Target-Specific Effects of Deep Brain Stimulation for Tourette Syndrome: A Systematic Review and Meta-Analysis

Laura Wehmeyer; Thomas Schüller; Jana Kiess; Petra Heiden; Veerle Visser-Vandewalle; Juan Carlos Baldermann; Pablo Andrade

doi:10.3389/fneur.2021.769275

Target-Specific Effects of Deep Brain Stimulation for Tourette Syndrome: A Systematic Review and Meta-Analysis

Front Neurol. 2021 Oct 20:12:769275. doi: 10.3389/fneur.2021.769275. eCollection 2021.

Authors

Laura Wehmeyer¹, Thomas Schüller², Jana Kiess², Petra Heiden¹, Veerle Visser-Vandewalle¹, Juan Carlos Baldermann^{2

3}, Pablo Andrade¹

Affiliations

¹ Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany.
² Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
³ Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany.

Abstract

Background: Extended research has pointed to the efficacy of deep brain stimulation (DBS) in treatment of patients with treatment-refractory Tourette syndrome (TS). The four most commonly used DBS targets for TS include the centromedian nucleus-nucleus ventrooralis internus (CM-Voi) and the centromedian nucleus-parafascicular (CM-Pf) complexes of the thalamus, and the posteroventrolateral (pvIGPi) and the anteromedial portion of the globus pallidus internus (amGPi). Differences and commonalities between those targets need to be compared systematically. Objective: Therefore, we evaluated whether DBS is effective in reducing TS symptoms and target-specific differences. Methods: A PubMed literature search was conducted according to the PRISMA guidelines. Eligible literature was used to conduct a systematic review and meta-analysis. Results: In total, 65 studies with 376 patients were included. Overall, Yale Global Tic Severity Scale (YGTSS) scores were reduced by more than 50 in 69% of the patients. DBS also resulted in significant reductions of secondary outcome measures, including the total YGTSS, modified Rush Video-Based Tic Rating Scale (mRVRS), Yale-Brown Obsessive Compulsive Scale (YBOCS), and Becks Depression Inventory (BDI). All targets resulted in significant reductions of YGTSS scores and, with the exception of the CM-Pf, also in reduced YBOCS scores. Interestingly, DBS of pallidal targets showed increased YGTSS and YBOCS reductions compared to thalamic targets. Also, the meta-analysis including six randomized controlled and double-blinded trials demonstrated clinical efficacy of DBS for TS, that remained significant for GPi but not thalamic stimulation in two separate meta-analyses. Conclusion: We conclude that DBS is a clinically effective treatment option for patients with treatment-refractory TS, with all targets showing comparable improvement rates. Future research might focus on personalized and symptom-specific target selection.

Keywords: DBS; Tourette syndrome; deep brain stimulation; meta-analysis; neuromodulation; systematic review; tic disorders.

Publication types

Systematic Review