Surgery for Tourette syndrome

Abstract

Tourette syndrome is a chronic neuropsychiatric disorder characterized by motor and vocal tics. In the majority of cases, tics are associated by behavioral disorders such as obsessive-compulsive behavior. First symptoms typically appear in early childhood. Mostly symptoms disappear when adulthood is reached. Treatment options consist of behavioral therapy and medication. In refractory cases, surgery may be an option. In the past, several attempts have been made to treat therapy-refractory patients through neurosurgical ablative procedures. In 1999, deep brain stimulation was introduced as a novel treatment option for patients with intractable Tourette syndrome. Up until now, five brain areas have been used or suggested as potential target areas for deep brain stimulation in Tourette syndrome. In the majority of the published cases, there is a clear effect on tics but most studies consist of only a limited number of patients. A strict patient selection is absolutely mandatory. There is a need for double-blinded multicenter trials with inclusion of more patients.

Keywords: DBS; Deep brain stimulation; GPE; GPI; Globus pallidus externus; Globus pallidus internus; IC; Internal capsule; NAC; Nucleus accumbens; OCD; Obsessive-compulsive disorder; SIB; Self-injurious behavior; TS; Tourette syndrome; YBOCS; YGTSS; Yale Global Tic Severity Scale; Yale-Brown Obsessive-Compulsive Scale.