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1. European Clinical Guidelines for Tourette Syndrome and Other Tic Disorders – version 2.0. Part IV: Deep Brain Stimulation

Author

Szejko, N, Worbe, Y, Hartmann, A, Visser Vandewalle, V, Ackermans, L, Ganos, C, Porta, M, Leentjens, A, Mehrkens, J, Huys, D, Baldermann, J, Kuhn, J, Karachi, C, Delorme, C, Foltynie, T, Cavanna, A, Cath, D, Müller-Vahl, K, Szejko N, Worbe Y, Hartmann A, Visser Vandewalle V, Ackermans L, Ganos C, Porta M, Leentjens AFG, Mehrkens J-H, Huys D, Baldermann JC, Kuhn J, Karachi C, Delorme C, Foltynie T, Cavanna A, Cath D, Müller-Vahl K, Szejko, N, Worbe, Y, Hartmann, A, Visser Vandewalle, V, Ackermans, L, Ganos, C, Porta, M, Leentjens, A, Mehrkens, J, Huys, D, Baldermann, J, Kuhn, J, Karachi, C, Delorme, C, Foltynie, T, Cavanna, A, Cath, D, Müller-Vahl, K, Szejko N, Worbe Y, Hartmann A, Visser Vandewalle V, Ackermans L, Ganos C, Porta M, Leentjens AFG, Mehrkens J-H, Huys D, Baldermann JC, Kuhn J, Karachi C, Delorme C, Foltynie T, Cavanna A, Cath D, and Müller-Vahl K

Abstract

In 2011 the European Society for the Study of Tourette Syndrome (ESSTS) published its first European clinical guidelines for the treatment of Tourette Syndrome (TS) with part IV on deep brain stimulation (DBS). Here, we present a revised version of these guidelines with updated recommendations based on the current literature covering the last decade as well as a survey among ESSTS experts. Currently, data from the International Tourette DBS Registry and Database, two meta-analyses, and eight randomized controlled trials (RCTs) are available. Interpretation of outcomes is limited by small sample sizes and short follow-up periods. Compared to open uncontrolled case studies, RCTs report less favorable outcomes with conflicting results. This could be related to several different aspects including methodological issues, but also substantial placebo effects. These guidelines, therefore, not only present currently available data from open and controlled studies, but also include expert knowledge. Although the overall database has increased in size since 2011, definite conclusions regarding the efficacy and tolerability of DBS in TS are still open to debate. Therefore, we continue to consider DBS for TS as an experimental treatment that should be used only in carefully selected, severely affected and otherwise treatment-resistant patients.

Published
2022

2. Predictors of short-term impulsive and compulsive behaviour after subthalamic stimulation in Parkinson disease.

Author

Sauerbier, Anna, Loehrer, Philipp, Jost, Stefanie T., Heil, Shania, Petry-Schmelzer, Jan N., Herberg, Johanna, Bachon, Pia, Aloui, Salima, Gronostay, Alexandra, Klingelhoefer, Lisa, Baldermann, J. Carlos, Huys, Daniel, Nimsky, Christopher, Barbe, Michael T., Fink, Gereon R., Martinez-Martin, Pablo, Chaudhuri, K. Ray, Visser-Vandewalle, Veerle, Timmermann, Lars, and Weintraub, Daniel

Subjects
SUBTHALAMIC nucleus, PARKINSON'S disease, WILCOXON signed-rank test, MEMORY disorders, TREATMENT effectiveness, BRAIN stimulation, COMPULSIVE behavior, PARKINSON'S disease treatment, DEEP brain stimulation, RESEARCH, DIENCEPHALON, RESEARCH methodology, BEHAVIOR, MEDICAL cooperation, EVALUATION research, COMPARATIVE studies, QUALITY of life, LONGITUDINAL method
Abstract

Background: The effects of subthalamic stimulation (subthalamic nucleus-deep brain stimulation, STN-DBS) on impulsive and compulsive behaviours (ICB) in Parkinson's disease (PD) are understudied.Objective: To investigate clinical predictors of STN-DBS effects on ICB.Methods: In this prospective, open-label, multicentre study in patients with PD undergoing bilateral STN-DBS, we assessed patients preoperatively and at 6-month follow-up postoperatively. Clinical scales included the Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale (QUIP-RS), PD Questionnaire-8, Non-Motor Symptom Scale (NMSS), Unified PD Rating Scale in addition to levodopa-equivalent daily dose total (LEDD-total) and dopamine agonists (LEDD-DA). Changes at follow-up were analysed with Wilcoxon signed-rank test and corrected for multiple comparisons (Bonferroni method). We explored predictors of QUIP-RS changes using correlations and linear regressions. Finally, we dichotomised patients into 'QUIP-RS improvement or worsening' and analysed between-group differences.Results: We included 55 patients aged 61.7 years±8.4 with 9.8 years±4.6 PD duration. QUIP-RS cut-offs and psychiatric assessments identified patients with preoperative ICB. In patients with ICB, QUIP-RS improved significantly. However, we observed considerable interindividual variability of clinically relevant QUIP-RS outcomes as 27.3% experienced worsening and 29.1% an improvement. In post hoc analyses, higher baseline QUIP-RS and lower baseline LEDD-DA were associated with greater QUIP-RS improvements. Additionally, the 'QUIP-RS worsening' group had more severe baseline impairment in the NMSS attention/memory domain.Conclusions: Our results show favourable ICB outcomes in patients with higher preoperative ICB severity and lower preoperative DA doses, and worse outcomes in patients with more severe baseline attention/memory deficits. These findings emphasise the need for comprehensive non-motor and motor symptoms assessments in patients undergoing STN-DBS.Trial Registration Number: DRKS00006735. [ABSTRACT FROM AUTHOR]

Published
2021
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3. European Clinical Guidelines for Tourette Syndrome and Other Tic Disorders – version 2.0. Part IV: Deep Brain Stimulation

Author

Andreas Hartmann, Cécile Delorme, Mauro Porta, Natalia Szejko, Jens Kuhn, Kirsten R. Müller-Vahl, Albert F.G. Leentjens, Jan-Hinnerk Mehrkens, Yulia Worbe, Linda Ackermans, Daniel Huys, Juan Carlos Baldermann, Christos Ganos, Thomas Foltynie, Andrea E. Cavanna, Carine Karachi, Veerle Visser-Vandewalle, Danielle C. Cath, Szejko, N, Worbe, Y, Hartmann, A, Visser Vandewalle, V, Ackermans, L, Ganos, C, Porta, M, Leentjens, A, Mehrkens, J, Huys, D, Baldermann, J, Kuhn, J, Karachi, C, Delorme, C, Foltynie, T, Cavanna, A, Cath, D, Müller-Vahl, K, Medical University of Warsaw - Poland, Yale University School of Medicine, Unité de neurophysiologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre De Référence National 'Syndrome Gilles de la Tourette', Pôle des Maladies du Système Nerveux [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de Neurochirurgie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], University Hospital of Cologne [Cologne], Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], IRCCS Istituto Ortopedico Galeazzi, Ludwig-Maximilians-Universität München (LMU), Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], University College of London [London] (UCL), University of Birmingham [Birmingham], University Medical Center Groningen [Groningen] (UMCG), Hannover Medical School [Hannover] (MHH), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
Databases, Factual, ASSESSMENT RECOMMENDATIONS, medicine.medical_treatment, Guideline, Tourette syndrome, law.invention, DOUBLE-BLIND, 0302 clinical medicine, Randomized controlled trial, QUALITY-OF-LIFE, law, Developmental and Educational Psychology, Child and adolescent psychiatry, Deep brain stimulation, Registries, THALAMIC-STIMULATION, 0303 health sciences, General Medicine, 3. Good health, Psychiatry and Mental health, Tolerability, Tics, TRIAL, European Society for the Study of Tourette Syndrome (ESSTS), medicine.medical_specialty, LONG-TERM, NUCLEUS-ACCUMBENS, Guidelines, Placebo, PATIENT SELECTION, 03 medical and health sciences, medicine, Humans, Intensive care medicine, TERM-FOLLOW-UP, 030304 developmental biology, GLOBUS-PALLIDUS INTERNUS, Tic, business.industry, medicine.disease, Treatment, Tic Disorders, Treatment of Tourette syndrome, Pediatrics, Perinatology and Child Health, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, 030217 neurology & neurosurgery
Abstract

In 2011 the European Society for the Study of Tourette Syndrome (ESSTS) published its first European clinical guidelines for the treatment of Tourette Syndrome (TS) with part IV on deep brain stimulation (DBS). Here, we present a revised version of these guidelines with updated recommendations based on the current literature covering the last decade as well as a survey among ESSTS experts. Currently, data from the International Tourette DBS Registry and Database, two meta-analyses, and eight randomized controlled trials (RCTs) are available. Interpretation of outcomes is limited by small sample sizes and short follow-up periods. Compared to open uncontrolled case studies, RCTs report less favorable outcomes with conflicting results. This could be related to several different aspects including methodological issues, but also substantial placebo effects. These guidelines, therefore, not only present currently available data from open and controlled studies, but also include expert knowledge. Although the overall database has increased in size since 2011, definite conclusions regarding the efficacy and tolerability of DBS in TS are still open to debate. Therefore, we continue to consider DBS for TS as an experimental treatment that should be used only in carefully selected, severely affected and otherwise treatment-resistant patients.

Published
2022

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