title: Long-term outcome of thalamic deep brain stimulation in two patients with Tourette syndrome.
abstract: OBJECTIVE
  Thalamic deep brain stimulation for intractable Tourette Syndrome was introduced in 1999 by Vandewalle et al. In this follow-up study, the authors report on the long-term (6 and 10 years) outcome in terms of tic reduction, cognition, mood and side effects of medial thalamic deep brain stimulation in two previously described Tourette patients.
  
  
  METHODS
  The authors compared the outcome of two patients at 6 and 10 years after surgery with their preoperative status and after 8 months and 5 years of treatment, respectively. Standardised video recordings were scored by three independent investigators. Both patients underwent (neuro)psychological assessment at all time points of follow-up.
  
  
  RESULTS
  Tic improvement observed at 5 years in patient 1 (90.1%) was maintained at 10 years (92.6%). In patient 2, the tic improvement at 8 months (82%) was slightly decreased at 6 years (78%). During follow-up, case 1 revealed no changes in cognition, but case 2 showed a decrease in verbal fluency and learning which was in line with his subjective reports. Case 2 showed a slight decrease in depression, but overall psychopathology was still high at 6 years after surgery with an increase in anger and aggression together with difficulties in social adaptation. Besides temporary hardware-related complications, no distressing adverse effects were observed.
  
  
  CONCLUSIONS
  Bilateral thalamic stimulation may provide sustained tic benefit after at least 6 years, but to maximise overall outcome, attention is needed for postoperative psychosocial adaptation, already prior to surgery.
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Centre, Oxfordlaan 10, Maastricht, The Netherlands. ackermanslinda@hotmail.com
authors.forename: Linda
authors.initials: L
authors.lastname: Ackermans
authors.forename: Annelien
authors.initials: A
authors.lastname: Duits
authors.forename: Yasin
authors.initials: Y
authors.lastname: Temel
authors.forename: Ania
authors.initials: A
authors.lastname: Winogrodzka
authors.forename: Frenk
authors.initials: F
authors.lastname: Peeters
authors.forename: Emile A M
authors.initials: EA
authors.lastname: Beuls
authors.forename: Veerle
authors.initials: V
authors.lastname: Visser-Vandewalle
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology; D003072:Cognition Disorders / Q000628:therapy; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D003863:Depression / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013788:Thalamus / Q000502:physiology* / Q000601:surgery; D020323:Tics / Q000628:therapy; D005879:Tourette Syndrome / Q000628:therapy*