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Tourette syndrome deep brain stimulation: A review and updated recommendations
Author(s) -
Schrock Lauren E.,
Mink Jonathan W.,
Woods Douglas W.,
Porta Mauro,
Servello Dominico,
VisserVandewalle Veerle,
Silburn Peter A.,
Foltynie Thomas,
Walker Harrison C.,
ShahedJimenez Joohi,
Savica Rodolfo,
Klassen Bryan T.,
Machado Andre G.,
Foote Kelly D.,
Zhang JianGuo,
Hu Wei,
Ackermans Linda,
Temel Yasin,
Mari Zoltan,
Changizi Barbara K.,
Lozano Andres,
Auyeung M.,
Kaido Takanobu,
Agid Yves,
Welter Marie L.,
Khandhar Suketu M.,
Mogilner Alon Y.,
Pourfar Michael H.,
Walter Benjamin L.,
Juncos Jorge L.,
Gross Robert E.,
Kuhn Jens,
Leckman James F.,
Neimat Joseph A,
Okun Michael S.
Publication year - 2015
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.26094
Subject(s) - tics , deep brain stimulation , tourette syndrome , psychogenic disease , movement disorders , population , psychiatry , medicine , psychology , malingering , neuropsychology , pediatrics , physical medicine and rehabilitation , disease , cognition , environmental health , parkinson's disease
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. © 2014 International Parkinson and Movement Disorder Society