Introduction: Tourette Syndrome (TS) is a common neurological disorder characterized by frequent and disabling motor or vocal tics. There has been wide reported variation in patient responses to deep brain stimulation (DBS) for TS treatment. However, the potentially synergistic effects of multifocal DBS placements have not been extensively explored in younger patient populations.
Methods: Our patient is a 19 year-old male with a medical history significant for TS and comorbid psychological disorders. Despite medical treatment, the patient’s violent tics progressed from simple back extension motor tics to vigorous and aggressive behaviors harming himself and those around him. He received multiple opinions and trialed numerous therapies without success. After a thorough and detailed discussion with the patient and his family, he was ultimately referred for neurosurgical evaluation for placement of deep brain stimulation with selected targets of the bilateral nucleus accumbens (NAcc) and bilateral centromedian thalamus (cmT) for lead implantation.
Results: Over 2 years of clinical follow up, the patient showed significant improvement of preoperative violent tics. After 3 years of postoperative follow-up and DBS acclimation, it was noted that, while on a stable dose of 1mg of haloperidol BID, “[patient] did not exhibit any tics.” Prior to operation, multiple doses of haloperidol were taken without relief of symptoms. However, with multifocal DBS leads in place, the patient’s tics are well controlled on a low-moderate dosage of the medication. His emotional lability is now reported as less volatile and less extreme. He has become considerably more social and talkative, and is now even described as gentle.
Conclusion : The remarkable findings from this case provide promise for the future of multifocal electrode placement for TS, even in younger populations. Following DBS placement, our patient experienced substantial improvement from his preoperative violent behavior and mood lability—a goal previously unimaginable to him and his family.
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