De novo and rescue DBS leads for refractory Tourette syndrome patients with severe comorbid OCD: a multiple case report

J Neurol. 2009 Sep;256(9):1533-9. doi: 10.1007/s00415-009-5159-6. Epub 2009 May 13.

Abstract

Invasive treatment for Gilles de la Tourette syndrome has shown interesting results in a number of published reports; it seems to be evolving into a promising therapeutic procedure for those patients demonstrating disabling clinical pictures who are refractory to conservative treatments. There are important issues concerning the stimulated brain target, with different nuclei currently under investigation. Our group asked in this pilot study whether Tourette syndrome could be treated by tailoring specific brain targets for specific symptoms. Deep brain stimulation for Tourette syndrome may thus in the future be tailored and patient specific, utilizing specific target regions for individual clinical manifestations. In our early experience we did not adequately address non-motor clinical symptoms as we only used a thalamic target. More recently in an obsessive compulsive disease cohort we have had success in using the anterior limb of the internal capsule and nucleus accumbens region as targets for stimulation. We therefore explored the option of a "rescue" procedure for our Tourette patients with persistent obsessive-compulsive disorder following ventralis oralis/centromedianus-parafascicularis (Vo/CM-Pf) deep brain stimulation. Following two cases where rescue anterior limb of internal capsule/nucleus accumbens leads were employed, we performed two additional procedures (anterior limb of the internal capsule plus ventralis oralis/centromedianus-parafascicularis and anterior limb of the internal capsule alone) with some mild improvement of comorbid obsessive-compulsive disorder, although the number of observations in this case series was low. Overall, the effects observed with using the anterior limb of the internal capsule either alone or as a rescue were less than expected. In this report we detail our experience with this approach.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Comorbidity
  • Deep Brain Stimulation* / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Internal Capsule / pathology
  • Internal Capsule / physiopathology
  • Internal Capsule / surgery
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Obsessive-Compulsive Disorder / epidemiology
  • Obsessive-Compulsive Disorder / therapy*
  • Pilot Projects
  • Thalamus / pathology
  • Thalamus / physiopathology
  • Thalamus / surgery
  • Tourette Syndrome / epidemiology
  • Tourette Syndrome / therapy*
  • Treatment Outcome