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Deep brain stimulation (DBS) may improve disabling tics in severely affected medication and behaviorally resistant Tourette syndrome (TS). Here we review all reported cases of TS DBS and provide updated recommendations for selection, assessment, and management of potential TS DBS cases based on the literature and implantation experience. Candidates should have a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) diagnosis of TS with severe motor and vocal tics, which despite exhaustive medical and behavioral treatment trials result in significant impairment. Deep brain stimulation should be offered to patients only by experienced DBS centers after evaluation by a multidisciplinary team. Rigorous preoperative and postoperative outcome measures of tics and associated comorbidities should be used. Tics and comorbid neuropsychiatric conditions should be optimally treated per current expert standards, and tics should be the major cause of disability. Psychogenic tics, embellishment, and malingering should be recognized and addressed. We have removed the previously suggested 25-year-old age limit, with the specification that a multidisciplinary team approach for screening is employed. A local ethics committee or institutional review board should be consulted for consideration of cases involving persons younger than 18 years of age, as well as in cases with urgent indications. Tourette syndrome patients represent a unique and complex population, and studies reveal a higher risk for post-DBS complications. Successes and failures have been reported for multiple brain targets; however, the optimal surgical approach remains unknown. Tourette syndrome DBS, though still evolving, is a promising approach for a subset of medication refractory and severely affected patients.

While the use of deep brain stimulation (DBS) for the treatment of neurological disorders has risen substantially over the last decade, it is often difficult to compare the results from different studies due to the lack of consistent reporting of key study parameters. We present guidelines to standardize the reporting of clinical studies of DBS for Parkinson's disease (PD). These guidelines provide a minimal set of required data elements to facilitate the interpretation and comparison of results across published clinical studies. The guidelines, summarized in the format of a checklist, may also have utility in the planning of clinical studies of DBS for PD as well as other neurological and psychiatric disorders.

Purpose: Functional MRI (fMRI) can provide insights into the functioning of the sensorimotor system, which is of particular interest in studying people with movement disorders or chronic pain conditions. This creates a demand for manipulanda that can fit and operate within the environment of a MRI scanner. Here, the authors present a magnetomechanical device that delivers a vibrotactile sensation to the skin with a force of approximately 9 N. Methods: MRI compatibility of the device was tested in a 3 T scanner using a phantom to simulate the head. Preliminary investigation into the effectiveness of the device at producing cortical and subcortical activity was also conducted with a group of seven healthy subjects. The vibration was applied to the right extensor carpi ulnaris tendon to induce a kinesthetic illusion of flexion and extension of the wrist. Results: The MRI compatibility tests showed the device did not produce image artifacts and the generated electromagnetic field did not disrupt the static magnetic field of the scanner or its operation. The subject group results showed activity in the contralateral putamen, premotor cortex, and dorsal lateral prefrontal cortex. Ipsilaterally, there was increased activity in the superior and inferior parietal lobules. Areas that activated bilaterally included the thalamus, anterior cingulate, secondary somatosensory areas (S2), temporal lobes, and visual association areas. Conclusions: This device offers an effective tool with precise control over the vibratory stimulus, delivering higher forces than some other types of devices (e.g., piezoelectric actuators). It can be useful for investigating sensory systems and sensorimotor integration.