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Deep brain stimulation in Tourette syndrome: the known and the unknown
  1. Kirsten R Muller-Vahl
  1. Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
  1. Correspondence to Dr Kirsten R Muller-Vahl, Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover 30623, Germany; mueller-vahl.kirsten{at}

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How much data are needed to conclude the effectiveness of deep brain stimulation in Tourette syndrome?

The paper by Johnson et al 1 is based on a collaboration with the International Tourette Syndrome (TS) Deep Brain Stimulation (DBS) database and registry. This TS DBS database/registry has been initiated in 2012 by a group of researchers and clinicians led by Michael Okun. They aimed to collect as many data as possible to increase the database on efficacy, safety and surgical approaches of DBS in TS. Without any doubt, there is a critical need to increase current knowledge since the absolute number of patients who received DBS is still low and until today only a very limited number of randomised controlled trials (RCTs) including only a small number of patients have been performed. Twenty years after the introduction of DBS in the treatment of TS, less than 200 patients have been reported in the literature and data of only five RCTs have been published including 3 to 16 patients (altogether N=43 patients). Furthermore and in contrast to most other indications, in TS the optimal target is still unknown. So far, 10 different brain areas have been suggested including four targets in the centromedial (CM) thalamus, the anteromedial and the posteroventrolateral part of the globus pallidus internus (GPi), the globus pallidus externus, the nucleus accumbens, the anterior limb of internal capsule and the subthalamic …

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