Evidence map›Paper›PMID 29340590›Full record

ArticleJAMA neurology2018

Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome: The International Tourette Syndrome Deep Brain Stimulation Public Database and Registry.

Daniel Martinez-Ramirez, Joohi Jimenez-Shahed, James Frederick Leckman, Mauro Porta, Domenico Servello, Fan-Gang Meng, Jens Kuhn, Daniel Huys, Juan Carlos Baldermann, Thomas Foltynie and 39 more

Erratum issued Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JAMA neurology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT06889480 (MultitArget STereotactic Electrophysiological Recording and Stimulation for Tourette Syndrome), which is not on this map. Cited by 101 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
101citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06889480 narecruitingnot on this mapstarted 2024, after this paper: background citation

MultitArget STereotactic Electrophysiological Recording and Stimulation for Tourette Syndrome

TypeinterventionalSponsorBeijing Tiantan HospitalRan2024 to 2026Enrolled5ConditionsTourette Syndrome, Deep Brain StimulationArmsNew Target DBS, CM-DBS, Sham Stimulation
3 · Its place in the literature

Who cites it

101 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Guideline
  7. Trial
  8. Trial
  9. Tourette syndrome.Nature reviews. Disease primers · 2026
    Review
  10. Review
  11. Article
  12. Review
  13. A Multi-Symptom Circuit Architecture of Obsessive-Compulsive Disorder.medRxiv : the preprint server for health sciences · 2025
    Article
  14. Review
  15. Review
  16. Review
  17. Review
  18. Functional Neuroanatomy of Tics: A Brain Network Perspective.The Psychiatric clinics of North America · 2025
    Review
  19. Pain in Tourette Syndrome: A Comprehensive Review.Journal of child and adolescent psychopharmacology · 2025
    Review
  20. Review

41 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

49 authors.

Daniel Martinez-RamirezCenter for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville.
Joohi Jimenez-ShahedParkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas.
James Frederick LeckmanYale Child Study Center, Yale University School of Medicine, New Haven, Connecticut.
Mauro PortaTourette's Syndrome and Movement Disorders Center, Galeazzi Hospital, Milan, Italy.
Domenico ServelloNeurosurgical Department, Isituto Ortopedico Galeazzi, Milan, Italy.
Fan-Gang MengDepartment of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Jens KuhnDepartment of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
Daniel HuysDepartment of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
Juan Carlos BaldermannDepartment of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
Thomas FoltynieSobell Department of Motor Neuroscience, University College London Institute of Neurology, London, United Kingdom.
Marwan I HarizSobell Department of Motor Neuroscience, University College London Institute of Neurology, London, United Kingdom.
Eileen M JoyceSobell Department of Motor Neuroscience, University College London Institute of Neurology, London, United Kingdom.
Ludvic ZrinzoSobell Department of Motor Neuroscience, University College London Institute of Neurology, London, United Kingdom.
Zinovia KefalopoulouSobell Department of Motor Neuroscience, University College London Institute of Neurology, London, United Kingdom.
Peter SilburnQueensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia.
Terry CoyneQueensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia.
Alon Y MogilnerDepartment of Neurosurgery, Center for Neuromodulation, New York University Langone Medical Center, New York.
Michael H PourfarDepartment of Neurosurgery, Center for Neuromodulation, New York University Langone Medical Center, New York.
Suketu M KhandharDepartment of Neurology, The Permanente Medical Group (Kaiser Permanente Northern California), Comprehensive Movement Disorders Program, Sacramento, California.
Man AuyeungDepartment of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR China.
Jill Louise OstremDepartment of Neurology, University of California, San Francisco.
Veerle Visser-VandewalleDepartment of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany.
Marie-Laure WelterThe French National Institute of Health and Medical Research U 1127, The National Center for Scientific Research 7225, Sorbonne Universités, University of Pierre and Marie Curie University of Paris 06 UMR S 1127, Institut du Cerveau et de la Moëlle Epinière, The Brain and Spinal Cord Institute, Paris, France.
Luc MalletAssistance Publique-Hôpitaux de Paris, Personalised Neurology and Psychiatry University Department, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Université Paris-Est Créteil, Créteil, France.
Carine KarachiInstitut du Cerveau et de la Moëlle Epinière, The French National Institute of Health and Medical Research U 1127, The National Center for Scientific Research 7225, Sorbonne Universités, University of Paris 06, UMR S 1127 Paris, France; Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France.
Jean Luc HouetoService de Neurologie, Centers for Clinical Investigation 1402, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.
Bryan Timothy KlassenDepartment of Neurology, Mayo Clinic, Rochester, Minnesota.
Linda AckermansDepartment of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands.
Takanobu KaidoDepartment of Neurosurgery, National Hospital Organization Nara Medical Center, Nara, Japan.
Yasin TemelMaastricht University Medical Center, Maastricht, the Netherlands; MHeNs, Experimental Neurosurgery, Maastricht University, Maastricht, the Netherlands.
Robert E GrossEmory University, Atlanta, Georgia.
Harrison C WalkerDivision of Movement Disorders, Department of Neurology, University of Alabama at Birmingham.
Andres M LozanoToronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
Benjamin L WalterSchool of Medicine, Case Western Reserve University, Cleveland, Ohio.
Zoltan MariDepartment of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, Maryland.
William S AndersonDepartment of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, Maryland.
Barbara Kelly ChangiziDepartment of Neurology, The Ohio State University Wexner Medical Center, Columbus.
Elena MoroDivision of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
Sarah Elizabeth ZauberDepartment of Neurology, Indiana University School of Medicine, Indianapolis.
Lauren E SchrockNeuromodulation Research Center, Department of Neurology, University of Minnesota, Minneapolis.
Jian-Guo ZhangDepartment of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Wei HuCenter for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville.
Kyle RizerCenter for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville.
Erin H MonariCenter for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville.
Kelly D FooteCenter for Movement Disorders and Neurorestoration, Department of Neurosurgery, University of Florida, Gainesville.
Irene A MalatyCenter for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville.
Wissam DeebCenter for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville.
Aysegul GunduzBrain Map Lab, Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville.
Michael S OkunCenter for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville.

Funding

Mobile Decision Support System for Nurse Management of Neuromodulation TherapyR01NR014852 · NINR · UNIVERSITY OF UTAH · PI BUTSON, CHRISTOPHER R, OKUN, MICHAEL S · 2015 to 2019
$2.9M
THE HUMAN THALAMOCORTICAL NETWORK IN TOURETTE SYNDROMER01NS096008 · NINDS · UNIVERSITY OF FLORIDA · PI GUNDUZ, AYSEGUL, OKUN, MICHAEL S · 2016 to 2020
$1.8M
NINDS NIH HHS R01 NS096008NINR NIH HHS R01 NR014852
6 · The paper itself

Abstract

Importance: Collective evidence has strongly suggested that deep brain stimulation (DBS) is a promising therapy for Tourette syndrome. Objective: To assess the efficacy and safety of DBS in a multinational cohort of patients with Tourette syndrome. Design, Setting, and Participants: The prospective International Deep Brain Stimulation Database and Registry included 185 patients with medically refractory Tourette syndrome who underwent DBS implantation from January 1, 2012, to December 31, 2016, at 31 institutions in 10 countries worldwide. Exposures: Patients with medically refractory symptoms received DBS implantation in the centromedian thalamic region (93 of 163 [57.1%]), the anterior globus pallidus internus (41 of 163 [25.2%]), the posterior globus pallidus internus (25 of 163 [15.3%]), and the anterior limb of the internal capsule (4 of 163 [2.5%]). Main Outcomes and Measures: Scores on the Yale Global Tic Severity Scale and adverse events. Results: The International Deep Brain Stimulation Database and Registry enrolled 185 patients (of 171 with available data, 37 females and 134 males; mean [SD] age at surgery, 29.1 [10.8] years [range, 13-58 years]). Symptoms of obsessive-compulsive disorder were present in 97 of 151 patients (64.2%) and 32 of 148 (21.6%) had a history of self-injurious behavior. The mean (SD) total Yale Global Tic Severity Scale score improved from 75.01 (18.36) at baseline to 41.19 (20.00) at 1 year after DBS implantation (P < .001). The mean (SD) motor tic subscore improved from 21.00 (3.72) at baseline to 12.91 (5.78) after 1 year (P < .001), and the mean (SD) phonic tic subscore improved from 16.82 (6.56) at baseline to 9.63 (6.99) at 1 year (P < .001). The overall adverse event rate was 35.4% (56 of 158 patients), with intracranial hemorrhage occurring in 2 patients (1.3%), infection in 4 patients with 5 events (3.2%), and lead explantation in 1 patient (0.6%). The most common stimulation-induced adverse effects were dysarthria (10 [6.3%]) and paresthesia (13 [8.2%]). Conclusions and Relevance: Deep brain stimulation was associated with symptomatic improvement in patients with Tourette syndrome but also with important adverse events. A publicly available website on outcomes of DBS in patients with Tourette syndrome has been provided.

Indexed as

RegistriesTreatment OutcomeAdolescentAdultCohort StudiesDatabases, FactualDeep Brain StimulationFemaleGlobus PallidusHumansInternational CooperationMaleMiddle AgedSeverity of Illness IndexSingle-Blind MethodThalamus

Identifiers

PMID29340590
PMCPMC5885852

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.