Temporary deep brain stimulation in Gilles de la Tourette syndrome: A feasible approach?
BACKGROUND
Gilles de la Tourette Syndrome (GTS) is a complex neuropsychiatric disorder, characterized by chronic motor and vocal tics, associated in 50-90% of cases with psychiatric comorbidities. Patients with moderate and severe clinical picture are treated with psychotherapy and pharmacological therapy. Deep brain stimulation (DBS) is reserved for pharmacological refractory GTS patients. As GTS tends to improve with time and potentially resolves in the second decade of life, the major concern of DBS in GTS is the age at which the patient undergoes surgical procedure. Some authors suggest performing DBS after 18 years, others after 25 years of age.


METHODS
We present a 25-year-old patient with GTS, who was aged 17 years and was treated with thalamic DBS. DBS resulted in progressive and sustained improvement of tics and co-morbidities. After 6 years of DBS treatment, it was noted that the clinical improvement was maintained also in OFF stimulation setting, so it was decided to keep it off. After 2 years in off-setting and stable clinical picture the entire DBS device was removed. Six months after DBS device removal the patient remained symptom-free.


CONCLUSIONS
DBS is a therapeutic option reserved for severe and refractory GTS cases. In our opinion DBS might be considered as a temporary application in GTS.
Department of Neurology and Neurosurgery, IRCCS Galeazzi, Milan, Italy, Via Riccardo Galeazzi 4, Milan, Italy Cap 20161.
Edvin
E
Zekaj
Department of Neurology and Neurosurgery, IRCCS Galeazzi, Milan, Italy, Via Riccardo Galeazzi 4, Milan, Italy Cap 20161.
Christian
C
Saleh
Department of Neurology and Neurosurgery, IRCCS Galeazzi, Milan, Italy, Via Riccardo Galeazzi 4, Milan, Italy Cap 20161.
Mauro
M
Porta
Department of Neurology and Neurosurgery, IRCCS Galeazzi, Milan, Italy, Via Riccardo Galeazzi 4, Milan, Italy Cap 20161.
Domenico
D
Servello
Deep brain stimulation; Gilles de la Tourette syndrome; management; timing