Long-term outcome of thalamic deep brain stimulation in two patients with Tourette syndrome

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 81; no. 10; pp. 1068 - 1072
• Main Authors: Ackermans, Linda, Duits, Annelien, Temel, Yasin, Winogrodzka, Ania, Peeters, Frenk, Beuls, Emile A M, Visser-Vandewalle, Veerle
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.10.2010; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adult; Affect - physiology; Biological and medical sciences; Cognition & reasoning; Cognition Disorders - therapy; Deep brain stimulation; Deep Brain Stimulation - adverse effects; Deep Brain Stimulation - methods; Depression - therapy; electrical stimulation; Follow-Up Studies; Gilles De La Tourette; Humans; Male; Medical imaging; Medical sciences; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Neurology; neurosurgery; Patients; psychiatry; Surgery; Thalamus; Thalamus - physiology; Thalamus - surgery; Tics - therapy; Tourette Syndrome; Tourette Syndrome - therapy; Human; Nervous system diseases; Prognosis; Deep brain stimulation; Central nervous system disease; Gilles de la Tourette syndrome; Degenerative disease; Long term; Cerebral disorder; GILLES DE LA TOURETTE; PSYCHIATRY; ELECTRICAL STIMULATION; NEUROSURGERY
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2009.176859

ObjectiveThalamic deep brain stimulation for intractable Tourette Syndrome was introduced in 1999 by Vandewalle et al. In this follow-up study, the authors report on the long-term (6 and 10 years) outcome in terms of tic reduction, cognition, mood and side effects of medial thalamic deep brain stimulation in two previously described Tourette patients.MethodsThe authors compared the outcome of two patients at 6 and 10 years after surgery with their preoperative status and after 8 months and 5 years of treatment, respectively. Standardised video recordings were scored by three independent investigators. Both patients underwent (neuro)psychological assessment at all time points of follow-up.ResultsTic improvement observed at 5 years in patient 1 (90.1%) was maintained at 10 years (92.6%). In patient 2, the tic improvement at 8 months (82%) was slightly decreased at 6 years (78%). During follow-up, case 1 revealed no changes in cognition, but case 2 showed a decrease in verbal fluency and learning which was in line with his subjective reports. Case 2 showed a slight decrease in depression, but overall psychopathology was still high at 6 years after surgery with an increase in anger and aggression together with difficulties in social adaptation. Besides temporary hardware-related complications, no distressing adverse effects were observed.ConclusionBilateral thalamic stimulation may provide sustained tic benefit after at least 6 years, but to maximise overall outcome, attention is needed for postoperative psychosocial adaptation, already prior to surgery.