title: Microelectrode-guided deep brain stimulation for Tourette syndrome: within-subject comparison of different stimulation sites.
abstract: BACKGROUND
  As medical therapy for Tourette syndrome (TS) is ineffective in a small subset of patients, surgical interventions, including deep brain stimulation at various sites, have been developed in recent years.
  
  
  METHODS
  We present the case of a 40-year-old woman with TS whose severe tics had caused unilateral blindness. Despite trials of more than 40 medications, her symptoms improved significantly only after placement of bilateral deep brain stimulators in the anterior inferior internal capsule. However, symptomatic improvement was not complete, and her electrode connections eventually became permanently damaged by the remaining retrocollic jerks. She underwent removal of the internal capsule electrodes and placement of centromedian nucleus thalamic stimulators with significantly improved tic control.
  
  
  CONCLUSIONS
  Whereas the anterior internal capsule site had also produced psychiatric side effects such as altered mood and impulse control, the thalamic site has not done so to date. Thus, distinct surgical targets for TS may be appropriate for patients with specific comorbidities.
authors: Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass., USA.
authors: Donald C
authors: DC
authors: Shields
authors: Ming L
authors: ML
authors: Cheng
authors: Alice W
authors: AW
authors: Flaherty
authors: John T
authors: JT
authors: Gale
authors: Emad N
authors: EN
authors: Eskandar
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D020772:Internal Capsule / Q000503:physiopathology*; D008839:Microelectrodes; D019964:Mood Disorders / Q000209:etiology; D013788:Thalamus / Q000503:physiopathology*; D005879:Tourette Syndrome / Q000503:physiopathology / Q000628:therapy*