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Long-term outcome of thalamic deep brain stimulation in two patients with Tourette syndrome
  1. Linda Ackermans1,2,3,
  2. Annelien Duits2,3,4,
  3. Yasin Temel1,2,3,
  4. Ania Winogrodzka2,3,5,
  5. Frenk Peeters3,4,
  6. Emile A M Beuls1,6,
  7. Veerle Visser-Vandewalle1,2,3
  1. 1Departments of Neurosurgery, Maastricht Institute for Neuromodulative Development, Maastricht University Medical Centre, Maastricht, The Netherlands
  2. 2Maastricht Institute for Neuromodulative Development (MIND), Maastricht University Medical Centre, Maastricht, The Netherlands
  3. 3School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
  4. 4Psychiatry and Psychology, Maastricht Institute for Neuromodulative Development, Maastricht University Medical Centre, Maastricht, The Netherlands
  5. 5Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
  6. 6Department of Basic Medical Sciences, University of Hasselt, Diepenbeek, Belgium
  1. Correspondence to Miss Linda Ackermans, Department of Neurosurgery, Maastricht University Medical Centre, Oxfordlaan 10, 6229 EV Maastricht, The Netherlands; ackermanslinda{at}hotmail.com

Abstract

Objective Thalamic 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.

Methods The 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.

Results Tic 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.

Conclusion Bilateral 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.

  • Thalamus
  • deep brain stimulation
  • Tourette Syndrome
  • electrical stimulation
  • Gilles De La Tourette
  • neurosurgery
  • psychiatry

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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