Temporary deep brain stimulation in Gilles de la Tourette syndrome: A feasible approach?

Domenico Servello,Christian Saleh,Mauro Porta,Edvin Zekaj

doi:10.4103/2152-7806.161242

Abstract

Background:Gilles de la Tourette Syndrome (GTS) is a complex neuropsychiatric disorder, characterized by chronic motor and vocal tics, associated in 50–90% of cases with psychiatric comorbidities. Patients with moderate and severe clinical picture are treated with psychotherapy and pharmacological therapy. Deep brain stimulation (DBS) is reserved for pharmacological refractory GTS patients. As GTS tends to improve with time and potentially resolves in the second decade of life, the major concern of DBS in GTS is the age at which the patient undergoes surgical procedure. Some authors suggest performing DBS after 18 years, others after 25 years of age.Case Description:We present a 25-year-old patient with GTS, who was aged 17 years and was treated with thalamic DBS. DBS resulted in progressive and sustained improvement of tics and co-morbidities. After 6 years of DBS treatment, it was noted that the clinical improvement was maintained also in OFF stimulation setting, so it was decided to keep it off. After 2 years in off-setting and stable clinical picture the entire DBS device was removed. Six months after DBS device removal the patient remained symptom-free.Conclusions:DBS is a therapeutic option reserved for severe and refractory GTS cases. In our opinion DBS might be considered as a temporary application in GTS.

Highlights

Gilles de la Tourette Syndrome (GTS) is a complex neuropsychiatric disorder, characterized by chronic motor and vocal tics, associated in 50–90% of cases with psychiatric comorbidities
Co‐morbidities such as attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), depression and anxiety disorders are present in 50–90% of patients.[8]
Observational approach with regular follow‐ups should be reserved to mild cases without social impairment and interferences with daily activities

Summary

Conclusions

DBS is a therapeutic option reserved for severe and refractory GTS cases. In our opinion DBS might be considered as a temporary application in GTS. We present a patient with GTS,[10] who at the age of 17 years underwent bilateral deep brain stimulation (DBS) for severe and refractory GTS. Three months prior to surgery, the patient developed a severe “status ticcosus” (continuous motor and vocal tics) that obliged him to leave school. His clinical condition did not respond to any treatment. Three years after IPG replacement, it was noticed that the IPG was turned off once again, but surprisingly this time the patient ( aged 23 years) did not present any aggravation of symptoms In light of his stable clinical status the patient and his caregivers decided to leave the IPG in OFF state.

Findings

DISCUSSION

CONCLUSION