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Deep brain stimulation in Tourette’s syndrome: evidence to date

Authors Casagrande SCB, Cury RG, Alho EJL, Fonoff ET

Received 2 September 2018

Accepted for publication 19 February 2019

Published 29 April 2019 Volume 2019:15 Pages 1061—1075


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Roger Pinder

Sara CB Casagrande,1 Rubens G Cury,1 Eduardo JL Alho,2 Erich Talamoni Fonoff2

1Department of Neurology, School of Medicine, Movement Disorders Center, University of São Paulo, São Paulo, Brazil; 2Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil

Abstract: Tourette’s syndrome (TS) is a neurodevelopmental disorder that comprises vocal and motor tics associated with a high frequency of psychiatric comorbidities, which has an important impact on quality of life. The onset is mainly in childhood and the symptoms can either fade away or require pharmacological therapies associated with cognitive-behavior therapies. In rare cases, patients experience severe and disabling symptoms refractory to conventional treatments. In these cases, deep brain stimulation (DBS) can be considered as an interesting and effective option for symptomatic control. DBS has been studied in numerous trials as a therapy for movement disorders, and currently positive data supports that DBS is partially effective in reducing the motor and non-motor symptoms of TS. The average response, mostly from case series and prospective cohorts and only a few controlled studies, is around 40% improvement on tic severity scales. The ventromedial thalamus has been the preferred target, but more recently the globus pallidus internus has also gained some notoriety. The mechanism by which DBS is effective on tics and other symptoms in TS is not yet understood. As refractory TS is not common, even reference centers have difficulties in performing large controlled trials. However, studies that reproduce the current results in larger and multicenter randomized controlled trials to improve our knowledge so as to support the best target and stimulation settings are still lacking. This article will discuss the selection of the candidates, DBS targets and mechanisms on TS, and clinical evidence to date reviewing current literature about the use of DBS in the treatment of TS.

Keywords: deep brain stimulation, DBS, Tourette’s syndrome, tics

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