BACKGROUND: Deep brain stimulation (DBS) in patients with severe, refractory Tourette syndrome (TS) has demonstrated promising but variable results thus far. The thalamus and anteromedial globus pallidus internus (amGPi) have been the most commonly stimulated sites within the cortico-striato thalamic circuit, but an optimal target is yet to be elucidated. OBJECTIVES: This study of 15 patients with long-term amGPi DBS for severe TS investigated whether a specific anatomical site within the amGPi correlated with optimal clinical outcome for the measures of tics, obsessive compulsive behaviour (OCB), and mood. METHODS: Validated clinical assessments were used to measure tics, OCB, quality of life, anxiety, and depression before DBS and at the latest follow-up (17-82 months). Electric field simulations were created for each patient using information on electrode location and individual stimulation parameters. A subsequent regression analysis correlated these patient-specific simulations to percentage changes in outcome measures in order to identify any significant voxels related to clinical improvement. RESULTS: A region within the ventral limbic GPi, specifically on the medial medullary lamina in the pallidum at the level of the AC-PC, was significantly associated with improved tics but not mood or OCB outcome. CONCLUSIONS: This study adds further support to the application of DBS in a tic-related network, though factors such as patient sample size and clinical heterogeneity remain as limitations and replication is required.
BACKGROUND: Deep brain stimulation (DBS) in patients with severe, refractory Tourette syndrome (TS) has demonstrated promising but variable results thus far. The thalamus and anteromedial globus pallidus internus (amGPi) have been the most commonly stimulated sites within the cortico-striato thalamic circuit, but an optimal target is yet to be elucidated. OBJECTIVES: This study of 15 patients with long-term amGPi DBS for severe TS investigated whether a specific anatomical site within the amGPi correlated with optimal clinical outcome for the measures of tics, obsessive compulsive behaviour (OCB), and mood. METHODS: Validated clinical assessments were used to measure tics, OCB, quality of life, anxiety, and depression before DBS and at the latest follow-up (17-82 months). Electric field simulations were created for each patient using information on electrode location and individual stimulation parameters. A subsequent regression analysis correlated these patient-specific simulations to percentage changes in outcome measures in order to identify any significant voxels related to clinical improvement. RESULTS: A region within the ventral limbic GPi, specifically on the medial medullary lamina in the pallidum at the level of the AC-PC, was significantly associated with improved tics but not mood or OCB outcome. CONCLUSIONS: This study adds further support to the application of DBS in a tic-related network, though factors such as patient sample size and clinical heterogeneity remain as limitations and replication is required.
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: Kara A Johnson; P Thomas Fletcher; Domenico Servello; Alberto Bona; Mauro Porta; Jill L Ostrem; Eric Bardinet; Marie-Laure Welter; Andres M Lozano; Juan Carlos Baldermann; Jens Kuhn; Daniel Huys; Thomas Foltynie; Marwan Hariz; Eileen M Joyce; Ludvic Zrinzo; Zinovia Kefalopoulou; Jian-Guo Zhang; Fan-Gang Meng; ChenCheng Zhang; Zhipei Ling; Xin Xu; Xinguang Yu; Anouk Yjm Smeets; Linda Ackermans; Veerle Visser-Vandewalle; Alon Y Mogilner; Michael H Pourfar; Leonardo Almeida; Aysegul Gunduz; Wei Hu; Kelly D Foote; Michael S Okun; Christopher R Butson Journal: J Neurol Neurosurg Psychiatry Date: 2019-05-25 Impact factor: 10.154
Authors: Laura Wehmeyer; Thomas Schüller; Jana Kiess; Petra Heiden; Veerle Visser-Vandewalle; Juan Carlos Baldermann; Pablo Andrade Journal: Front Neurol Date: 2021-10-20 Impact factor: 4.086
Authors: Natalia Szejko; Yulia Worbe; Andreas Hartmann; Veerle Visser-Vandewalle; Linda Ackermans; Christos Ganos; Mauro Porta; Albert F G Leentjens; Jan-Hinnerk Mehrkens; Daniel Huys; Juan Carlos Baldermann; Jens Kuhn; Carine Karachi; Cécile Delorme; Thomas Foltynie; Andrea E Cavanna; Danielle Cath; Kirsten Müller-Vahl Journal: Eur Child Adolesc Psychiatry Date: 2021-10-04 Impact factor: 4.785