Evidence map›Paper›PMID 31129620›Full record

ArticleJournal of neurology, neurosurgery, and psychiatry2019

Image-based analysis and long-term clinical outcomes of deep brain stimulation for Tourette syndrome: a multisite study.

Kara A Johnson, P Thomas Fletcher, Domenico Servello, Alberto Bona, Mauro Porta, Jill L Ostrem, Eric Bardinet, Marie-Laure Welter, Andres M Lozano, Juan Carlos Baldermann and 24 more

2 registry-linked trialsOpen access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of neurology, neurosurgery, and psychiatry, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 49 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
49citing papers in PubMed, 2 pooled it
19.0field-weighted citation impact, top 1% of its field
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.

NCT04128397 nacompletednot on this map

An Exploratory Study of Continuous Theta Burst Stimulation (cTBS) Based on Functional Magnetic Resonance Imaging (fMRI) in the Treatment of Tic Disorder

TypeinterventionalSponsorSecond Affiliated Hospital, Zhejiang University, School of MedicineRan2018 to 2019Enrolled95ConditionsTic Disorders, Tourette SyndromeArmstraditional stimulation site continuous theta burst stimulation (cTBS), precise stimulation site cTBS
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

49 citing papers in PubMed, 2 syntheses or guidelines pooled it, 99 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Optimal Deep Brain Stimulation Locations for Gilles de la Tourette Syndrome.medRxiv : the preprint server for health sciences · 2026
    Article
  4. Review
  5. Review
  6. Review
  7. Article
  8. Article
  9. Article
  10. Deep brain stimulation for Tourette's syndrome.The Cochrane database of systematic reviews · 2024
    Article
  11. The role of neuroactive steroids in tic disorders.Neuroscience and biobehavioral reviews · 2024
    Review
  12. Review
  13. Article
  14. Tics: neurological disorders determined by a deficit in sensorimotor gating processes.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2022
    Review
  15. Review
  16. Article
  17. Article
  18. Review
  19. Article
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

34 authors at 15 institutions in 8 countries.

Kara A JohnsonScientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA.ORCID 0000-0001-6556-8957
P Thomas FletcherScientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA.
Domenico ServelloNeurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy.
Alberto BonaNeurosurgical Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy.
Mauro PortaTourette's Syndrome and Movement Disorders Center, IRCCS Istituto Ortopedico Galeazzi, Milan, Lombardia, Italy.
Jill L OstremDepartment of Neurology, University of California San Francisco, San Francisco, California, USA.
Eric BardinetInstitut du Cerveau et de la Moelle Epiniere, Paris, Île-de-France, France.
Marie-Laure WelterSorbonne Universités, University of Pierre and Marie Curie University of Paris, the French National Institute of Health and Medical Research U 1127, the National Center for Scientific Research 7225, Paris, France.
Andres M LozanoDivision of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Juan Carlos BaldermannDepartment of Psychiatry and Psychotherapy, University of Cologne, Koln, Nordrhein-Westfalen, Germany.
Jens KuhnDepartment of Psychiatry and Psychotherapy, University of Cologne, Koln, Nordrhein-Westfalen, Germany.
Daniel HuysDepartment of Psychiatry and Psychotherapy, University of Cologne, Koln, Nordrhein-Westfalen, Germany.ORCID 0000-0002-9124-4128
Thomas FoltynieQueen Square, Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, University College London Institute of Neurology, London, UK.ORCID 0000-0003-0752-1813
Marwan HarizQueen Square, Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, University College London Institute of Neurology, London, UK.
Eileen M JoyceQueen Square, Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, University College London Institute of Neurology, London, UK.
Ludvic ZrinzoQueen Square, Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, University College London Institute of Neurology, London, UK.
Zinovia KefalopoulouQueen Square, Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, University College London Institute of Neurology, London, UK.
Jian-Guo ZhangBeijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Fan-Gang MengBeijing Neurosurgical Institute, Capital Medical University, Beijing, China.
ChenCheng ZhangDepartment of Functional Neurosurgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Zhipei LingDepartment of Neurosurgery, PLA Army General Hospital, Beijing, China.
Xin XuDepartment of Neurosurgery, PLA Army General Hospital, Beijing, China.
Xinguang YuDepartment of Neurosurgery, PLA Army General Hospital, Beijing, China.
Anouk Yjm SmeetsDepartment of Neurosurgery, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.
Linda AckermansDepartment of Neurosurgery, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands.
Veerle Visser-VandewalleDepartment of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Koln, Nordrhein-Westfalen, Germany.
Alon Y MogilnerCenter for Neuromodulation, Departments of Neurology and Neurosurgery, New York University Medical Center, New York, New York, USA.
Michael H PourfarCenter for Neuromodulation, Departments of Neurology and Neurosurgery, New York University Medical Center, New York, New York, USA.
Leonardo AlmeidaFixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida, USA.
Aysegul GunduzFixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida, USA.
Wei HuFixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida, USA.
Kelly D FooteFixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida, USA.
Michael S OkunFixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida, USA.
Christopher R ButsonScientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA butson@sci.utah.edu.ORCID 0000-0002-2319-1263
National Hospital for Neurology and Neurosurgery · GBUniversity of Florida · USIstituto Ortopedico Galeazzi · ITThe Military General Hospital of Beijing PLA · CNUniversity of Cologne · DEUniversity of Utah · USCapital Medical University · CNColumbia University Irving Medical Center · USMaastricht University Medical Centre · NLInstitut du Cerveau · FRShanghai Jiao Tong University · CNSorbonne Université · FRUniversity Hospital Cologne · DEUniversity of California, San Francisco · USUniversity of Toronto · CA

Funding

UNIVERSITY OF UTAH CENTER FOR CLINICAL AND TRANSLATIONAL SCIENCE-UL1: BPCAUL1RR025764 · NCRR · UNIVERSITY OF UTAH · PI MCCLAIN, DONALD A. · 2008 to 2011
$19.4M
TRD - VisualizationP41GM103545 · NIGMS · UNIVERSITY OF UTAH · PI MACLEOD, ROB S. · 2012 to 2019
$9.7M
Together: Transforming and Translating Discovery to Improve HealthKL2TR001429 · NCATS · UNIVERSITY OF FLORIDA · PI GUIRGIS, FAHEEM W, LEEUWENBURGH, CHRISTIAAN · 2015 to 2023
$5.5M
University of Utah Center for Clinical and Translational Science-UL1UL1TR000105 · NCATS · UNIVERSITY OF UTAH · PI MCCLAIN, DONALD A. · 2012 to 2013
$5.1M
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
NCATS NIH HHS KL2 TR001429NCATS NIH HHS UL1 TR000105NCRR NIH HHS UL1 RR025764NIGMS NIH HHS P41 GM103545NINDS NIH HHS R01 NS096008NINR NIH HHS R01 NR014852
6 · The paper itself

Abstract

backgroundDeep brain stimulation (DBS) can be an effective therapy for tics and comorbidities in select cases of severe, treatment-refractory Tourette syndrome (TS). Clinical responses remain variable across patients, which may be attributed to differences in the location of the neuroanatomical regions being stimulated. We evaluated active contact locations and regions of stimulation across a large cohort of patients with TS in an effort to guide future targeting.

methodsWe collected retrospective clinical data and imaging from 13 international sites on 123 patients. We assessed the effects of DBS over time in 110 patients who were implanted in the centromedial (CM) thalamus (n=51), globus pallidus internus (GPi) (n=47), nucleus accumbens/anterior limb of the internal capsule (n=4) or a combination of targets (n=8). Contact locations (n=70 patients) and volumes of tissue activated (n=63 patients) were coregistered to create probabilistic stimulation atlases.

resultsTics and obsessive-compulsive behaviour (OCB) significantly improved over time (p<0.01), and there were no significant differences across brain targets (p>0.05). The median time was 13 months to reach a 40% improvement in tics, and there were no significant differences across targets (p=0.84), presence of OCB (p=0.09) or age at implantation (p=0.08). Active contacts were generally clustered near the target nuclei, with some variability that may reflect differences in targeting protocols, lead models and contact configurations. There were regions within and surrounding GPi and CM thalamus that improved tics for some patients but were ineffective for others. Regions within, superior or medial to GPi were associated with a greater improvement in OCB than regions inferior to GPi.

conclusionThe results collectively indicate that DBS may improve tics and OCB, the effects may develop over several months, and stimulation locations relative to structural anatomy alone may not predict response. This study was the first to visualise and evaluate the regions of stimulation across a large cohort of patients with TS to generate new hypotheses about potential targets for improving tics and comorbidities.

Indexed as

AdolescentAdultAtlases as TopicCohort StudiesCompulsive BehaviorDeep Brain StimulationFemaleGlobus PallidusHumansInternal CapsuleIntralaminar Thalamic NucleiMagnetic Resonance ImagingMaleMiddle AgedNucleus AccumbensObsessive Behaviorglobus pallidusneuromodulationobsessive-compulsive behaviorthalamustics

Identifiers

PMID31129620
PMCPMC6744301
OpenAlexW2944941766

What OpenQuestion holds

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LicenceCC BY-NC
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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.