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New perspectives in the field of deep brain stimulation (DBS) at Tourette. Research at UMC + Maastricht reveals: fewer "tics" in the short and long term
The application of deep brain stimulation (DBS) in the syndrome of Gilles de la Tourette can be made both to have a positive effect in the long run. The number of tics, uncontrolled movements and / or characteristic sounds of Tourette, decreases significantly by the stimulation of a certain deep nucleus in the brain. It's one of the new ideas that research at Maastricht UMC + has produced. Neurosurgeon in training Dr Anouk Smeets recently obtained his doctorate on this research
Tourette's Syndrome
Gilles de la Tourette syndrome is a neuropsychiatric disorder, which occurs very little and whose cause is still largely unknown. . Only 1% of children must take care of it. In the case of two-thirds of the affected children, the symptoms disappear naturally with the years where their expressions decline. A third, however, suffers from typical Tourette symptoms, the so-called tics.
The social consequences can be enormous if the tics are not controlled by a standard treatment. Young people often do not have the opportunity to attend a study program or study and young adults have no or little work. It is also often difficult to get in touch because Tourette patients avoid social opportunities as much as possible. This means that they are often isolated socially in adulthood
Standard therapy / DBS
The standard treatment of Tourette patients consists of behavioral therapy and drugs (antipsychotics). If this standard treatment does not have the desired result, then DBS may be an option for adult patients with a severe form of the syndrome. At DBS, the electrodes are inserted into a specific deep cerebral nucleus. These electrodes are connected to a battery / neurostimulator, which is placed subcutaneously elsewhere in the body (usually in the abdomen or under the clavicle). The neurostimulator continuously delivers electrical impulses, which influence brain activity in this part of the brain via the electrodes. The treatment is used for neurological and psychiatric disorders. Maastricht UMC + is the only Dutch center that DBS applies to Tourette patients.
Clinical neurophysiological research done in Maastricht with colleagues from the Israeli Bar-Ilan University showed that the globus pallidus internus, a deep core in the brain that modulates movement, behavior, and emotions, is involved in the syndrome of Gilles de la Tourette. The stimulation of this globus pallidus internus gives very good results. The number of tics, in the short and long term, decreases significantly after the DBS. In addition, there does not appear to be a long-term imbalance between the improvement of tics and side effects, apart from the stimulation of the thalamus (possible side effects: loss of energy, loss of vision and sexual disorders). )
Early-acting Tourette
Tourette Patients have been treated with DBS since 1999 and the guidelines have long recommended not to operate patients in whom behavioral therapy and medications have not worked during treatment. 25th year of life. Research conducted at the UMC + Maastricht has contributed to the revision of this directive worldwide. The operation should be possible at a younger age, with the understanding that it is always a last option. In addition, the advantages and disadvantages of treatment should be carefully analyzed and discussed with the individual patient.
Tics
The recently promoted neurosurgeon training Anouk Smeets: "The 18-25 age group is a crucial development phase. We do not want to prevent patients in this age group from using CPS. Because of tics, they often encounter serious training / study or job search problems, and with DBS, we can tackle these tics. But we continue to look critically at the pros and cons. "So, there is always a lot of attention for the possible side effects, which can vary by patient.A neuropsychologist evaluates whether a patient can handle a DBS operation
Anouk Smeets earned his Ph.D. University of Maastricht on June 1, 2018 under the title: New ideas on deep brain stimulation for Tourette's syndrome Research on DBS in Gilles de la Tourette's syndrome led to a series of publications Scientists, including in [19099008] Clinical Neurology and Neurosurgery, Neuromodulation, Movement Disorders and Neuroethics.
Source: Medical Center of the University of Maastricht + [19659015]
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