Skip to main content
SpringerLink
Log in

European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: deep brain stimulation

  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

A Publisher’s Erratum to this article was published on 14 July 2011

Abstract

Ten years ago deep brain stimulation (DBS) has been introduced as an alternative and promising treatment option for patients suffering from severe Tourette syndrome (TS). It seemed timely to develop a European guideline on DBS by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). For a narrative review a systematic literature search was conducted and expert opinions of the guidelines group contributed also to the suggestions. Of 63 patients reported so far in the literature 59 had a beneficial outcome following DBS with moderate to marked tic improvement. However, randomized controlled studies including a larger number of patients are still lacking. Although persistent serious adverse effects (AEs) have hardly been reported, surgery-related (e.g., bleeding, infection) as well as stimulation-related AEs (e.g., sedation, anxiety, altered mood, changes in sexual function) may occur. At present time, DBS in TS is still in its infancy. Due to both different legality and practical facilities in different European countries these guidelines, therefore, have to be understood as recommendations of experts. However, among the ESSTS working group on DBS in TS there is general agreement that, at present time, DBS should only be used in adult, treatment resistant, and severely affected patients. It is highly recommended to perform DBS in the context of controlled trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ackermans L, Temel Y, Bauer NJC, Visser-Vandewalle V (2007) Vertical gaze palsy after thalamic stimulation for Tourette syndrome: case report. Neurosurgery 61:E1100 discussion E1100

    Article  PubMed  Google Scholar 

  2. Ackermans L, Temel Y, Cath D, van der Linden C, Bruggeman R, Kleijer M, Nederveen P, Schruers K, Colle H, Tijssen MA, Visser-Vandewalle V, Dutch Flemish Tourette Surgery Study Group (2006) Deep brain stimulation in Tourette’s syndrome: two targets? Mov Disord 21:709–713

    Article  PubMed  Google Scholar 

  3. Ackermans L, Temel Y, Visser-Vandewalle V (2008) Deep brain stimulation in Tourette’s syndrome. Neurotherapeutics 5:339–344

    Article  PubMed  Google Scholar 

  4. Babel TB, Warnke PC, Ostertag CB (2001) Immediate and long term outcome after infrathalamic and thalamic lesioning for intractable Tourette’s syndrome. J Neurol Neurosurg Psychiatr 70:666–671

    Article  PubMed  CAS  Google Scholar 

  5. Bajwa RJ, de Lotbinière AJ, King RA, Jabbari B, Quatrano S, Kunze K, Scahill L, Leckman JF (2007) Deep brain stimulation in Tourette’s syndrome. Mov Disord 22:1346–1350

    Article  PubMed  Google Scholar 

  6. Black KJ (2009) Patient page. Deep brain stimulation for Tourette syndrome. Neurology 73:e87–e90

    Article  PubMed  Google Scholar 

  7. Burd L, Kerbeshian PJ, Barth A, Klug MG, Avery PK, Benz B (2001) Long-term follow-up of an epidemiologically defined cohort of patients with Tourette syndrome. J Child Neurol 16:431–437

    PubMed  CAS  Google Scholar 

  8. Burdick A, Foote KD, Goodman W, Ward HE, Ricciuti N, Murphy T, Haq I, Okun MS (2010) Lack of benefit of accumbens/capsular deep brain stimulation in a patient with both tics and obsessive–compulsive disorder. Neurocase 16:321–330

    Article  PubMed  Google Scholar 

  9. Dehning S, Mehrkens J, Müller N, Bötzel K (2008) Therapy-refractory Tourette syndrome: beneficial outcome with globus pallidus internus deep brain stimulation. Mov Disord 23:1300–1302

    Article  PubMed  Google Scholar 

  10. Diederich NJ, Kalteis K, Stamenkovic M, Pieri V, Alesch F (2005) Efficient internal pallidal stimulation in Gilles de la Tourette syndrome: a case report. Mov Disord 20:1496–1499

    Article  PubMed  Google Scholar 

  11. Dueck A, Wolters A, Wunsch K, Bohne-Suraj S, Mueller J, Haessler F, Benecke R, Buchmann J (2009) Deep brain stimulation of globus pallidus internus in a 16-year-old boy with severe tourette syndrome and mental retardation. Neuropediatrics 40:239–242

    Article  PubMed  CAS  Google Scholar 

  12. Flaherty AW, Williams ZM, Amirnovin R, Kasper E, Rauch SL, Cosgrove GR, Eskandar EN (2005) Deep brain stimulation of the anterior internal capsule for the treatment of Tourette syndrome: technical case report. Neurosurgery 57(Suppl 4):E403 discussion E403

    Article  PubMed  Google Scholar 

  13. Foltynie T, Martinez-Torres I, Zrinzo L, Joyce E, Cavanna A, Jahanshahi M, Limousin P, Hariz M (2009) Improvement in vocal and motor tics following DBS of motor GPi for Tourette syndrome, not accompanied by subjective improvement in quality of life—a case report. Mov Disord 24(Suppl 1):S497–S498

    Google Scholar 

  14. Gallagher CL, Garell PC, Montgomery EB (2006) Hemi tics and deep brain stimulation. Neurology 66:E12

    Article  PubMed  Google Scholar 

  15. Hassler R, Dieckmann G (1970) Stereotaxic treatment of tics and inarticulate cries or coprolalia considered as motor obsessional phenomena in Gilles de la Tourette’s disease. Rev Neurol 123:89–100

    PubMed  CAS  Google Scholar 

  16. Houeto JL, Karachi C, Mallet L, Pillon B, Yelnik J, Mesnage V, Welter ML, Navarro S, Pelissolo A, Damier P, Pidoux B, Dormont D, Cornu P, Agid Y (2005) Tourette’s syndrome and deep brain stimulation. J Neurol Neurosurg Psychiatr 76:992–995

    Article  PubMed  CAS  Google Scholar 

  17. Houeto J, Giré P (2008) Tics and Tourette syndrome: diagnosis, course and treatment principles. Presse Med 37(2 Pt 2):263–270

    Article  PubMed  Google Scholar 

  18. Kuhn J, Lenartz D, Mai JK, Huff W, Lee S, Koulousakis A, Klosterkoetter J, Sturm V (2007) Deep brain stimulation of the nucleus accumbens and the internal capsule in therapeutically refractory Tourette-syndrome. J Neurol 254:963–965

    Article  PubMed  Google Scholar 

  19. Leckman JF, Riddle MA, Hardin MT, Ort SI, Swartz KL, Stevenson J, Cohen DJ (1989) The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 28:566–573

    Article  PubMed  CAS  Google Scholar 

  20. van der Linden C, Colle H, Vandewalle V, Alessi G, Rijckaert D, de Waele L (2002) Successful treatment of tics with bilateral internal pallidum (GPi) stimulation in a 27-year-old male patient with Gilles de la Tourette’s syndrome (GTS). Mov Disord 17:P1130

    Google Scholar 

  21. Maciunas RJ, Maddux BN, Riley DE, Whitney CM, Schoenberg MR, Ogrocki PJ, Albert JM, Gould DJ (2007) Prospective randomized double-blind trial of bilateral thalamic deep brain stimulation in adults with Tourette syndrome. J Neurosurg 107:1004–1014

    Article  PubMed  Google Scholar 

  22. Martinez-Torres I, Hariz MI, Zrinzo L, Foltynie T, Limousin P (2009) Improvement of tics after subthalamic nucleus deep brain stimulation. Neurology 72:1787–1789

    Article  PubMed  CAS  Google Scholar 

  23. Mink JW (2009) Clinical review of DBS for Tourette syndrome. Front Biosci 1:72–76

    Google Scholar 

  24. Mink JW, Walkup J, Frey KA, Como P, Cath D, Delong, Erenberg G, Jankovic J, Juncos J, Leckman JF, Swerdlow N, Visser-Vandewalle V, Vitek JL, Tourette Syndrome Association, Inc (2006) Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome. Mov Disord 21:1831–1838

    Article  PubMed  Google Scholar 

  25. Neimat JS, Patil PG, Lozano AM (2006) Novel surgical therapies for Tourette syndrome. J Child Neurol 21:715–718

    Article  PubMed  Google Scholar 

  26. Neuner I, Podoll K, Lenartz D, Sturm V, Schneider F (2009) Deep brain stimulation in the nucleus accumbens for intractable Tourette’s syndrome: follow-up report of 36 months. Biol Psychiatry 65:e5–e6

    Article  PubMed  Google Scholar 

  27. Okun MS, Fernandez HH, Foote KD, Murphy TK, Goodman WK (2008) Avoiding deep brain stimulation failures in Tourette syndrome. J Neurol Neurosurg Psychiatr 79:111–112

    Article  PubMed  Google Scholar 

  28. Porta M, Brambilla A, Cavanna AE, Servello D, Sassi M, Rickards H, Robertson MM (2009) Thalamic deep brain stimulation for treatment-refractory Tourette syndrome: two-year outcome. Neurology 73:1375–1380

    Article  PubMed  CAS  Google Scholar 

  29. Porta M, Servello D, Sevello D, Sassi M, Brambilla A, Defendi S, Priori A, Robertson M (2009) Issues related to deep brain stimulation for treatment-refractory Tourette’s syndrome. Eur Neurol 62:264–273

    Article  PubMed  Google Scholar 

  30. Poysky J, Jimenez-Shahed J (2007) Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome. Mov Disord 22:1366–1367 author reply 1367–1368

    Article  PubMed  Google Scholar 

  31. Rickards H, Wood C, Cavanna AE (2008) Hassler and Dieckmann’s seminal paper on stereotactic thalamotomy for Gilles de la Tourette syndrome: translation and critical reappraisal. Mov Disord 23:1966–1972

    Article  PubMed  Google Scholar 

  32. Riley DE, Whitney CM, Maddux BN, Schoenberg MS, Maciunas RJ (2007) Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome. Mov Disord 22:1366 author reply 1367–1368

    Article  PubMed  Google Scholar 

  33. Roessner V, Plessen K, Rizzo R, Skov L, Strand G, Stern J, Termine C, Hoekstra P; the ESSTS Guidelines Group. European clinical guidelines for Tourette syndrome and other chronic tic disorders. Part II: pharmacological treatment. Eur Child Adolesc Psychiatry

  34. Servello D, Porta M, Sassi M, Brambilla A, Robertson MM (2008) Deep brain stimulation in 18 patients with severe Gilles de la Tourette syndrome refractory to treatment: the surgery and stimulation. J Neurol Neurosurg Psychiatr 79:136–142

    Article  PubMed  CAS  Google Scholar 

  35. Servello D, Sassi M, Brambilla A, Porta M, Haq I, Foote KD, Okun MS (2009) De novo and rescue DBS leads for refractory Tourette syndrome patients with severe comorbid OCD: a multiple case report. J Neurol 256:1533–1539

    Article  PubMed  Google Scholar 

  36. Shahed J, Poysky J, Kenney C, Simpson R, Jankovic J (2007) GPi deep brain stimulation for Tourette syndrome improves tics and psychiatric comorbidities. Neurology 68:159–160

    Article  PubMed  CAS  Google Scholar 

  37. Shields DC, Cheng ML, Flaherty AW, Gale JT, Eskandar EN (2008) Microelectrode-guided deep brain stimulation for Tourette syndrome: within-subject comparison of different stimulation sites. Stereotact Funct Neurosurg 86:87–91

    Article  PubMed  Google Scholar 

  38. Temel Y, Visser-Vandewalle V (2004) Surgery in Tourette syndrome. Mov Disord 19:3–14

    Article  PubMed  Google Scholar 

  39. Vandewalle V, van der Linden C, Groenewegen HJ, Caemaert J (1999) Stereotactic treatment of Gilles de la Tourette syndrome by high frequency stimulation of thalamus. Lancet 353(9154):724

    Article  PubMed  CAS  Google Scholar 

  40. Verdellen C, van de Griendt J, Hartmann A, Murphy T; the ESSTS Guidelines Group. European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions. Eur Child Adolesc Psychiatry

  41. Vilela Filho O, Ragazzo P, Silva D, Souza J, Oliveira P, Ribeiro T (2008) Bilateral GPe-DBS for Tourette’s syndrome (Abstr.). Neurotarget 3:65

    Google Scholar 

  42. Vilela Filho O, Ragazzo P, Souza J, Silva D, Oliveira P, Piedimonte F, Ribeiro T (2010) Bilateral GPe-DBS for Tourette syndrome: a double-blind prospective controlled study of seven patients (Abstr.). In: Abstract book of the ASSFN (American Society for Stereotactic and Functional Neurosurgery), 2010 biennial meeting. Bridging the Future of Neurosurgery, New York

  43. Visser-Vandewalle V (2007) DBS in tourette syndrome: rationale, current status and future prospects. Acta Neurochir Suppl 97(Pt 2):215–222

    Article  PubMed  CAS  Google Scholar 

  44. Visser-Vandewalle V, Ackermans L, van der Linden C, Temel Y, Tijssen MA, Schruers KR, Nederveen P, Kleijer M, Boon P, Weber W, Cath D (2006) Deep brain stimulation in Gilles de la Tourette’s syndrome. Neurosurgery 58:E590

    PubMed  Google Scholar 

  45. Visser-Vandewalle V, Temel Y, Boon P, Vreeling F, Colle H, Hoogland G, Groenewegen HJ, van der Linden C (2003) Chronic bilateral thalamic stimulation: a new therapeutic approach in intractable Tourette syndrome. Report of three cases. J Neurosurg 99:1094–1100

    Article  PubMed  Google Scholar 

  46. Welter M, Mallet L, Houeto J, Karachi C, Czernecki V, Cornu P, Navarro S, Pidoux B, Dormont D, Bardinet E, Yelnik J, Damier P, Agid Y (2008) Internal pallidal and thalamic stimulation in patients with Tourette syndrome. Arch Neurol 65:952–957

    Article  PubMed  Google Scholar 

  47. Zabek M, Sobstyl M, Koziara H, Dzierzecki S (2008) Deep brain stimulation of the right nucleus accumbens in a patient with Tourette syndrome. Case report. Neurol Neurochir Pol 42:554–555

    PubMed  Google Scholar 

Download references

Conflict of interest

Commercial firms and governmental organisations did not play a role in, or fund, the development of these guidelines. Kirsten R. Müller-Vahl, Danielle C. Cath, Andrea E. Cavanna, Sandra Dehning, Veerle Visser-Vandewalle declare that they have no conflict of interest. Potential conflicts of interest: Mauro Porta: scientific advisory board of Lundbeck, the Netherlands; Mary Robertson has recently received a grant from the Tourette’s Action-UK (Grant to support Dr AE Cavanna), she has also received honoraria from Janssen-Cilag, Eli Lilly, and has received Royalties for books from Blackwells Science, David Fulton/Granada/Taylor Francis, Oxford University Press and also Jessica Kingsley Publishers, she also sits on the Medical Advisory Board for the Italian Tourette Syndrome Association and The Tourette Syndrome Foundation of Canada; Davide Martino: honoraria for symposia from UCB Pharma, Chiesi Pharmaceuticals, Novartis, and Boehringer-Ingelheim.

Author information

Authors and Affiliations

  1. Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Kirsten R. Müller-Vahl

  2. Department of Clinical and Health Psychology, Utrecht University/Altrecht Academic Anxiety Outpatient Services, Utrecht, The Netherlands

    Danielle C. Cath

  3. Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation, Birmingham, UK

    Andrea E. Cavanna

  4. Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University Munich, Munich, Germany

    Sandra Dehning

  5. Movement Disorders and Tourette Centre, IRCCS Galeazzi, Milan, Italy

    Mauro Porta

  6. Department of Mental Health Sciences, UCL, London, UK

    Mary M. Robertson

  7. Department of Neurosurgery, University Hospital Maastricht, Maastricht, The Netherlands

    Veerle Visser-Vandewalle

Authors
  1. Kirsten R. Müller-Vahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Danielle C. Cath
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea E. Cavanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sandra Dehning
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mauro Porta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mary M. Robertson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Veerle Visser-Vandewalle
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the ESSTS Guidelines Group

Corresponding author

Correspondence to Kirsten R. Müller-Vahl.

Additional information

Members of the ESSTS Guidelines Group are listed under Appendix.

An erratum to this article can be found at http://dx.doi.org/10.1007/s00787-011-0195-z

Appendix

Appendix

Members of the ESSTS Guidelines Group: Christos Androutsos, Harald Aschauer, Gillian Baird, Netty Bos-Veneman, Ariana Brambilla, Francesco Cardona, Danielle C. Cath, Andrea E. Cavanna, Virginie Czernecki, Sandra Dehning, Alan Eapter, Luca Farkas, Julia Gadaros, Andreas Hartmann, Elizabeth Hauser, Isabel Heyman, Tammy Hedderly, Pieter J. Hoekstra, Anne Korsgaard, Georgina M. Jackson, Linnea Larsson, Andrea G. Ludolph, Davide Martino, Claudia Menghetti, Nanette Mol Debes, Norbert Muller, Kirsten Muller-Vahl, Alexander Munchau, Tara Murphy, Richard Musil, Peter Nagy, Judith Nurnberger, Ben Oostra, Perry Paschou, Massimo Pasquini, Kirsten J. Plessen, Mauro Porta, Hugh Rickards, Renata Rizzo, Mary M. Robertson, Veit Roessner, Aribert Rothenberger, Domenico Servello, Liselotte Skov, Jeremy S. Stern, Gerd Strand, Zsannett Tarnok, Cristiano Termine, Jolande Van der Griendt, Cara Verdellen, Veerle Visser-Vandewalle, Ebba Wannag, Tomas Wolanczyck.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Müller-Vahl, K.R., Cath, D.C., Cavanna, A.E. et al. European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: deep brain stimulation. Eur Child Adolesc Psychiatry 20, 209–217 (2011). https://doi.org/10.1007/s00787-011-0166-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-011-0166-4

Keywords

Search

Navigation