Severe Whip-Like Cervical Tics as an Indication For Thalamic Deep Brain Stimulation: Report of Two Cases

Abstract

Background: Cervical spinal cord injury caused by cervical tics associated with Tourette syndrome (TS) is a recognized complication; however, the role of deep brain stimulation (DBS) in mitigating the risk of such injuries remains unclear.

Case report: We report two cases of TS with severe cervical tics, both of which responded favorably to DBS. In one case, DBS prevented the progression of cervical spinal cord injury, whereas in the other case, it prevented its onset.

Discussion: Poor control of severe cervical tics is a significant risk factor for cervical spinal cord injury, and early consideration of DBS is recommended.

Highlights: This case report presents two cases in which deep brain stimulation (DBS) was effective for patients with Tourette syndrome exhibiting severe cervical tics. Through this report, we demonstrate the potential effectiveness of DBS as a treatment to reduce the risk of cervical spinal cord injury caused by severe cervical tics.

Keywords: Tourette syndrome; cervical spinal cord injury; deep brain stimulation.

Figure 1

Preoperative sequential photographs of case 1 (A) and case 2 (B), demonstrating severe cervical tics with forceful neck extension.

Figure 2

Pre- and postoperative evaluation of case 2. Sagittal T2-weighted magnetic resonance imaging revealed a high-intensity area extending from the C3 to C6 levels (A). Postoperative X-ray confirmed proper lead placement (B). When the neck was extended, the IPG caught on the clavicle, placing stress on the cable (arrowhead), which was presumed to have caused cable breakage (C).