Deep brain stimulation (DBS) has been used in the treatment of severely affected treatment-refractory
patients with Tourette's syndrome. Visser-Vandewalle and colleagues (
1
,
2
) led the way from ablation to deep brain stimulation in this syndrome. They were
the first to apply high-frequency stimulation in three treatment-resistant patients
with Tourette's. A variety of target points come into question when assessing the
optimal site for stimulation to take place. For DBS in Tourette's patients, the globus
pallidus internus (posteroventrolateral part, anteromedial part), the thalamus (centromedian
nucleus, substantia periventricularis, and nucleus ventro-oralis internus) and the
nucleus accumbens/anterior limb of the internal capsule (
3
,
4
) have all been used as target points. Significant reductions in the severity of tics,
as assessed by the Yale Global Tic Severity Scale (YGTSS), of up to 84% have been
reported for DBS (
4
). Most outcome reports limit themselves however, to 3–12 months after surgery (
4
).To read this article in full you will need to make a payment
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References
- Stereotactic treatment of Gilles de la Tourette syndrome by high frequency stimulation of thalamus.Lancet. 1999; 353: 724
- Chronic bilateral thalamic stimulation: A new therapeutic approach in intractable Tourette syndrome.J Neurosurg. 2003; 99: 1094-1100
- Deep brain stimulation in movement and psychiatric disorders.Biol Psychiatry. 2007; 61: 831-835
- Deep brain stimulation for psychiatric disorders.Neurotherapeutics. 2008; 5: 50-58
- Inhibitory deficits in Tourette's syndrome.Dev Psychobiol. 2008; 50: 9-18
- The temporal dynamics of tics in Gilles de la Tourette syndrome.Biol Psychiatry. 1998; 44: 1337-1348
- Basal Ganglia volumes in patients with Gilles de la Tourette syndrome.Arch Gen Psychiatry. 2003; 60: 415-424
- Morphologic features of the amygdala and hippocampus in children and adults with Tourette syndrome.Arch Gen Psychiatry. 2007; 64: 1281-1291
- Electrical stimulation of the anterior limbs of the internal capsules in patients with severe obsessive–compulsive disorder: Anecdotal reports.Neurosurg Clin N Am. 2003; 14: 267-274
Article info
Publication history
Published online: November 13, 2008
Identification
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© 2009 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
