Tourette syndrome deep brain stimulation: A review and updated recommendations

Tourette Syndrome Association International Deep Brain Stimulation (DBS) Database and Registry Study Group

Research output: Contribution to journalReview article

112 Citations (Scopus)

Abstract

Deep brain stimulation (DBS) may improve disabling tics in severely affected medication and behaviorally resistant Tourette syndrome (TS). Here we review all reported cases of TS DBS and provide updated recommendations for selection, assessment, and management of potential TS DBS cases based on the literature and implantation experience. Candidates should have a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) diagnosis of TS with severe motor and vocal tics, which despite exhaustive medical and behavioral treatment trials result in significant impairment. Deep brain stimulation should be offered to patients only by experienced DBS centers after evaluation by a multidisciplinary team. Rigorous preoperative and postoperative outcome measures of tics and associated comorbidities should be used. Tics and comorbid neuropsychiatric conditions should be optimally treated per current expert standards, and tics should be the major cause of disability. Psychogenic tics, embellishment, and malingering should be recognized and addressed. We have removed the previously suggested 25-year-old age limit, with the specification that a multidisciplinary team approach for screening is employed. A local ethics committee or institutional review board should be consulted for consideration of cases involving persons younger than 18 years of age, as well as in cases with urgent indications. Tourette syndrome patients represent a unique and complex population, and studies reveal a higher risk for post-DBS complications. Successes and failures have been reported for multiple brain targets; however, the optimal surgical approach remains unknown. Tourette syndrome DBS, though still evolving, is a promising approach for a subset of medication refractory and severely affected patients.

Original languageEnglish (US)
Pages (from-to)448-471
Number of pages24
JournalMovement Disorders
Volume30
Issue number4
DOIs
StatePublished - Apr 1 2015

Fingerprint

Tics
Tourette Syndrome
Deep Brain Stimulation
Diagnostic and Statistical Manual of Mental Disorders
Malingering
Ethics Committees
Research Ethics Committees
Comorbidity
Outcome Assessment (Health Care)
Brain
Population

Keywords

  • DBS
  • Deep brain stimulation
  • Guidelines
  • Tourette syndrome

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Tourette Syndrome Association International Deep Brain Stimulation (DBS) Database and Registry Study Group (2015). Tourette syndrome deep brain stimulation: A review and updated recommendations. Movement Disorders, 30(4), 448-471. https://doi.org/10.1002/mds.26094

Tourette syndrome deep brain stimulation : A review and updated recommendations. / Tourette Syndrome Association International Deep Brain Stimulation (DBS) Database and Registry Study Group.

In: Movement Disorders, Vol. 30, No. 4, 01.04.2015, p. 448-471.

Research output: Contribution to journalReview article

Tourette Syndrome Association International Deep Brain Stimulation (DBS) Database and Registry Study Group 2015, 'Tourette syndrome deep brain stimulation: A review and updated recommendations', Movement Disorders, vol. 30, no. 4, pp. 448-471. https://doi.org/10.1002/mds.26094
Tourette Syndrome Association International Deep Brain Stimulation (DBS) Database and Registry Study Group. Tourette syndrome deep brain stimulation: A review and updated recommendations. Movement Disorders. 2015 Apr 1;30(4):448-471. https://doi.org/10.1002/mds.26094
Tourette Syndrome Association International Deep Brain Stimulation (DBS) Database and Registry Study Group. / Tourette syndrome deep brain stimulation : A review and updated recommendations. In: Movement Disorders. 2015 ; Vol. 30, No. 4. pp. 448-471.
@article{9f88436d7d97400c861c0d03fee4fa31,
title = "Tourette syndrome deep brain stimulation: A review and updated recommendations",
abstract = "Deep brain stimulation (DBS) may improve disabling tics in severely affected medication and behaviorally resistant Tourette syndrome (TS). Here we review all reported cases of TS DBS and provide updated recommendations for selection, assessment, and management of potential TS DBS cases based on the literature and implantation experience. Candidates should have a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) diagnosis of TS with severe motor and vocal tics, which despite exhaustive medical and behavioral treatment trials result in significant impairment. Deep brain stimulation should be offered to patients only by experienced DBS centers after evaluation by a multidisciplinary team. Rigorous preoperative and postoperative outcome measures of tics and associated comorbidities should be used. Tics and comorbid neuropsychiatric conditions should be optimally treated per current expert standards, and tics should be the major cause of disability. Psychogenic tics, embellishment, and malingering should be recognized and addressed. We have removed the previously suggested 25-year-old age limit, with the specification that a multidisciplinary team approach for screening is employed. A local ethics committee or institutional review board should be consulted for consideration of cases involving persons younger than 18 years of age, as well as in cases with urgent indications. Tourette syndrome patients represent a unique and complex population, and studies reveal a higher risk for post-DBS complications. Successes and failures have been reported for multiple brain targets; however, the optimal surgical approach remains unknown. Tourette syndrome DBS, though still evolving, is a promising approach for a subset of medication refractory and severely affected patients.",
keywords = "DBS, Deep brain stimulation, Guidelines, Tourette syndrome",
author = "{Tourette Syndrome Association International Deep Brain Stimulation (DBS) Database and Registry Study Group} and Schrock, {Lauren E.} and Mink, {Jonathan W.} and Woods, {Douglas W.} and Mauro Porta and Dominico Servello and Veerle Visser-Vandewalle and Silburn, {Peter A.} and Thomas Foltynie and Walker, {Harrison C.} and Joohi Shahed-Jimenez and Rodolfo Savica and Bryan Klassen and Machado, {Andre G.} and Foote, {Kelly D.} and Zhang, {Jian Guo} and Wei Hu and Linda Ackermans and Yasin Temel and Zoltan Mari and Changizi, {Barbara K.} and Andres Lozano and M. Auyeung and Takanobu Kaido and Yves Agid and Welter, {Marie L.} and Khandhar, {Suketu M.} and Mogilner, {Alon Y.} and Pourfar, {Michael H.} and Walter, {Benjamin L.} and Juncos, {Jorge L.} and Gross, {Robert E.} and Jens Kuhn and Leckman, {James F.} and Neimat, {Joseph A.} and Okun, {Michael S.}",
year = "2015",
month = "4",
day = "1",
doi = "10.1002/mds.26094",
language = "English (US)",
volume = "30",
pages = "448--471",
journal = "Movement Disorders",
issn = "0885-3185",
publisher = "John Wiley and Sons Inc.",
number = "4",

}

TY - JOUR

T1 - Tourette syndrome deep brain stimulation

T2 - A review and updated recommendations

AU - Tourette Syndrome Association International Deep Brain Stimulation (DBS) Database and Registry Study Group

AU - Schrock, Lauren E.

AU - Mink, Jonathan W.

AU - Woods, Douglas W.

AU - Porta, Mauro

AU - Servello, Dominico

AU - Visser-Vandewalle, Veerle

AU - Silburn, Peter A.

AU - Foltynie, Thomas

AU - Walker, Harrison C.

AU - Shahed-Jimenez, Joohi

AU - Savica, Rodolfo

AU - Klassen, Bryan

AU - Machado, Andre G.

AU - Foote, Kelly D.

AU - Zhang, Jian Guo

AU - Hu, Wei

AU - Ackermans, Linda

AU - Temel, Yasin

AU - Mari, Zoltan

AU - Changizi, Barbara K.

AU - Lozano, Andres

AU - Auyeung, M.

AU - Kaido, Takanobu

AU - Agid, Yves

AU - Welter, Marie L.

AU - Khandhar, Suketu M.

AU - Mogilner, Alon Y.

AU - Pourfar, Michael H.

AU - Walter, Benjamin L.

AU - Juncos, Jorge L.

AU - Gross, Robert E.

AU - Kuhn, Jens

AU - Leckman, James F.

AU - Neimat, Joseph A.

AU - Okun, Michael S.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Deep brain stimulation (DBS) may improve disabling tics in severely affected medication and behaviorally resistant Tourette syndrome (TS). Here we review all reported cases of TS DBS and provide updated recommendations for selection, assessment, and management of potential TS DBS cases based on the literature and implantation experience. Candidates should have a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) diagnosis of TS with severe motor and vocal tics, which despite exhaustive medical and behavioral treatment trials result in significant impairment. Deep brain stimulation should be offered to patients only by experienced DBS centers after evaluation by a multidisciplinary team. Rigorous preoperative and postoperative outcome measures of tics and associated comorbidities should be used. Tics and comorbid neuropsychiatric conditions should be optimally treated per current expert standards, and tics should be the major cause of disability. Psychogenic tics, embellishment, and malingering should be recognized and addressed. We have removed the previously suggested 25-year-old age limit, with the specification that a multidisciplinary team approach for screening is employed. A local ethics committee or institutional review board should be consulted for consideration of cases involving persons younger than 18 years of age, as well as in cases with urgent indications. Tourette syndrome patients represent a unique and complex population, and studies reveal a higher risk for post-DBS complications. Successes and failures have been reported for multiple brain targets; however, the optimal surgical approach remains unknown. Tourette syndrome DBS, though still evolving, is a promising approach for a subset of medication refractory and severely affected patients.

AB - Deep brain stimulation (DBS) may improve disabling tics in severely affected medication and behaviorally resistant Tourette syndrome (TS). Here we review all reported cases of TS DBS and provide updated recommendations for selection, assessment, and management of potential TS DBS cases based on the literature and implantation experience. Candidates should have a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) diagnosis of TS with severe motor and vocal tics, which despite exhaustive medical and behavioral treatment trials result in significant impairment. Deep brain stimulation should be offered to patients only by experienced DBS centers after evaluation by a multidisciplinary team. Rigorous preoperative and postoperative outcome measures of tics and associated comorbidities should be used. Tics and comorbid neuropsychiatric conditions should be optimally treated per current expert standards, and tics should be the major cause of disability. Psychogenic tics, embellishment, and malingering should be recognized and addressed. We have removed the previously suggested 25-year-old age limit, with the specification that a multidisciplinary team approach for screening is employed. A local ethics committee or institutional review board should be consulted for consideration of cases involving persons younger than 18 years of age, as well as in cases with urgent indications. Tourette syndrome patients represent a unique and complex population, and studies reveal a higher risk for post-DBS complications. Successes and failures have been reported for multiple brain targets; however, the optimal surgical approach remains unknown. Tourette syndrome DBS, though still evolving, is a promising approach for a subset of medication refractory and severely affected patients.

KW - DBS

KW - Deep brain stimulation

KW - Guidelines

KW - Tourette syndrome

UR - http://www.scopus.com/inward/record.url?scp=84926203961&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84926203961&partnerID=8YFLogxK

U2 - 10.1002/mds.26094

DO - 10.1002/mds.26094

M3 - Review article

C2 - 25476818

AN - SCOPUS:84926203961

VL - 30

SP - 448

EP - 471

JO - Movement Disorders

JF - Movement Disorders

SN - 0885-3185

IS - 4

ER -