Motor Improvement and Emotional Stabilization in Patients With Tourette Syndrome After Deep Brain Stimulation of the Ventral Anterior and Ventrolateral Motor Part of the Thalamus

Daniel Huys; Christina Bartsch; Philip Koester; Doris Lenartz; Mohammad Maarouf; Jörg Daumann; Jürgen K Mai; Joachim Klosterkötter; Stefan Hunsche; Veerle Visser-Vandewalle; Christiane Woopen; Lars Timmermann; Volker Sturm; Jens Kuhn

doi:10.1016/j.biopsych.2014.05.014

Motor Improvement and Emotional Stabilization in Patients With Tourette Syndrome After Deep Brain Stimulation of the Ventral Anterior and Ventrolateral Motor Part of the Thalamus

Biol Psychiatry. 2016 Mar 1;79(5):392-401. doi: 10.1016/j.biopsych.2014.05.014. Epub 2014 Jun 2.

Affiliations

¹ Departments of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany. Electronic address: Daniel.Huys@uk-koeln.de.
² Departments of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
³ Departments of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany.
⁴ Departments of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany; Department of Functional Neurosurgery and Stereotaxy, Hospitals of Cologne, Cologne-Merheim, Germany.
⁵ Department of Anatomy, University of Düsseldorf, Düsseldorf, Germany.
⁶ Institute for the History of Medicine and Medical Ethics, Research Unit Ethics, University of Cologne, Cologne, Germany.
⁷ Department of Neurology, University of Cologne, Cologne, Germany.

PMID: 25034948
DOI: 10.1016/j.biopsych.2014.05.014

Abstract

Background: Since its first application in 1999, the potential benefit of deep brain stimulation (DBS) in reducing symptoms of otherwise treatment-refractory Tourette syndrome (TS) has been documented in several publications. However, uncertainty regarding the ideal neural targets remains, and the eventuality of so far undocumented but possible negative long-term effects on personality fuels the debate about the ethical implications of DBS.

Methods: In this prospective open-label trial, eight patients (three female, five male) 19-56 years old with severe and medically intractable TS were treated with high-frequency DBS of the ventral anterior and ventrolateral motor part of the thalamus. To assess the course of TS, its clinical comorbidities, personality parameters, and self-perceived quality of life, patients underwent repeated psychiatric assessments at baseline and 6 and 12 months after DBS onset.

Results: Analysis indicated a strongly significant and beneficial effect of DBS on TS symptoms, trait anxiety, quality of life, and global functioning with an apparently low side-effect profile. In addition, presurgical compulsivity, anxiety, emotional dysregulation, and inhibition appeared to be significant predictors of surgery outcome.

Conclusions: Trading off motor effects and desirable side effects against surgery-related risks and negative implications, stimulation of the ventral anterior and ventrolateral motor part of the thalamus seems to be a valuable option when considering DBS for TS.

Keywords: Deep brain stimulation; Motor tics; Thalamic stimulation; Thalamus; Tic disorder; Tourette; Tourette syndrome; Vocal tics.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anxiety
Comorbidity
Compulsive Behavior
Deep Brain Stimulation*
Emotions
Female
Humans
Male
Middle Aged
Prospective Studies
Psychiatric Status Rating Scales
Quality of Life
Self Concept
Thalamus / physiology*
Tic Disorders / therapy*
Tourette Syndrome / therapy*
Treatment Outcome
Young Adult