TY - JOUR
T1 - Image-based analysis and long-term clinical outcomes of deep brain stimulation for Tourette syndrome
T2 - a multisite study
AU - Johnson, Kara A.
AU - Fletcher, P. Thomas
AU - Servello, Domenico
AU - Bona, Alberto
AU - Porta, Mauro
AU - Ostrem, Jill L.
AU - Bardinet, Eric
AU - Welter, Marie Laure
AU - Lozano, Andres M.
AU - Baldermann, Juan Carlos
AU - Kuhn, Jens
AU - Huys, Daniel
AU - Foltynie, Thomas
AU - Hariz, Marwan
AU - Joyce, Eileen M.
AU - Zrinzo, Ludvic
AU - Kefalopoulou, Zinovia
AU - Zhang, Jian Guo
AU - Meng, Fan Gang
AU - Zhang, Chen Cheng
AU - Ling, Zhipei
AU - Xu, Xin
AU - Yu, Xinguang
AU - Smeets, Anouk Y.J.M.
AU - Ackermans, Linda
AU - Visser-Vandewalle, Veerle
AU - Mogilner, Alon Y.
AU - Pourfar, Michael H.
AU - Almeida, Leonardo
AU - Gunduz, Aysegul
AU - Hu, Wei
AU - Foote, Kelly D.
AU - Okun, Michael S.
AU - Butson, Christopher R.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2019.
PY - 2019/5/25
Y1 - 2019/5/25
N2 - background Deep brain stimulation (DBS) can be an effective therapy for tics and comorbidities in select cases of severe, treatment-refractory Tourette syndrome (TS). Clinical responses remain variable across patients, which may be attributed to differences in the location of the neuroanatomical regions being stimulated. We evaluated active contact locations and regions of stimulation across a large cohort of patients with TS in an effort to guide future targeting. Methods We collected retrospective clinical data and imaging from 13 international sites on 123 patients. We assessed the effects of DBS over time in 110 patients who were implanted in the centromedial (CM) thalamus (n=51), globus pallidus internus (GPi) (n=47), nucleus accumbens/anterior limb of the internal capsule (n=4) or a combination of targets (n=8). Contact locations (n=70 patients) and volumes of tissue activated (n=63 patients) were coregistered to create probabilistic stimulation atlases. results Tics and obsessive–compulsive behaviour (OCB) significantly improved over time (p<0.01), and there were no significant differences across brain targets (p>0.05). The median time was 13 months to reach a 40% improvement in tics, and there were no significant differences across targets (p=0.84), presence of OCB (p=0.09) or age at implantation (p=0.08). Active contacts were generally clustered near the target nuclei, with some variability that may reflect differences in targeting protocols, lead models and contact configurations. There were regions within and surrounding GPi and CM thalamus that improved tics for some patients but were ineffective for others. Regions within, superior or medial to GPi were associated with a greater improvement in OCB than regions inferior to GPi. Conclusion The results collectively indicate that DBS may improve tics and OCB, the effects may develop over several months, and stimulation locations relative to structural anatomy alone may not predict response. This study was the first to visualise and evaluate the regions of stimulation across a large cohort of patients with TS to generate new hypotheses about potential targets for improving tics and comorbidities.
AB - background Deep brain stimulation (DBS) can be an effective therapy for tics and comorbidities in select cases of severe, treatment-refractory Tourette syndrome (TS). Clinical responses remain variable across patients, which may be attributed to differences in the location of the neuroanatomical regions being stimulated. We evaluated active contact locations and regions of stimulation across a large cohort of patients with TS in an effort to guide future targeting. Methods We collected retrospective clinical data and imaging from 13 international sites on 123 patients. We assessed the effects of DBS over time in 110 patients who were implanted in the centromedial (CM) thalamus (n=51), globus pallidus internus (GPi) (n=47), nucleus accumbens/anterior limb of the internal capsule (n=4) or a combination of targets (n=8). Contact locations (n=70 patients) and volumes of tissue activated (n=63 patients) were coregistered to create probabilistic stimulation atlases. results Tics and obsessive–compulsive behaviour (OCB) significantly improved over time (p<0.01), and there were no significant differences across brain targets (p>0.05). The median time was 13 months to reach a 40% improvement in tics, and there were no significant differences across targets (p=0.84), presence of OCB (p=0.09) or age at implantation (p=0.08). Active contacts were generally clustered near the target nuclei, with some variability that may reflect differences in targeting protocols, lead models and contact configurations. There were regions within and surrounding GPi and CM thalamus that improved tics for some patients but were ineffective for others. Regions within, superior or medial to GPi were associated with a greater improvement in OCB than regions inferior to GPi. Conclusion The results collectively indicate that DBS may improve tics and OCB, the effects may develop over several months, and stimulation locations relative to structural anatomy alone may not predict response. This study was the first to visualise and evaluate the regions of stimulation across a large cohort of patients with TS to generate new hypotheses about potential targets for improving tics and comorbidities.
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U2 - 10.1136/jnnp-2019-320379
DO - 10.1136/jnnp-2019-320379
M3 - Article
C2 - 31129620
AN - SCOPUS:85066884608
SN - 0022-3050
VL - 90
SP - 1078
EP - 1090
JO - Journal of Neurology, Neurosurgery and Psychiatry
JF - Journal of Neurology, Neurosurgery and Psychiatry
IS - 10
ER -