Tourette syndrome is a neuropsychiatric disorder characterized by motor and speech tics. Initial symptoms usually appear in early childhood. While there is improvement in many cases in adulthood, there are patients who suffer from pronounced symptoms throughout their lives and respond inadequately to drug therapy or behavioral therapy. For these patients, deep brain stimulation (DBS) is a new and promising treatment method. Below we provide an overview of the neurosurgical treatment options for Tourette syndrome at Inselspital.
How does Tourette syndrome manifest itself?
The main symptoms of Gilles-de-la-Tourette syndrome, or Tourette syndrome for short, are motor or speech tics.
Tics are spontaneous, non-suppressible and involuntary verbal expressions or movements. These may include:
- repetitive eye blinking
- snorting
- grimacing
- uttering meaningless sounds
- imitating animal sounds
- swearing
- repeated utterance of obscene swear words
The concrete appearance varies from patient to patient. Some of the tics occur permanently, several times a day or in series.
Tourette syndrome is often accompanied by other disorders such as obsessive-compulsive disorder or attention deficit hyperactivity disorder (ADHD).
What is the cause of Tourette syndrome?
The exact causes of Tourette syndrome are unknown. Today, it is assumed to be a complex neuronal developmental disorder. Genetic factors as well as environmental factors can promote the onset of the disease.
Individual responsible genes have not been identified so far. It is rather assumed that several genes involved in the development of Tourette syndrome as well as corresponding environmental influences (e.g. oxygen deficiency during birth) must come together for Tourette syndrome to develop. A dysfunction in the internal structures of the cerebrum, more specifically in the area of the thalamus and basal ganglia, seems to play a critical role. These brain areas also form the basis for deep brain stimulation (DBS) as a therapeutic measure.
What are the treatment options?
Diagnosis and treatment of Tourette syndrome should be performed by a neurologist or psychiatrist experienced in the field of tic disorders.
Behavioral therapy
Behavioral therapy is the treatment of choice for Tourette syndrome.
Drug therapy
Drug therapy can be supportive in severe cases.
Deep brain stimulation
If symptoms do not adequately respond to this multimodal therapy, DBS is a treatment alternative.
Study situation on deep brain stimulation
Since the first successful treatment of a Tourette's patient with deep brain stimulation, published in 1999, more than 50 scientific papers have been published, considering a total of more than 160 patient data.
A recently published meta-analysis (summary of primary investigations) of these studies shows that, on average, a significant symptom reduction of about 50% can be achieved with deep brain stimulation in Tourette patients *. The response to stimulation varied considerably between individual patients. After all, 80% of patients experienced at least a 25% symptom reduction.
Why you should seek treatment at Inselspital
Since not all patients benefit equally from the stimulation, a good patient selection by an interdisciplinary team is a necessary prerequisite for a successful response to therapy. Criteria that eligible patients should meet have been defined in corresponding guidelines *.
At Inselspital, all eligible patients are individually evaluated by experienced neurologists, neuropediatricians, psychiatrists and neurosurgeons. This takes place at our monthly interdisciplinary DBS board. The decision for or against DBS is subsequently made in the best interest of our patients.
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Baldermann JC, Schüller T, Huys D et al. Deep Brain Stimulation for Tourette-Syndrome: A Systematic Review and Meta-Analysis. Brain Stimul. 2016;9:296-304.
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Schrock LE, Mink JW, Woods DW et al. Tourette syndrome deep brain stimulation: a review and updated recommendations. Mov Disord. 2015;30:448-471.