Deep brain stimulation of the anterior internal capsule for the treatment of Tourette syndrome: technical case report.
OBJECTIVE
Medical treatment of Tourette syndrome is often ineffective or is accompanied by debilitating side effects, therefore prompting the need to evaluate surgical therapies.


METHODS
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.


METHODS
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.


CONCLUSIONS
Our findings suggest that stimulation of the anterior internal capsule may be a safe and effective procedure for the treatment of Tourette syndrome.
Flaherty
Alice W
AW
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Williams
Ziv M
ZM
Amirnovin
Ramin
R
Kasper
Ekkehard
E
Rauch
Scott L
SL
Cosgrove
G Rees
GR
Eskandar
Emad N
EN
D000328:Adult; D046690:Deep Brain Stimulation / Q000379:methods*; D003936:Diagnosis, Computer-Assisted / Q000379:methods; D004307:Dose-Response Relationship, Radiation; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020772:Internal Capsule / Q000503:physiopathology* / Q000528:radiation effects; D008279:Magnetic Resonance Imaging / Q000379:methods; D005879:Tourette Syndrome / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome