1/5. Bilateral globus pallidus lesions in a patient with tourette syndrome and related disorders.BACKGROUND: The neuroanatomic and pathologic basis of Tourette's syndrome or related disorders such as obsessive-compulsive disorder and attention deficit-hyperactivity disorder remains unknown. Although a substantial body of neuroimaging and other data implicate basal ganglia and some point out specifically the globus pallidus in the etiopathogenesis of these three related disorders, no clear or pathologically significant isolated lesions restricted to this region have yet been demonstrated, with the exception of obsessive-compulsive disorder. methods: A seventeen-year-old male case of tourette syndrome with comorbid obsessive-compulsive disorder, attention deficit-hyperactivity disorder, stuttering and gait disturbance, who had negative family history is presented. RESULTS: The patient has failed to respond to drug treatment and his MRI scan revealed bilateral and symmetrical globus pallidus lesions with specific "tiger's eye" appearance of unknown etiology. CONCLUSIONS: Well-localized lesions in the globus pallidus support growing data suggesting the involvement of this brain region in tourette syndrome and related disorders.- - - - - - - - - - ranking = 1keywords = globus pallidus, pallidus, globus (Clic here for more details about this article) |
2/5. Tourette's syndrome and deep brain stimulation.In this prospective double blind randomised "N of 1" study, a patient with a severe form of Tourette's syndrome was treated with bilateral high frequency stimulation of the centromedian-parafascicular complex (Ce-Pf) of the thalamus, the internal part of the globus pallidus (GPi), or both. Stimulation of either target improved tic severity by 70%, markedly ameliorated coprolalia, and eliminated self injuries. Severe forms of Tourette's syndrome may benefit from stimulation of neuronal circuits within the basal ganglia, thus confirming the role of the dysfunction of limbic striato-pallido-thalamo-cortical systems in this disorder.- - - - - - - - - - ranking = 0.14285714285714keywords = globus pallidus, pallidus, globus (Clic here for more details about this article) |
3/5. Efficient internal pallidal stimulation in Gilles de la tourette syndrome: a case report.The usefulness of deep brain stimulation (DBS) of thalamic nuclei in Gilles de la tourette syndrome (GTS) has recently been advocated. We report on a 14-month follow-up study of a patient with intractable GTS in whom bilateral DBS of the internal globus pallidus was carried out. Tic frequency per minute decreased by 73% in the postoperative phase and in particular the vocal tics became less intense. pronation/ supination bradykinesia of the left extremities was a well-tolerated, permanent side effect. Pallidal DBS could become a valuable rescue therapy for otherwise intractable GTS.- - - - - - - - - - ranking = 0.14285714285714keywords = globus pallidus, pallidus, globus (Clic here for more details about this article) |
4/5. 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 = 0.14285714285714keywords = globus pallidus, pallidus, globus (Clic here for more details about this article) |
5/5. Gilles de la Tourette's syndrome. A postmortem neuropathological and immunohistochemical study.Immunocytochemical studies of the human forebrain have shown that enkephalin-like, dynorphin-like and substance-P-like immunoreactivity (respectively ELI, DLI, and SPI) normally present in unique pattern (now termed woolly fibers) in the globus pallidus and substantia nigra, in which their concentration is at its densest. Quantitative determinations moreover indicate that the levels of all 3 peptides are higher in the globus pallidus and substantia nigra than in any other region of the brain. We report here the distribution of immunoreactivity of these 3 peptides in the brain of a patient showing the typical clinical manifestations of Gilles de la Tourette's syndrome (TS); a disease for which no characteristic or consistent neuropathological features have been discerned. In the case described here neuropathological examination by means of the usual histopathological methods showed no abnormalities to which the patient's illness could be ascribed. ELI- and SPLI-positive woolly fibers were densely stained and of normal distribution. DLI-staining was, however, considerably less dense throughout the brain than normal. The most striking finding was the total absence of DLI-positive woolly fibers in the dorsal part of the external segment of the globus pallidus; the ventral pallidum showed very faint staining. These observations, which indicate a decrease of dynorphin in striatal fibers projecting to the globus pallidus, are, to our knowledge, the first evidence of a distinct pathological change in the brain in TS.- - - - - - - - - - ranking = 0.57142857142857keywords = globus pallidus, pallidus, globus (Clic here for more details about this article) |