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Deep brain stimulation in Tourette's syndrome: two targets?
Linda Ackermans1, Yasin Temel, Danielle Cath
1Department of Neurosurgery, University Hospital Maastricht, Maastricht, The Netherlands. ackermanslinda@hotmail.com
Summary
Deep brain stimulation (DBS) effectively reduced tics and compulsions in two patients with intractable Tourette's syndrome (TS). Both thalamic and pallidal stimulation showed significant benefits when conservative treatments failed.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Intractable Tourette's syndrome (TS) presents significant challenges when conservative treatments are ineffective or cause adverse effects.
- Associated behavioral symptoms, such as compulsions, often accompany TS, complicating management.
Observation:
- This report details two cases of intractable Tourette's syndrome treated with deep brain stimulation (DBS).
- One patient received bilateral thalamic stimulation targeting the centromedian nucleus, substantia periventricularis, and nucleus ventro-oralis internus.
- The second patient underwent bilateral pallidal stimulation in the posteroventral globus pallidus internus (GPi).
Findings:
- Both patients experienced a substantial reduction in both motor tics and behavioral compulsions following DBS.
- Bilateral thalamic stimulation demonstrated efficacy in one patient.
- Bilateral GPi stimulation proved effective in the other patient.
Implications:
- Deep brain stimulation of either the thalamus or the globus pallidus internus is a viable therapeutic option for intractable Tourette's syndrome.
- DBS offers a promising alternative for patients with severe TS and associated behavioral symptoms who have not responded to other treatments.
- These findings support the role of neuromodulation in managing complex movement disorders like Tourette's syndrome.