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

• Published in: Journal of neurology Vol. 256; no. 9; pp. 1533 - 1539
• Main Authors: Servello, Domenico, Sassi, Marco, Brambilla, Arianna, Porta, Mauro, Haq, Ihtsham, Foote, Kelly D., Okun, Michael S.
• Format: Journal Article
• Language: English
• Published: Heidelberg D. Steinkopff-Verlag 01-09-2009; Springer; Springer Nature B.V
• Subjects: Adult; Biological and medical sciences; Comorbidity; Deep Brain Stimulation - methods; Female; Follow-Up Studies; Humans; Internal Capsule - pathology; Internal Capsule - physiopathology; Internal Capsule - surgery; Magnetic Resonance Imaging; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Neurology; Neuroradiology; Neurosciences; Obsessive-Compulsive Disorder - epidemiology; Obsessive-Compulsive Disorder - therapy; Original Communication; Pilot Projects; Thalamus - pathology; Thalamus - physiopathology; Thalamus - surgery; Tourette Syndrome - epidemiology; Tourette Syndrome - therapy; Treatment Outcome; OCD; Accumbens; DBS; Psychosurgery; Thalamus; CM; Tourette; Human; Nervous system diseases; OLD; Central nervous system; De novo; Encephalon; Cerebral disorder; Case study; Refractory; Central nervous system disease; Gilles de la Tourette syndrome; Degenerative disease
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-009-5159-6

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.