Archival Report| Volume 79, ISSUE 5, P392-401, March 01, 2016

Motor Improvement and Emotional Stabilization in Patients With Tourette Syndrome After Deep Brain Stimulation of the Ventral Anterior and Ventrolateral Motor Part of the Thalamus



      Since its first application in 1999, the potential benefit of deep brain stimulation (DBS) in reducing symptoms of otherwise treatment-refractory Tourette syndrome (TS) has been documented in several publications. However, uncertainty regarding the ideal neural targets remains, and the eventuality of so far undocumented but possible negative long-term effects on personality fuels the debate about the ethical implications of DBS.


      In this prospective open-label trial, eight patients (three female, five male) 19–56 years old with severe and medically intractable TS were treated with high-frequency DBS of the ventral anterior and ventrolateral motor part of the thalamus. To assess the course of TS, its clinical comorbidities, personality parameters, and self-perceived quality of life, patients underwent repeated psychiatric assessments at baseline and 6 and 12 months after DBS onset.


      Analysis indicated a strongly significant and beneficial effect of DBS on TS symptoms, trait anxiety, quality of life, and global functioning with an apparently low side-effect profile. In addition, presurgical compulsivity, anxiety, emotional dysregulation, and inhibition appeared to be significant predictors of surgery outcome.


      Trading off motor effects and desirable side effects against surgery-related risks and negative implications, stimulation of the ventral anterior and ventrolateral motor part of the thalamus seems to be a valuable option when considering DBS for TS.


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      Linked Article

      • Deep Brain Stimulation for Tourette Syndrome: Lessons Learned and Future Directions
        Biological PsychiatryVol. 79Issue 5
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          Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder that affects neural circuits involved in sensory and motor processing as well as cognitive control. Tics consist of repetitive, unwanted, non–goal-directed muscle contractions involving discrete muscle groups, which are associated with preceding sensory phenomena (urges) and are variably suppressible by volition (1). Most individuals with TS experience improvement of their tics in late adolescence or early adulthood. However, a few individuals have severe and self-injurious tics that are refractory to currently available behavioral and pharmacologic interventions.
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