Deep brain stimulation for Tourette syndrome: target selection

Ashwin Viswanathan, Joohi Jimenez-Shahed, José Fidel Baizabal Carvallo, Joseph Jankovic
Stereotactic and Functional Neurosurgery 2012, 90 (4): 213-24

BACKGROUND/AIMS: Tourette syndrome (TS) is a complex neurological disorder manifested chiefly by motor and phonic tics and a variety of behavioral comorbidities, including attention disorder, obsessive-compulsive disorder and impulse control problems. Surgical treatment is increasingly considered when tics become troublesome or even disabling or self-injurious despite optimal medical therapy. In this review, we describe the surgical techniques, stimulation parameters, outcomes of deep brain stimulation (DBS) in TS, and critically review target choices.

METHODS: A search of the PubMed database was performed to identify all articles discussing DBS and TS. 'Tourette' and 'Stimulation' were used as MeSH headings.

RESULTS: Since the first report of thalamic DBS for TS in 1999, follow-up on less than 100 patients has been reported in the literature. Reported targets for DBS include the thalamic centromedian nucleus and substantia periventricularis, posteroventral globus pallidus internus, ventromedial globus pallidus internus, globus pallidus externus, anterior limb of the internal capsule and nucleus accumbens.

CONCLUSIONS: Determination of the optimal surgical target will require a multicenter, randomized trial, and an expanded understanding of the neurobiology of TS.

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