RS, Dolan RJ (2000) A functional neuroanatomy of tics in Tourette syndrome. Arch Gen Psychiatry 57: 741–748

    Article  PubMed  CAS  Google Scholar 

  30. Sturm V, Lenartz D, Koulousakis A, Treuer H, Herholz K, Klein JC, Klosterkotter J (2003) The nucleus accumbens: a target for deep brain stimulation in obsessive-compulsive-and anxiety-disorders. J Chem Neuroanat 26: 293–299

    Article  PubMed  Google Scholar 

  31. Temel Y, van Lankveld JJ, Boon P, Spincemaille GH, van der Linden C, Visser-Vandewalle V (2004) Deep brain stimulation of the thalamus can influence penile erection. Int J Impot Res 16: 91–94

    Article  PubMed  CAS  Google Scholar 

  32. Temel Y, Visser-Vandewalle V (2004) Surgery in Tourette syndrome. Mov Disord 19: 3–14

    Article  PubMed  Google Scholar 

  33. 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. Mov Dis 17Suppl 5: 1130 (S341)

    Google Scholar 

  34. Vandewalle V, van der Linden C, Groenewegen HJ, Caemaert J (1999) Stereotactic treatment of Gilles de la Tourette syndrome by high frequency stimulation of thalamus. Lancet 353: 724

    Article  PubMed  CAS  Google Scholar 

  35. Vidailhet M, Vercueil L, Houeto JL, Krystkowiak P, Benabid AL, Cornu P, Lagrange C, Tezenas du Montcel S, Dormont D, Grand S, Blond S, Detante O, Pillon B, Ardouin C, Agid Y, Destee A, Pollak P, French Stimulation du Pallidum Interne dans la Dystonie (SPIDY) Study Group (2005) Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia. N Engl J Med 352: 459–467

    Article  PubMed  CAS  Google Scholar 

  36. Visser-Vandewalle V, Temel Y, Boon P, Vreeling F, Colle H, Hoogland G, Groenewegen H, van der Linden Ch (2003) Chronic bilateral thalamic stimulation: a new therapeutic approach in intractable Tourette syndrome. J Neurosurg 99: 1094–1100

    Article  PubMed  Google Scholar 

  37. Visser-Vandewalle V, Ackermans L, van der Linden C, Temel Y, Tijssen MA, Schruers KR, Nederveen P, Kleijer M, Boon P, Weber W, Cath D (2006) Deep brain stimulation in Gilles de la Tourette’s syndrome. Guidelines of the Dutch-Flemish Tourette Surgery Study Group. Neurosurgery 58: E590

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    V. Visser-Vandewalle

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  1. V. Visser-Vandewalle
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Correspondence to V. Visser-Vandewalle .

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Editors and Affiliations

  1. Department of Neurosurgery, University of Athens, Athens, Greece

    Damianos E. Sakas

  2. University Hospital of Wales, Cardiff, UK

    Brian A. Simpson

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© 2007 Springer-Verlag

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Visser-Vandewalle, V. (2007). DBS in Tourette syndrome: rationale, current status and future prospects. In: Sakas, D.E., Simpson, B.A. (eds) Operative Neuromodulation. Acta Neurochirurgica Supplements, vol 97/2. Springer, Vienna. https://doi.org/10.1007/978-3-211-33081-4_24

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  • DOI: https://doi.org/10.1007/978-3-211-33081-4_24

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-33080-7

  • Online ISBN: 978-3-211-33081-4

  • eBook Packages: MedicineMedicine (R0)

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