Juan Carlos Baldermann1, Thomas Schüller2, Daniel Huys2, Ingrid Becker3, Lars Timmermann4, Frank Jessen2, Veerle Visser-Vandewalle5, Jens Kuhn2. 1. Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany. Electronic address: juan.baldermann@uk-koeln.de. 2. Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany. 3. Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany. 4. Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany. 5. Department of Stereotactic and Functional Neurosurgery, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
Abstract
BACKGROUND: A significant proportion of patients with Tourette syndrome (TS) continue to experience symptoms across adulthood that in severe cases fail to respond to standard therapies. For these cases, deep brain stimulation (DBS) is emerging as a promising treatment option. OBJECTIVE: We conducted a systematic literature review to evaluate the efficacy of DBS for GTS. METHODS: Individual data of case reports and series were pooled; the Yale Global Tic Severity Scale (YGTSS) was chosen as primary outcome parameter. RESULTS: In total, 57 studies were eligible, including 156 cases. Overall, DBS resulted in a significant improvement of 52.68% (IQR = 40.74, p < 0.001) in the YGTSS. Analysis of controlled studies significantly favored stimulation versus off stimulation with a standardized mean difference of 0.96 (95% CI: 0.36-1.56). Disentangling different target points revealed significant YGTSS reductions after stimulation of the thalamus, the posteroventrolateral part and the anteromedial part of the globus pallidus internus, the anterior limb of the internal capsule and nucleus accumbens with no significant difference between these targets. A significant negative correlation of preoperative tic scores with the outcome of thalamic stimulation was found. CONCLUSIONS: Despite small patient numbers, we conclude that DBS for GTS is a valid option for medically intractable patients. Different brain targets resulted in comparable improvement rates, indicating a modulation of a common network. Future studies might focus on a better characterization of the clinical effects of distinct regions, rather than searching for a unique target.
BACKGROUND: A significant proportion of patients with Tourette syndrome (TS) continue to experience symptoms across adulthood that in severe cases fail to respond to standard therapies. For these cases, deep brain stimulation (DBS) is emerging as a promising treatment option. OBJECTIVE: We conducted a systematic literature review to evaluate the efficacy of DBS for GTS. METHODS: Individual data of case reports and series were pooled; the Yale Global Tic Severity Scale (YGTSS) was chosen as primary outcome parameter. RESULTS: In total, 57 studies were eligible, including 156 cases. Overall, DBS resulted in a significant improvement of 52.68% (IQR = 40.74, p < 0.001) in the YGTSS. Analysis of controlled studies significantly favored stimulation versus off stimulation with a standardized mean difference of 0.96 (95% CI: 0.36-1.56). Disentangling different target points revealed significant YGTSS reductions after stimulation of the thalamus, the posteroventrolateral part and the anteromedial part of the globus pallidus internus, the anterior limb of the internal capsule and nucleus accumbens with no significant difference between these targets. A significant negative correlation of preoperative tic scores with the outcome of thalamic stimulation was found. CONCLUSIONS: Despite small patient numbers, we conclude that DBS for GTS is a valid option for medically intractable patients. Different brain targets resulted in comparable improvement rates, indicating a modulation of a common network. Future studies might focus on a better characterization of the clinical effects of distinct regions, rather than searching for a unique target.
Authors: Andrea A Kühn; R Mark Richardson; Wolf-Julian Neumann; Robert S Turner; Benjamin Blankertz; Tom Mitchell Journal: Neurotherapeutics Date: 2019-01 Impact factor: 7.620
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: Daniel Martinez-Ramirez; Joohi Jimenez-Shahed; James Frederick Leckman; Mauro Porta; Domenico Servello; Fan-Gang Meng; Jens Kuhn; Daniel Huys; Juan Carlos Baldermann; Thomas Foltynie; Marwan I Hariz; Eileen M Joyce; Ludvic Zrinzo; Zinovia Kefalopoulou; Peter Silburn; Terry Coyne; Alon Y Mogilner; Michael H Pourfar; Suketu M Khandhar; Man Auyeung; Jill Louise Ostrem; Veerle Visser-Vandewalle; Marie-Laure Welter; Luc Mallet; Carine Karachi; Jean Luc Houeto; Bryan Timothy Klassen; Linda Ackermans; Takanobu Kaido; Yasin Temel; Robert E Gross; Harrison C Walker; Andres M Lozano; Benjamin L Walter; Zoltan Mari; William S Anderson; Barbara Kelly Changizi; Elena Moro; Sarah Elizabeth Zauber; Lauren E Schrock; Jian-Guo Zhang; Wei Hu; Kyle Rizer; Erin H Monari; Kelly D Foote; Irene A Malaty; Wissam Deeb; Aysegul Gunduz; Michael S Okun Journal: JAMA Neurol Date: 2018-03-01 Impact factor: 18.302
Authors: Andres M Lozano; Nir Lipsman; Hagai Bergman; Peter Brown; Stephan Chabardes; Jin Woo Chang; Keith Matthews; Cameron C McIntyre; Thomas E Schlaepfer; Michael Schulder; Yasin Temel; Jens Volkmann; Joachim K Krauss Journal: Nat Rev Neurol Date: 2019-03 Impact factor: 42.937