title: Motor Improvement and Emotional Stabilization in Patients With Tourette Syndrome After Deep Brain Stimulation of the Ventral Anterior and Ventrolateral Motor Part of the Thalamus.
abstract: BACKGROUND
  Since its first application in 1999, the potential benefit of deep brain stimulation (DBS) in reducing symptoms of otherwise treatment-refractory Tourette syndrome (TS) has been documented in several publications. However, uncertainty regarding the ideal neural targets remains, and the eventuality of so far undocumented but possible negative long-term effects on personality fuels the debate about the ethical implications of DBS.
  
  
  METHODS
  In this prospective open-label trial, eight patients (three female, five male) 19-56 years old with severe and medically intractable TS were treated with high-frequency DBS of the ventral anterior and ventrolateral motor part of the thalamus. To assess the course of TS, its clinical comorbidities, personality parameters, and self-perceived quality of life, patients underwent repeated psychiatric assessments at baseline and 6 and 12 months after DBS onset.
  
  
  RESULTS
  Analysis indicated a strongly significant and beneficial effect of DBS on TS symptoms, trait anxiety, quality of life, and global functioning with an apparently low side-effect profile. In addition, presurgical compulsivity, anxiety, emotional dysregulation, and inhibition appeared to be significant predictors of surgery outcome.
  
  
  CONCLUSIONS
  Trading off motor effects and desirable side effects against surgery-related risks and negative implications, stimulation of the ventral anterior and ventrolateral motor part of the thalamus seems to be a valuable option when considering DBS for TS.
authors.affiliation: Departments of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany. Electronic address: Daniel.Huys@uk-koeln.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Huys
authors.affiliation: Departments of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Bartsch
authors.affiliation: Departments of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Koester
authors.affiliation: Departments of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany.
authors.forename: Doris
authors.initials: D
authors.lastname: Lenartz
authors.affiliation: Departments of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany; Department of Functional Neurosurgery and Stereotaxy, Hospitals of Cologne, Cologne-Merheim, Germany.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Maarouf
authors.affiliation: Departments of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Daumann
authors.affiliation: Department of Anatomy, University of Düsseldorf, Düsseldorf, Germany.
authors.forename: Jürgen K
authors.initials: JK
authors.lastname: Mai
authors.affiliation: Departments of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Klosterkötter
authors.affiliation: Departments of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hunsche
authors.affiliation: Departments of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany.
authors.forename: Veerle
authors.initials: V
authors.lastname: Visser-Vandewalle
authors.affiliation: Institute for the History of Medicine and Medical Ethics, Research Unit Ethics, University of Cologne, Cologne, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Woopen
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Timmermann
authors.affiliation: Departments of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Sturm
authors.affiliation: Departments of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Kuhn
mesh_terms: D000328:Adult; D001007:Anxiety; D015897:Comorbidity; D003192:Compulsive Behavior; D046690:Deep Brain Stimulation; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012649:Self Concept; D013788:Thalamus / Q000502:physiology*; D013981:Tic Disorders / Q000628:therapy*; D005879:Tourette Syndrome / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Deep brain stimulation; Motor tics; Thalamic stimulation; Thalamus; Tic disorder; Tourette; Tourette syndrome; Vocal tics