Avoiding deep brain stimulation failures in Tourette syndrome
- Departments of Neurology, Neurosurgery and Psychiatry, Movement Disorders Center, McKnight Brain Institute, Gainesville, Florida, USA
- Dr M S Okun, Department of Neurology, University of Florida Brain Institute, 100 S Newell Dr, Room L3-101, 3rd Floor Neurology, Gainesville, FL 32611, USA; okun{at}neurology.ufl.edu
Deep brain stimulation (DBS) surgery has emerged as an effective treatment for addressing basal ganglia disorders such as Parkinson’s disease, essential tremor and dystonia.1–9 Recently, several groups have applied DBS for the treatment of obsessive–compulsive disorder (OCD)10 and Tourette syndrome (TS).10–18 The largest open label TS series to date19 utilising a single brain target is published in this issue of J Neurol Neurosurg Psychiatry (see page 136). Although three targets have been tested in open label series for TS, the authors focused their work on the centromedian thalamus–parafascicular complex (inclusive of the ventralis oralis). The globus pallidus interna and externa, and the anterior limb of the internal capsule/nucleus accumbens have also emerged as potentially effective targets for amelioration of medication refractory tics, although they have been less studied.20–25 As studies of DBS for TS proceed, we should endeavour to apply the principles we have learned from more established applications of DBS …
