title: Lack of benefit of accumbens/capsular deep brain stimulation in a patient with both tics and obsessive-compulsive disorder.
abstract: LAY SUMMARY: This case report illustrates lack of clinical efficacy of deep brain stimulation (DBS) for control of tics in a case of mild Tourette syndrome (TS) with severe comorbid obsessive-compulsive disorder (OCD). The brain target for stimulation was the anterior limb internal capsule (ALIC).
  
  
  OBJECTIVE
  To investigate the effect of anterior limb of internal capsule/nucleus accumbens (ALIC-NA) DBS on mild motor and vocal tics in a Tourette syndrome (TS) patient with severe OCD.
  
  
  BACKGROUND
  The optimum target to address symptoms of TS with DBS remains unknown. Earlier lesional therapy utilized thalamic targets and also the ALIC for select cases which had been diagnosed with other psychiatric disorders. Evidence regarding the efficacy of DBS for the symptoms of TS may aid in better defining a brain target's suitability for use. We report efficacy data on ALIC-NA DBS in a patient with severe OCD and mild TS.
  
  
  METHODS
  A 33-year-old man underwent bilateral ALIC-NA DBS. One month following implantation, a post-operative CT scan was obtained to verify lead locations. Yale Global Tic Severity Scales (YGTSS) and modified Rush Videotape Rating scales (MRVRS) were obtained throughout the first 6 months, as well as careful clinical examinations by a specialized neurology and psychiatry team. The patient has been followed for 30 months.
  
  
  RESULTS
  YGTSS scores worsened by 17% during the first 6 months. MRVRS scores also worsened over 30 total months of follow-up. There was a lack of clinically significant tic reduction although subjectively the patient felt tics improved mildly.
  
  
  CONCLUSIONS
  DBS in the ALIC-NA failed to effectively address mild vocal and motor tics in a patient with TS and severe comorbid OCD.
authors.affiliation: University of Florida Department of Neurosurgery, Gainesville, FL, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Burdick
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Foote
authors.forename: Wayne
authors.initials: W
authors.lastname: Goodman
authors.forename: Herbert E
authors.initials: HE
authors.lastname: Ward
authors.forename: Nicola
authors.initials: N
authors.lastname: Ricciuti
authors.forename: Tanya
authors.initials: T
authors.lastname: Murphy
authors.forename: Ihtsham
authors.initials: I
authors.lastname: Haq
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D020772:Internal Capsule / Q000502:physiology*; D008297:Male; D009714:Nucleus Accumbens / Q000502:physiology*; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology / Q000601:surgery*; D011569:Psychiatric Status Rating Scales; D020323:Tics / Q000601:surgery*; D005879:Tourette Syndrome / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome