Johnson, Kara A., Fletcher, P. Thomas, Servello, Domenico, Bona, Alberto, Porta, Mauro, Ostrem, Jill L., Bardinet, Eric, Welter, Marie-Laure, Lozano, Andres M., Baldermann, Juan Carlos, Kuhn, Jens, Huys, Daniel, Foltynie, Thomas, Hariz, Marwan, Joyce, Eileen M., Zrinzo, Ludvic, Kefalopoulou, Zinovia, Zhang, Jian-Guo, Meng, Fan-Gang, Zhang, ChenCheng ORCID: 0000-0003-4472-4134, Ling, Zhipei, Xu, Xin, Yu, Xinguang, Smeets, Anouk Yjm, Ackermans, Linda, Visser-Vandewalle, Veerle, Mogilner, Alon Y., Pourfar, Michael H., Almeida, Leonardo, Gunduz, Aysegul, Hu, Wei, Foote, Kelly D., Okun, Michael S. and Butson, Christopher R. (2019). Image-based analysis and long-term clinical outcomes of deep brain stimulation for Tourette syndrome: a multisite study. J. Neurol. Neurosurg. Psychiatry, 90 (10). S. 1078 - 1091. LONDON: BMJ PUBLISHING GROUP. ISSN 1468-330X

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Abstract

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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Johnson, Kara A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fletcher, P. ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Servello, DomenicoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bona, AlbertoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Porta, MauroUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ostrem, Jill L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bardinet, EricUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Welter, Marie-LaureUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lozano, Andres M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baldermann, Juan CarlosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kuhn, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Huys, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Foltynie, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hariz, MarwanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Joyce, Eileen M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zrinzo, LudvicUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kefalopoulou, ZinoviaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zhang, Jian-GuoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meng, Fan-GangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zhang, ChenChengUNSPECIFIEDorcid.org/0000-0003-4472-4134UNSPECIFIED
Ling, ZhipeiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Xu, XinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Yu, XinguangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Smeets, Anouk YjmUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ackermans, LindaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Visser-Vandewalle, VeerleUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mogilner, Alon Y.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pourfar, Michael H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Almeida, LeonardoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gunduz, AysegulUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hu, WeiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Foote, Kelly D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Okun, Michael S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Butson, Christopher R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-132805
DOI: 10.1136/jnnp-2019-320379
Journal or Publication Title: J. Neurol. Neurosurg. Psychiatry
Volume: 90
Number: 10
Page Range: S. 1078 - 1091
Date: 2019
Publisher: BMJ PUBLISHING GROUP
Place of Publication: LONDON
ISSN: 1468-330X
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
GLOBUS-PALLIDUS INTERNUS; DOUBLE-BLIND; THALAMIC-STIMULATION; TIC SEVERITY; ACTIVATION VOLUMES; BASAL GANGLIA; IMPROVEMENT; SURGERY; TISSUE; TRIALMultiple languages
Clinical Neurology; Psychiatry; SurgeryMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/13280

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