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

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.