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Normative Functional Connectivity of Thalamic Stimulation for Reducing Tic Severity in Tourette Syndrome

  • Author Footnotes
    1 JCB and CH contributed equally to this work as joint first authors.
    Juan Carlos Baldermann
    Correspondence
    Address correspondence to Juan Carlos Baldermann, M.D.
    Footnotes
    1 JCB and CH contributed equally to this work as joint first authors.
    Affiliations
    Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany

    Department of Psychiatry and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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  • Author Footnotes
    1 JCB and CH contributed equally to this work as joint first authors.
    Christina Hennen
    Footnotes
    1 JCB and CH contributed equally to this work as joint first authors.
    Affiliations
    Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany

    Department of Psychiatry and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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  • Thomas Schüller
    Affiliations
    Department of Psychiatry and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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  • Pablo Andrade
    Affiliations
    Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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  • Veerle Visser-Vandewalle
    Affiliations
    Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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  • Andreas Horn
    Affiliations
    Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Movement Disorders and Neuromodulation Unit, Department of Neurology, Berlin, Germany

    Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

    Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

    Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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  • Till A. Dembek
    Affiliations
    Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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  • Jan Niklas Petry-Schmelzer
    Affiliations
    Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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  • Joshua Niklas Strelow
    Affiliations
    Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany

    Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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  • Hannah Jergas
    Affiliations
    Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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  • Jens Kuhn
    Affiliations
    Department of Psychiatry and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany

    Department of Psychiatry, Psychotherapy, and Psychosomatics, Johanniter Hospital Oberhausen, Oberhausen, Germany
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  • Author Footnotes
    2 MTB and DH contributed equally to this work as joint last authors.
    Michael T. Barbe
    Footnotes
    2 MTB and DH contributed equally to this work as joint last authors.
    Affiliations
    Department of Neurology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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  • Author Footnotes
    2 MTB and DH contributed equally to this work as joint last authors.
    Daniel Huys
    Footnotes
    2 MTB and DH contributed equally to this work as joint last authors.
    Affiliations
    Department of Psychiatry and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany

    Department of Psychiatry and Psychotherapy III, LVR Klinik Bonn, Bonn, Germany
    Search for articles by this author
  • Author Footnotes
    1 JCB and CH contributed equally to this work as joint first authors.
    2 MTB and DH contributed equally to this work as joint last authors.
Published:April 29, 2022DOI:https://doi.org/10.1016/j.bpsc.2022.01.009
      Deep brain stimulation (DBS) for Tourette syndrome (TS) is an evolving therapy for severely affected patients. However, there is still ambiguity about the ideal target and networks that need to be modulated for optimal results. Recently, Johnson et al. (
      • Johnson K.
      • Duffley G.
      • Anderson D.N.
      • Ostrem J.L.
      • Welter M.-L.
      • Baldermann J.C.
      • et al.
      Structural connectivity predicts clinical outcomes of deep brain stimulation for Tourette syndrome.
      ,
      • Johnson K.A.
      • Duffley G.
      • Foltynie T.
      • Hariz M.
      • Zrinzo L.
      • Joyce E.M.
      • et al.
      Basal ganglia pathways associated with therapeutic pallidal deep brain stimulation for Tourette syndrome.
      ) demonstrated that tic reductions depend on normative structural connectivity seeding from stimulation sites, highlighting the utility of probing optimal fiber pathways, rather than focal targets (
      • Hollunder B.
      • Ganos C.
      • Horn A.
      Deep brain stimulation: From sweet spots to sweet networks?.
      ). Connectivity estimates derived from resting-state functional magnetic resonance imaging may extend these findings by deciphering polysynaptic, functionally linked networks that are not necessarily structurally connected. Pursuing this approach, we performed an analysis of stimulation-dependent functional connectivity to derive a network that, if modulated by thalamic DBS, explains tic reduction in severe TS.
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