Objective: To describe two cases of patients with pharmacological refractory Tourette syndrome who underwent DBS in a single center in Bogota Colombia from 2012 -2015.

Background: Tourette syndrome is a condition characterized by neurological and psychiatric symptoms with motor and vocal tics as the hallmark. As the disorder manifests during childhood and tends to subside over time, pharmacological and behavioral therapies are successfully in the majority of patients. However, some cases are refractory, evidencing the need for additional treatment options. Deep Brain Stimulation (DBS) has been explored in recent years showing promising results among various studies.

Methods: Authors performed a retrospective chart review of patients with diagnosis of Tourette syndrome according to DSM V criteria, evaluated by a multidisciplinary team which were candidates for DBS. Yale Global Tic Severity Scale (YGTSS) was applied before and after the procedure.

Results: Case 1: A 38-year-old male with history of vocal tics with prominent coprolalia that started around 16 years of age. In addition, severe dyskinetic cervical movements despite appropriate medical treatment. Pre-op YGTSS 98/100. Bilateral Gpi stimulation was done and 12 months after the procedure the YGTSS was 23/100 (76,5% reduction). The patient remained stable for another 24 months, but experienced acute worsening of his tics (YGTSS 37). Rupture of left brain electrode was documented requiring surgical replacement. Improvement was noticed again with a YGTSS of 21 that has been stable till his last follow up visit, completing 5 years after the initial DBS placement. Case 2: A 71-year-old male with a history of Tourette syndrome diagnosed at the age of 12, presents with increased frequency of his tics despite pharmacological treatment with partial improvement but adverse effects. Stimulation of bilateral Gpi was performed. Pre-op YGSTT 75/100, 1-year post-op YGSTT 20/100 (73,3 % improvement). Patient reported difficulty in his gait, that revealed hypokinesic pattern in the physical examination. Parameters of stimulation were adjusted, and improvement in gait was achieved without worsening of tics.

Conclusions: Growing body of literature supports DBS as a therapeutic option to treat refractory symptoms in Tourette syndrome. Our cases illustrate clinical scenarios in which DBS constitutes an invaluable tool. Absence of response to pharmacological options, severity of the clinical condition with limitation in quality of life, and risk of self-harm are some examples. Very similar degree of improvement was achieved in comparison to previous studies.

References: 1. Jankovic J, Kurlan R. Tourette syndrome: evolving concepts. Mov Disord. 2011;26(6):1149-1156. doi:10.1002/mds.23618. 2. Galvez-Jimenez N. Tics and Tourette syndrome: An adult perspective. Cleve Clin J Med. 2012;79(SUPPL.2). doi:10.3949/ccjm.79.s2a.07. 3. Flaherty AW, Williams ZM, Amirnovin R, et al. Deep brain stimulation of the anterior internal capsule for the treatment of tourette syndrome: Technical case report. Neurosurgery. 2005;57(4 SUPPL.). doi:10.1227/01.NEU.0000176854.24694.95. 4. Kim W, Pouratian N. Deep Brain Stimulation for Tourette Syndrome. Neurosurg Clin N Am. 2014;25(1):117-135. doi:10.1016/j.nec.2013.08.009. 5. Schrock LE, Mink JW, Woods DW, et al. Tourette syndrome deep brain stimulation: A review and updated recommendations. Mov Disord. 2015;30(4):448-471. doi:10.1002/mds.26094. 6. American Psychiatric Association. DSM-V.; 2013. doi:10.1176/appi.books.9780890425596.744053. 7. Lee DR, McKeith I, Mosimann U, Ghosh-Nodyal A, Thomas AJ. Examining carer stress in dementia: The role of subtype diagnosis and neuropsychiatric symptoms. Int J Geriatr Psychiatry. 2013;28(2):135-141. doi:10.1002/gps.3799. 8. Deeb W, Rossi PJ, Porta M, et al. The international deep brain stimulation registry and database for gilles de la tourette syndrome: How does it work? Front Neurosci. 2016;10(APR). doi:10.3389/fnins.2016.00170.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-in-tourette-syndrome-two-illustrative-cases/