Daniel Huys1, Christina Bartsch2, Philip Koester2, Doris Lenartz3, Mohammad Maarouf4, Jörg Daumann2, Jürgen K Mai5, Joachim Klosterkötter2, Stefan Hunsche3, Veerle Visser-Vandewalle3, Christiane Woopen6, Lars Timmermann7, Volker Sturm3, Jens Kuhn2. 1. Departments of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany. Electronic address: Daniel.Huys@uk-koeln.de. 2. Departments of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany. 3. Departments of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany. 4. Departments of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany; Department of Functional Neurosurgery and Stereotaxy, Hospitals of Cologne, Cologne-Merheim, Germany. 5. Department of Anatomy, University of Düsseldorf, Düsseldorf, Germany. 6. Institute for the History of Medicine and Medical Ethics, Research Unit Ethics, University of Cologne, Cologne, Germany. 7. Department of Neurology, University of Cologne, Cologne, Germany.
Abstract
BACKGROUND: Since its first application in 1999, the potential benefit of deep brain stimulation (DBS) in reducing symptoms of otherwise treatment-refractory Tourette syndrome (TS) has been documented in several publications. However, uncertainty regarding the ideal neural targets remains, and the eventuality of so far undocumented but possible negative long-term effects on personality fuels the debate about the ethical implications of DBS. METHODS: In this prospective open-label trial, eight patients (three female, five male) 19-56 years old with severe and medically intractable TS were treated with high-frequency DBS of the ventral anterior and ventrolateral motor part of the thalamus. To assess the course of TS, its clinical comorbidities, personality parameters, and self-perceived quality of life, patients underwent repeated psychiatric assessments at baseline and 6 and 12 months after DBS onset. RESULTS: Analysis indicated a strongly significant and beneficial effect of DBS on TS symptoms, trait anxiety, quality of life, and global functioning with an apparently low side-effect profile. In addition, presurgical compulsivity, anxiety, emotional dysregulation, and inhibition appeared to be significant predictors of surgery outcome. CONCLUSIONS: Trading off motor effects and desirable side effects against surgery-related risks and negative implications, stimulation of the ventral anterior and ventrolateral motor part of the thalamus seems to be a valuable option when considering DBS for TS.
BACKGROUND: Since its first application in 1999, the potential benefit of deep brain stimulation (DBS) in reducing symptoms of otherwise treatment-refractory Tourette syndrome (TS) has been documented in several publications. However, uncertainty regarding the ideal neural targets remains, and the eventuality of so far undocumented but possible negative long-term effects on personality fuels the debate about the ethical implications of DBS. METHODS: In this prospective open-label trial, eight patients (three female, five male) 19-56 years old with severe and medically intractable TS were treated with high-frequency DBS of the ventral anterior and ventrolateral motor part of the thalamus. To assess the course of TS, its clinical comorbidities, personality parameters, and self-perceived quality of life, patients underwent repeated psychiatric assessments at baseline and 6 and 12 months after DBS onset. RESULTS: Analysis indicated a strongly significant and beneficial effect of DBS on TS symptoms, trait anxiety, quality of life, and global functioning with an apparently low side-effect profile. In addition, presurgical compulsivity, anxiety, emotional dysregulation, and inhibition appeared to be significant predictors of surgery outcome. CONCLUSIONS: Trading off motor effects and desirable side effects against surgery-related risks and negative implications, stimulation of the ventral anterior and ventrolateral motor part of the thalamus seems to be a valuable option when considering DBS for TS.
Authors: Kara A Johnson; Gordon Duffley; Daria Nesterovich Anderson; Jill L Ostrem; Marie-Laure Welter; Juan Carlos Baldermann; Jens Kuhn; Daniel Huys; Veerle Visser-Vandewalle; Thomas Foltynie; Ludvic Zrinzo; Marwan Hariz; Albert F G Leentjens; Alon Y Mogilner; Michael H Pourfar; Leonardo Almeida; Aysegul Gunduz; Kelly D Foote; Michael S Okun; Christopher R Butson Journal: Brain Date: 2020-08-01 Impact factor: 13.501
Authors: Kara A Johnson; Gordon Duffley; Thomas Foltynie; Marwan Hariz; Ludvic Zrinzo; Eileen M Joyce; Harith Akram; Domenico Servello; Tommaso F Galbiati; Alberto Bona; Mauro Porta; Fan-Gang Meng; Albert F G Leentjens; Aysegul Gunduz; Wei Hu; Kelly D Foote; Michael S Okun; Christopher R Butson Journal: Biol Psychiatry Cogn Neurosci Neuroimaging Date: 2020-11-24
Authors: Wissam Deeb; Peter J Rossi; Mauro Porta; Veerle Visser-Vandewalle; Domenico Servello; Peter Silburn; Terry Coyne; James F Leckman; Thomas Foltynie; Marwan Hariz; Eileen M Joyce; Ludvic Zrinzo; Zinovia Kefalopoulou; Marie-Laure Welter; Carine Karachi; Luc Mallet; Jean-Luc Houeto; Joohi Shahed-Jimenez; Fan-Gang Meng; Bryan T Klassen; Alon Y Mogilner; Michael H Pourfar; Jens Kuhn; L Ackermans; Takanobu Kaido; Yasin Temel; Robert E Gross; Harrison C Walker; Andres M Lozano; Suketu M Khandhar; Benjamin L Walter; Ellen Walter; Zoltan Mari; Barbara K Changizi; Elena Moro; Juan C Baldermann; Daniel Huys; S Elizabeth Zauber; Lauren E Schrock; Jian-Guo Zhang; Wei Hu; Kelly D Foote; Kyle Rizer; Jonathan W Mink; Douglas W Woods; Aysegul Gunduz; Michael S Okun Journal: Front Neurosci Date: 2016-04-25 Impact factor: 4.677