title: Behavioral and motor improvement after deep brain stimulation of the globus pallidus externus in a case of Tourette's syndrome.
abstract: OBJECTIVE
  The objective of our paper is to show the partial decrease of therapeutic effect with battery exhaustion in a previously successfully treated patient with refractory Tourette's syndrome (TS).
  
  
  METHODS
  We present a 47-year-old patient diagnosed with TS based on the TS Study Group Criteria and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Surgery was considered based on refractoriness to conservative management. Presurgical evaluation included magnetic resonance imaging (MRI), positron emission tomography scan, and neuropsychologic, neurologic, and psychiatric tests utilizing Yale Brown Obsessive Compulsive Scale, Yale Global Tics Severity Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Global Assessment of Functioning Scale, and Mini-mental State Examination. Target coordinates were obtained from inversion recovery MRI. Quadripolar deep brain stimulation (DBS) electrodes were implanted bilaterally in the globus pallidus externus (GPe) and connected to the pulse generator in the same procedure. To determine the clinical response to DBS, the scores of the scales obtained preoperatively were compared with those obtained postoperatively.
  
  
  RESULTS
  No surgical complications were detected and according to the clinical scales the patient experienced a marked improvement of his symptoms, although he never showed obsessive-compulsive disorder components of any type. The battery was exhausted after two years with the subsequent significant partial loss of therapeutic effect.
  
  
  CONCLUSIONS
  GPe seems to be a highly promising target of DBS for the treatment of medically refractory TS. After battery exhaustion, the patient experienced a marked partial decrease in the therapeutic effect, which confirms the beneficial action of this method.
authors.affiliation: Fundacion CENIT para la Investigación en Neurociencias, Buenos Aires, Argentina.
authors.forename: Fabián
authors.initials: F
authors.lastname: Piedimonte
authors.forename: Juan Carlos M
authors.initials: JC
authors.lastname: Andreani
authors.forename: Leandro
authors.initials: L
authors.lastname: Piedimonte
authors.forename: Pablo
authors.initials: P
authors.lastname: Graff
authors.forename: Valeria
authors.initials: V
authors.lastname: Bacaro
authors.forename: Federico
authors.initials: F
authors.lastname: Micheli
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Vilela Filho
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D005917:Globus Pallidus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005879:Tourette Syndrome / Q000628:therapy*