What are the new treatments for Tourette’s? (+7 Criteria for DBS)
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The current detailed post will be explaining what the new treatments for Tourette’s are in detail. We will also be taking a close look at the various criteria for Deep Brain Stimulation, particularly for Tourette’s syndrome along with its complications.
What are the new treatments for Tourette’s?
The new treatments for Tourette’s are Ecopipam, Median Nerve Stimulation and Deep Brain Stimulation. While the research studies for these treatments are pretty rare and limited, these treatments are already being used at various centers to treat Tourette’s syndrome.
Ecocipam for Tourette’s and tics
Ecocipam is still classified as an experimental drug and has been studied on its effects on Tourette’s. The author of the study conducted on Ecocipam is Donald L. Gilbert, MD, who works at the Cincinnati Children’s Hospital Medical Center in Ohio.
The study was conducted on a total of 149 candidates who were aged between six years and 17 years, who were all diagnosed with Tourette’s syndrome. The group was divided into two groups to study the effects of Ecocipam.
One group of 74 members was given Ecocipam, while the other group of 75 members was given a placebo. For the measurement of the symptoms, two different tests were used. The first test assessed vocal tics and motor tics while the other test measured the overall symptoms of the tics.
After a gap of three months in which the members of the groups were given regular doses of the medication, the researchers found that the group which consumed Ecocipam had much lesser tics and symptoms when compared to the other group.
The group that took Ecocipam had an overall decrease of 30 percent of vocal and motor tics, and an additional 32 percent decrease in the overall symptoms of Tourette’s. The group also experienced fewer side effects like headaches and body fatigue.
Ecocipam aggressively targets the dopamine levels in the body by targeting the D1 receptor in the brain, instead of the D2 receptor which other medications target originally. Ecocipam
is still not released in the market as further studies need to be done for this.
Median Nerve Stimulation for Tourette’s
According to a study conducted by the University of Nottingham, Median Nerve Stimulation can also help in coping with Tourette’s. The author who led this study is Barbara Morera Maiquez who found that stimulation of the median nerve considerably reduced the frequency of tics.
In the study, a total group of 19 participants was used, in whom Tourette’s syndrome has been diagnosed. For the protocol, the participants were observed for periods of 1-minute and were administered pulses of median nerve stimulation.
As part of the control protocol, the participants were observed for periods of 1-minute where they were not given any such pulses of median nerve stimulation. The researchers found that the periods where MNS was administered led to a significant decrease in tics and the urge to tic.
After finding immense success in the study, the researchers are now backed with a new aim of making a wearable device through which any individual can easily control their tics when they are outside in a public setting.
Median Nerve Stimulation works by electrical current which is passed to the brain through the wrist. These pulses of current work on strengthening certain oscillations in the brain which lead to a reduction in tics.
Deep Brain Stimulation for Tourette’s syndrome
Deep Brain Stimulation has also been deeply studied of its effects on the symptoms of Tourette’s syndrome. While Deep Brain Stimulation had been approved for tremors and movement disorders before, it is now being used to treat tics at certain centers.
In a study published in the Journal of Neurology, the Centromedian-Parafascicular Complex of the Thalamus was studied for its effects on tics. Deep Brain Stimulation of this area of the brain led to a decrease in the level of motor tics in the participants.
At the same time, there was no significant decrease in the level of phonic tics in the participants. The authors of the study found that the results were promising but not concrete evidence of the possible effects of Deep Brain Stimulation on tics and Tourette’s.
There are also many other studies being conducted in regards to the effects of Deep Brain Stimulation on various other parts of the brain through which the symptoms of Tourette’s syndrome can be controlled and managed.
In Deep Brain Stimulation, an electrode is implanted into a target area of the brain. Another neuro-stimulator, also called the pulse generator, will be implanted at the collar bone region or the abdomen region.
These components are then connected with an extension cable. The pulses for the Deep Brain Stimulation will be given through certain contact points in the body, usually four. The physician will determine the duration, the frequency and the amplitude of the stimulation.
Criteria for Deep Brain Stimulation for Tourette’s syndrome
As of today, Deep Brain Stimulation for Tourette’s syndrome can come through as a treatment option, only if the person meets certain criteria. Some of the criteria which a person needs to match before being eligible for Deep Brain Stimulation for tics are:
- The person needs to be diagnosed for Tourette’s syndrome by an experienced psychiatrist or even a neurologist first and foremost.
- They also need to be above the age of 25 years. However, in many cases, younger candidates may also be chosen, but this is left up to the call of the attending physician.
- In the Yale Global Tic Severity Scale, the person needs to lean toward high levels of distress, incapacitation to do certain activities, self-harming behaviors with serious decrease of quality of life.
- The most important criterion which is considered is that the symptoms of the Tourette’s syndrome should not respond to other forms of treatment or therapy which is normally recommended for this condition.
Their prior treatment should also have been handled by an experienced neurologist who should have provided at least three pharmacological classes of treatments for the person, including alpha-adrenergic agonists, dopamine antagonists & benzodiazepine.
- Apart from these pharmacological interventions, the person should also have undergone behavioral interventions for the treatments of their tics or their Tourette’s syndrome. This is only if they have been evaluated in the past to be suitable for behavioral intervention.
- In case the person who is presenting with tics also has other psychological conditions like bipolar disorder, or anxiety or depression, these must be in a stable condition after proper treatment for a licensed and experienced mental health professional.
- Before the Deep Brain Stimulation study can take place, the person needs to be tested and screened for any type of cognitive dysfunctions, including dementia. This is done since cognitive impairments can interfere with the results of the study.
Complications of Deep Brain Stimulation for Tourette’s syndrome
While Deep Brain Stimulation certainly seems promising in terms of treatment of Tourette’s syndrome, there are certain complications which may arise, such as,
- Infection may arise in the brain due to the presence of the Deep Brain Stimulation device. Apart from the brain, the neuro-stimulator implantation area may also get infected. This has been found to occur in about five percent of patients undergoing DBS.
- Sometimes, the Deep Brain Stimulation procedure can negatively affect a person’s cognitive abilities or even their mood & affect. In certain rare cases, the person may also experience suicidal thoughts.
- The Deep Brain Stimulation device can also cause strokes of internal bleeding in the brain during the process of implantation.
Conclusion
The current detailed post has explained what the new treatments for Tourette’s are in detail. We have also taken a close look at the various criteria for Deep Brain Stimulation, particularly for Tourette’s syndrome along with its complications.
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