Tourette syndrome deep brain stimulation: A review and updated recommendations

Lauren E. Schrock, Jonathan W. Mink, Douglas W. Woods, Mauro Porta, Dominico Servello, Veerle Visser-Vandewalle, Peter A. Silburn, Thomas Foltynie, Harrison C. Walker, Joohi Shahed-Jimenez, Rodolfo Savica, Bryan T. Klassen, Andre G. Machado, Kelly D. Foote, Jian Guo Zhang, Wei Hu, Linda Ackermans, Yasin Temel, Zoltan Mari, Barbara K. ChangiziAndres Lozano, M. Auyeung, Takanobu Kaido, Yves Agid, Marie L. Welter, Suketu M. Khandhar, Alon Y. Mogilner, Michael H. Pourfar, Benjamin L. Walter, Jorge L. Juncos, Robert E. Gross, Jens Kuhn, James F. Leckman, Joseph A. Neimat, Michael S. Okun

Research output: Contribution to journalArticle

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 : official journal of the Movement Disorder Society
Volume30
Issue number4
DOIs
StatePublished - Apr 1 2015

Keywords

  • DBS
  • Deep brain stimulation
  • Guidelines
  • Tourette syndrome

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Medicine(all)

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  • Cite this

    Schrock, L. E., Mink, J. W., Woods, D. W., Porta, M., Servello, D., Visser-Vandewalle, V., Silburn, P. A., Foltynie, T., Walker, H. C., Shahed-Jimenez, J., Savica, R., Klassen, B. T., Machado, A. G., Foote, K. D., Zhang, J. G., Hu, W., Ackermans, L., Temel, Y., Mari, Z., ... Okun, M. S. (2015). Tourette syndrome deep brain stimulation: A review and updated recommendations. Movement disorders : official journal of the Movement Disorder Society, 30(4), 448-471. https://doi.org/10.1002/mds.26094