Thread Tools Display Modes
Old 04-01-2008, 07:58 PM #1
olsen's Avatar
olsen olsen is offline
Senior Member
Join Date: Aug 2006
Posts: 1,860
15 yr Member
olsen olsen is offline
Senior Member
olsen's Avatar
Join Date: Aug 2006
Posts: 1,860
15 yr Member
Default Deep Brain Stimulation for Tourette Syndrome

Deep Brain Stimulation for Tourette Syndrome
A small open-label trial establishes safety and suggests efficacy.

This is a report of experience with deep brain stimulation (DBS) in 18 patients with severe Gilles de la Tourette syndrome that was refractory to medication and psychobehavioral therapy. The stimulation targets were the bilateral centromedian–parafascicular complex and ventral oral nuclei of the thalamus. The main assessment instrument was the Yale Global Tic Severity Rating Scale. The study was open-label except for one double-blind assessment of nine patients during "on," "off," and sham "off" periods.

Overall, the patients improved significantly on the vocal-tic, motor-tic, and social-impairment components of the scale. Improvement was greater in the "on" than the "off" parameter. Patients experienced anxiety during the sham "off" period. The procedure was generally well tolerated.

Comment: This report represents the largest published series of patients with Tourette syndrome treated with deep brain stimulation. It can be considered an early-phase study that establishes safety and suggests efficacy.

There are, as would be expected at this stage, several unresolved issues. One of the most contentious issues is the identification of the most appropriate stimulation target. Several targets for Tourette syndrome have already been examined, including the globus pallidus, the anterior limb of the internal capsule, and the nucleus accumbens. The relative attributes, risks, and benefits of these targets for Tourette are not known. Tourette is a heterogeneous disease with important comorbidities, including obsessive-compulsive components. The extent to which the clinical features in individual patients could be used as predictors of benefit with DBS must be determined.

The best choice of stimulation parameters also remains unresolved. The choice so far is empirical. There is no biologic marker to help guide the choice between high-frequency and low-frequency stimulation or between intermittent and continuous stimulation or to guide the choice of stimulation intensity. The time lag between stimulation and response and the prolonged washout effect after cessation of stimulation contribute to the complexity of optimizing stimulation parameters.

Despite these challenges, this work is an important early step in examining the circuitry of Tourette and in understanding how modulation of these neural elements can lead to behavioral changes. Because relatively few patients have been operated on so far, data and resources must be pooled and common instruments and protocols used so that these issues can begin to be addressed.

— Andres M. Lozano, MD, PhD, FRCSC

Dr. Lozano is Professor of Surgery and RR Tasker Chair in Functional Neurosurgery, University of Toronto; Senior Scientist, Toronto Western Research Institute; President, World Society for Stereotactic and Functional Neurosurgery; and Canadian Research Chair in Neuroscience (Tier 1), Toronto Western Hospital, Toronto.

Published in Journal Watch Neurology April 1, 2008
Servello D et al. Deep brain stimulation in 18 patients with severe Gilles de la Tourette syndrome refractory to treatment: The surgery and stimulation. J Neurol Neurosurg Psychiatry 2008 Feb; 79:136.

Original article (Subscription may be required)
Medline abstract (Free)

Okun MS et al. Avoiding deep brain stimulation failures in Tourette syndrome. J Neurol Neurosurg Psychiatry 2008 Feb; 79:111.

Original article (Subscription may be required)
Medline abstract (Free)
In the last analysis, we see only what we are ready to see, what we have been taught to see. We eliminate and ignore everything that is not a part of our prejudices.

~ Jean-Martin Charcot

The future is already here it's just not very evenly distributed. William Gibson

Last edited by Chemar; 04-03-2008 at 08:04 AM. Reason: edit for copyright issues
olsen is offline   Reply With QuoteReply With Quote


Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off

Similar Threads
Thread Thread Starter Forum Replies Last Post
New Deep Brain Stimulation Device For Parkinson's, Under Evaluation lou_lou Parkinson's Disease 0 02-14-2008 03:02 AM
Sleep Chemical Central To Effectiveness Of Deep Brain Stimulation Stitcher Parkinson's Disease 0 12-24-2007 09:58 AM

All times are GMT -5. The time now is 05:11 AM.

Powered by vBulletin • Copyright ©2000 - 2024, Jelsoft Enterprises Ltd.

vBulletin Optimisation provided by vB Optimise v2.7.1 (Lite) - vBulletin Mods & Addons Copyright © 2024 DragonByte Technologies Ltd.

NeuroTalk Forums

Helping support those with neurological and related conditions.


The material on this site is for informational purposes only,
and is not a substitute for medical advice, diagnosis or treatment
provided by a qualified health care provider.

Always consult your doctor before trying anything you read here.