title: Tourette syndrome deep brain stimulation: a review and updated recommendations.
abstract: 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.
authors.affiliation: Department of Neurology, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Schrock
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Mink
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Woods
authors.forename: Mauro
authors.initials: M
authors.lastname: Porta
authors.forename: Dominico
authors.initials: D
authors.lastname: Servello
authors.forename: Veerle
authors.initials: V
authors.lastname: Visser-Vandewalle
authors.forename: Peter A
authors.initials: PA
authors.lastname: Silburn
authors.forename: Thomas
authors.initials: T
authors.lastname: Foltynie
authors.forename: Harrison C
authors.initials: HC
authors.lastname: Walker
authors.forename: Joohi
authors.initials: J
authors.lastname: Shahed-Jimenez
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Savica
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Klassen
authors.forename: Andre G
authors.initials: AG
authors.lastname: Machado
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Foote
authors.forename: Jian-Guo
authors.initials: JG
authors.lastname: Zhang
authors.forename: Wei
authors.initials: W
authors.lastname: Hu
authors.forename: Linda
authors.initials: L
authors.lastname: Ackermans
authors.forename: Yasin
authors.initials: Y
authors.lastname: Temel
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Mari
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Changizi
authors.forename: Andres
authors.initials: A
authors.lastname: Lozano
authors.forename: M
authors.initials: M
authors.lastname: Auyeung
authors.forename: Takanobu
authors.initials: T
authors.lastname: Kaido
authors.forename: Yves
authors.initials: Y
authors.lastname: Agid
authors.forename: Marie L
authors.initials: ML
authors.lastname: Welter
authors.forename: Suketu M
authors.initials: SM
authors.lastname: Khandhar
authors.forename: Alon Y
authors.initials: AY
authors.lastname: Mogilner
authors.forename: Michael H
authors.initials: MH
authors.lastname: Pourfar
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Walter
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Juncos
authors.forename: Robert E
authors.initials: RE
authors.lastname: Gross
authors.forename: Jens
authors.initials: J
authors.lastname: Kuhn
authors.forename: James F
authors.initials: JF
authors.lastname: Leckman
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Neimat
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods* / Q000639:trends; D017408:Guidelines as Topic; D006801:Humans; D005879:Tourette Syndrome / Q000175:diagnosis / Q000628:therapy*
keywords: DBS; Tourette syndrome; deep brain stimulation; guidelines