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De novo and rescue DBS leads for refractory Tourette syndrome patients with severe comorbid OCD: a multiple case report

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Abstract

Invasive treatment for Gilles de la Tourette syndrome has shown interesting results in a number of published reports; it seems to be evolving into a promising therapeutic procedure for those patients demonstrating disabling clinical pictures who are refractory to conservative treatments. There are important issues concerning the stimulated brain target, with different nuclei currently under investigation. Our group asked in this pilot study whether Tourette syndrome could be treated by tailoring specific brain targets for specific symptoms. Deep brain stimulation for Tourette syndrome may thus in the future be tailored and patient specific, utilizing specific target regions for individual clinical manifestations. In our early experience we did not adequately address non-motor clinical symptoms as we only used a thalamic target. More recently in an obsessive compulsive disease cohort we have had success in using the anterior limb of the internal capsule and nucleus accumbens region as targets for stimulation. We therefore explored the option of a “rescue” procedure for our Tourette patients with persistent obsessive-compulsive disorder following ventralis oralis/centromedianus-parafascicularis (Vo/CM-Pf) deep brain stimulation. Following two cases where rescue anterior limb of internal capsule/nucleus accumbens leads were employed, we performed two additional procedures (anterior limb of the internal capsule plus ventralis oralis/centromedianus-parafascicularis and anterior limb of the internal capsule alone) with some mild improvement of comorbid obsessive–compulsive disorder, although the number of observations in this case series was low. Overall, the effects observed with using the anterior limb of the internal capsule either alone or as a rescue were less than expected. In this report we detail our experience with this approach.

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Acknowledgments

The authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. We wish also to acknowledge Ms. Olga Lee Rachello for English language supervision.

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Authors and Affiliations

  1. Functional Neurosurgery Unit, Division of Neurosurgery, Istituto Galeazzi IRCCS Milan, Galeazzi Street 4, 20161, Milan, Italy

    Domenico Servello & Marco Sassi

  2. Division of Neurosurgery, Movement Disorders Center, Istituto Galeazzi IRCCS Milan, Galeazzi Street 4, 20161, Milan, Italy

    Arianna Brambilla & Mauro Porta

  3. Departments of Neurology and Neurosurgery, University of Florida Movement Disorders Center, College of Medicine, McKnight Brain Institute, Gainesville, FL, USA

    Ihtsham Haq, Kelly D. Foote & Michael S. Okun

Authors
  1. Domenico Servello
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  2. Marco Sassi
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  3. Arianna Brambilla
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  4. Mauro Porta
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  5. Ihtsham Haq
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  6. Kelly D. Foote
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  7. Michael S. Okun
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Correspondence to Marco Sassi.

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Servello, D., Sassi, M., Brambilla, A. et al. De novo and rescue DBS leads for refractory Tourette syndrome patients with severe comorbid OCD: a multiple case report. J Neurol 256, 1533–1539 (2009). https://doi.org/10.1007/s00415-009-5159-6

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  • DOI: https://doi.org/10.1007/s00415-009-5159-6

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