1/3. deep brain stimulation of the anterior internal capsule for the treatment of tourette syndrome: technical case report.OBJECTIVE AND IMPORTANCE: Medical treatment of tourette syndrome is often ineffective or is accompanied by debilitating side effects, therefore prompting the need to evaluate surgical therapies. CLINICAL PRESENTATION: We present the case of a 37-year-old woman with severe tourette syndrome since the age of 10 years. Her symptoms included frequent vocalizations and severe head and arm jerks that resulted in unilateral blindness. Trials of more than 40 medications and other therapies had failed to relieve the tics. INTERVENTION: We implanted bilateral electrodes in the anterior limb of the internal capsule, terminating in the vicinity of the nucleus accumbens. At 18-month follow-up, optimal stimulation continued to lower her tic frequency and severity significantly. CONCLUSION: Our findings suggest that stimulation of the anterior internal capsule may be a safe and effective procedure for the treatment of tourette syndrome.- - - - - - - - - - ranking = 1keywords = nucleus (Clic here for more details about this article) |
2/3. deep brain stimulation in Tourette's syndrome: two targets?In this report, we describe the effects of bilateral thalamic stimulation in one patient and of bilateral pallidal stimulation in another patient. Both patients suffered from intractable Tourette's syndrome (TS). Any conservative treatment had failed or had been stopped because of unbearable side effects in the 2 patients. In both cases, there was no comorbidity except for associated behavioral symptoms (compulsions). electrodes were implanted at the level of the medial part of the thalamus (centromedian nucleus, the substantia periventricularis, and the nucleus ventro-oralis internus) in one patient and in the posteroventral part of the globus pallidus internus (GPi) in the other patient. In both cases, deep brain stimulation (DBS) resulted in a substantial reduction of tics and compulsions. These data show that bilateral DBS of the thalamus as well as of the GPi can have a good effect on tics and behavioral symptoms in patients suffering from intractable TS.- - - - - - - - - - ranking = 2keywords = nucleus (Clic here for more details about this article) |
3/3. Three cases of symptom change in Tourette's syndrome and obsessive-compulsive disorder associated with paediatric cerebral malignancies.OBJECTIVE: To correlate behaviour manifestations with tumour location in three children who had Gilles de la Tourette's syndrome (GTS), obsessive-compulsive disorder (OCD), and primary cerebral malignancies. METHOD: Cases were ascertained from a chart review in a GTS and OCD specialty clinic. For each case the temporal progression of change in neuropsychiatric symptoms was qualitatively correlated with radiographic documentation of tumour progression. RESULTS: The change in symptom severities during tumour progression and treatment, together with prior neurobiological studies of GTS, suggest that the ventral striatum, corpus callosum, thalamus, and midbrain are potentially important neural substrates in the formation or modulation of tic symptoms. The limbic system, including the hypothalamus and cingulate, and the caudate nucleus, seem to be important in the neurobiology of OCD. All structures are neuroanatomically and functionally related to the corticostriato-thalamocortical circuitry that is thought to subserve symptom generation in both GTS and OCD. CONCLUSION: Although the malignancies were not likely to have caused the tic and OCD symptoms in these children, the locations of these intracranial lesions provide important clues in identifying brain regions that may contribute to the determination of tic and OCD severities.- - - - - - - - - - ranking = 1keywords = nucleus (Clic here for more details about this article) |