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Brain Sciences
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Deep Brain Stimulation and Tourette Syndrome
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Deep Brain Stimulation and Tourette Syndrome

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neuropsychiatry".

Deadline for manuscript submissions: closed (20 December 2020) | Viewed by 14348

Special Issue Editor

Prof. Dr. Veerle Visser-Vandewalle

E-Mail Website
Guest Editor
Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, 50937 Cologne, Germany
Interests: Deep Brain Stimulation; Tourette Syndrome; depression; Alzheimer dementia; movement disorders; obsessive-compulsive disorder

Special Issue Information

Dear Colleagues,

Tourette syndrome (TS) is a neuropsychiatric disorder characterized by involuntary stereotyped motor and phonic tics, typically starting during childhood. Its pathophysiology is not completely understood. Studies suggest it is due to an abnormal function of cortico-basal ganglia-thalamocortical pathways.

For treatment refractory cases, deep brain stimulation (DBS) might be considered. The first case of TS treated with DBS (1999) received leads in the medial part of the thalamus, at the anteromedial border of the centromedian nucleus and along the nucleus ventro-oralis internus (CM-Voi complex). Thereafter, different studies have been published with DBS on different targets within the thalamus, but also on other brain areas such as the globus pallidus internus, the ventroposterolateral (motor) as well as the anteromedial (limbic) areas, the globus pallidus externus, the internal capsule and nucleus acumbens, and the subthalamic nucleus.

Tractography is an imaging technique that has received a lot of attention recently because of its ability to unravel the underlying pathophysiology of specific neuropsychiatric disorders, and also for its ability to optimize the effects of DBS by defining the tracts that need to be modulated in order to have a positive clinical effect. As such, tractography has led to better insights into the pathophysiology of TS and better DBS targeting.

Prof. Dr. Veerle Visser-Vandewalle
Guest Editor

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Published Papers (3 papers)

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Research

11 pages, 1476 KiB  
Article
Connectivity Patterns of Deep Brain Stimulation Targets in Patients with Gilles de la Tourette Syndrome
by Petra Heiden, Mauritius Hoevels, Dilruba Bayram, Juan C. Baldermann, Thomas Schüller, Daniel Huys, Veerle Visser-Vandewalle and Pablo Andrade
Brain Sci. 2021, 11(1), 87; https://doi.org/10.3390/brainsci11010087 - 11 Jan 2021
Cited by 8 | Viewed by 5808
Abstract
Since 1999, several targets for deep brain stimulation (DBS) in Gilles de la Tourette syndrome (GTS) have emerged showing similar success rates. Studies using different tractography techniques have identified connectivity profiles associated with a better outcome for individual targets. However, GTS patients might [...] Read more.
Since 1999, several targets for deep brain stimulation (DBS) in Gilles de la Tourette syndrome (GTS) have emerged showing similar success rates. Studies using different tractography techniques have identified connectivity profiles associated with a better outcome for individual targets. However, GTS patients might need individualized therapy. The objective of this study is to analyze the connectivity profile of different DBS targets for GTS. We identified standard target coordinates for the centromedian nucleus/nucleus ventro-oralis internus (CM/Voi), the CM/parafascicular (CM-Pf) complex, the anteromedial globus pallidus internus (amGPi), the posteroventral GPi (pvGPi), the ventral anterior/ventrolateral thalamus (VA/VL), and the nucleus accumbens/anterior limb of the internal capsule (Nacc/ALIC). Probabilistic tractography was performed from the targets to different limbic and motor areas based on patient-specific imaging and a normative connectome (HCP). Our analysis showed significant differences between the connectivity profiles of standard DBS targets (p < 0.05). Among all targets, the pvGPi showed the strongest connection to the sensorimotor cortex, while the amGPi showed the strongest connection to the prefrontal cortex in patient-specific imaging. Differences were observed between the connectivity profiles when using probabilistic tractography based on patient data and HCP. Our findings showed that the connectivity profiles of different DBS targets to major motor and limbic areas differ significantly. In the future, these differences may be considered when planning DBS for GTS patients employing an individualized approach. There were compelling differences in connectivity profiles when using different tractography techniques. Full article
(This article belongs to the Special Issue Deep Brain Stimulation and Tourette Syndrome)
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12 pages, 6348 KiB  
Article
Modulation of Fibers to Motor Cortex during Thalamic DBS in Tourette Patients Correlates with Tic Reduction
by Pablo Andrade, Petra Heiden, Moritz Hoevels, Marc Schlamann, Juan C. Baldermann, Daniel Huys and Veerle Visser-Vandewalle
Brain Sci. 2020, 10(5), 302; https://doi.org/10.3390/brainsci10050302 - 15 May 2020
Cited by 20 | Viewed by 3895
Abstract
Probabilistic tractography in Tourette syndrome (TS) patients have shown an alteration in the connectivity of the primary motor cortex and supplementary motor area with the striatum and thalamus, suggesting an abnormal connectivity of the cortico-striatum-thalamocortical-pathways in TS. Deep brain stimulation (DBS) of the [...] Read more.
Probabilistic tractography in Tourette syndrome (TS) patients have shown an alteration in the connectivity of the primary motor cortex and supplementary motor area with the striatum and thalamus, suggesting an abnormal connectivity of the cortico-striatum-thalamocortical-pathways in TS. Deep brain stimulation (DBS) of the centromedian nucleus–nucleus ventrooralis internus (CM-Voi complex) in the thalamus is an effective treatment for refractory TS patients. We investigated the connectivity of activated fibers from CM-Voi to the motor cortex and its correlation between these projections and their clinical outcome. Seven patients with TS underwent CM-Voi-DBS surgery and were clinically evaluated preoperatively and six months postoperatively. We performed diffusion tensor imaging to display the activated fibers projecting from the CM-Voi to the different motor cortex regions of interest. These analyses showed that the extent of tic reduction during DBS is associated with the degree of stimulation-dependent connectivity between CM-Voi and the motor cortex, and in particular, an increased density of projections to the presupplementary motor area (preSMA). Non-responder patients displayed the largest amount of active fibers projecting into cortical areas other than motor cortex compared to responder patients. These findings support the notion that an abnormal connectivity of thalamocortical pathways underlies TS, and that modulation of these circuits through DBS could restore the function and reduce symptoms. Full article
(This article belongs to the Special Issue Deep Brain Stimulation and Tourette Syndrome)
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8 pages, 931 KiB  
Article
Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets
by Domenico Servello, Tommaso Francesco Galbiati, Roberta Balestrino, Guglielmo Iess, Edvin Zekaj, Sara De Michele and Mauro Porta
Brain Sci. 2020, 10(5), 301; https://doi.org/10.3390/brainsci10050301 - 15 May 2020
Cited by 18 | Viewed by 4064
Abstract
Gilles de la Tourette syndrome (GTS) is a complex neurodevelopmental disorder characterized by tics and, frequently, psychiatric and behavioral comorbidities. Above all, obsessive compulsive disorder/behavior (OCD/OCB) influences the clinical picture and has a severe impact on quality of life, eventually more than the [...] Read more.
Gilles de la Tourette syndrome (GTS) is a complex neurodevelopmental disorder characterized by tics and, frequently, psychiatric and behavioral comorbidities. Above all, obsessive compulsive disorder/behavior (OCD/OCB) influences the clinical picture and has a severe impact on quality of life, eventually more than the tics themselves. Deep brain stimulation (DBS) is an effective therapy in selected, refractory cases. Clinical response to DBS may vary according to the clinical picture, comorbidities, and to the anatomical target. This retrospective study compares the results obtained from DBS in the ventralis oralis/centromedian-parascicular nucleus of the thalamus (Voi-Cm/Pf) (41 patients) and antero-medial Globus Pallidus internus (am-GPi) (14 patients), evaluating clinical response over time by means of Yale Global Tic Severity Scale (YGTSS) and Yale–Brown Obsessive-Compulsive Scale (YBOCS) scores over a period of 48 months. A significant and stable improvement in the YGTSS and YBOCS has been obtained in both groups (p < 0.001). There was a significant difference in YBOCS improvement over time between the am-GPi group and the Voi-Cm/Pf group, indicating a better and faster control of OCD/OCB symptoms in the former group. The ratio of hardware removal was 23% and limited to 13 patients in the Voi-Cm/Pf group. These results confirm that DBS is an effective therapy in treating GTS and suggest that the am-GPi might be superior to Voi-Cm/Pf in alleviating comorbid OCD/OCB. Full article
(This article belongs to the Special Issue Deep Brain Stimulation and Tourette Syndrome)
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