title: Transient Manic-like Episode Following Bilateral Deep Brain Stimulation of the Nucleus Accumbens and the Internal Capsule in a Patient With Tourette Syndrome.
abstract: Objective.  Deep brain stimulation (DBS) increasingly attracts attention as a potential treatment of mental disorders. Beside depression and obsessive-compulsive disorders, DBS has already been shown to be beneficial for Tourette syndrome (TS). Clinical Presentation/Method.  The authors report on the outcome of a patient with treatment-resistant TS who underwent bilateral DBS of the nucleus accumbens and the internal capsule. Results.  Within the 10-month follow-up, a substantial reduction of tics has been observed. Yet, as a side-effect of DBS, the patient developed a transient manic-like episode when primarily stimulated by the most proximally contact in the internal capsule. Conclusions.  This case supports the hypothesis that DBS of the nucleus accumbens and the internal capsule represents an effective therapeutic alternative for otherwise treatment-resistant TS. Yet, future controlled studies are needed to determine optimal stimulation parameters and to reduce negative side-effects such as transient hypomanic episodes.
authors.affiliation: Departments of Psychiatry and Psychotherapy and Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany; and Institute of Anatomy I, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Kuhn
authors.forename: Doris
authors.initials: D
authors.lastname: Lenartz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huff
authors.forename: Jürgen K
authors.initials: JK
authors.lastname: Mai
authors.forename: Athanasios
authors.initials: A
authors.lastname: Koulousakis
authors.forename: Mohammad
authors.initials: M
authors.lastname: Maarouf
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Lee
authors.forename: Joachim
authors.initials: J
authors.lastname: Klosterkoetter
authors.forename: Volker
authors.initials: V
authors.lastname: Sturm