title: Thalamic Deep Brain Stimulation for Refractory Tourette Syndrome: Clinical Evidence for Increasing Disbalance of Therapeutic Effects and Side Effects at Long-Term Follow-Up.
abstract: OBJECTIVE
  Thalamic deep brain stimulation (DBS) is effective in reducing tics in patients with refractory Tourette syndrome at the short-term. Here, we report on the long-term outcome.
  
  
  METHODS
  Seven patients underwent bilateral DBS between 2001 and 2008. The target was the centromedian nucleus, substantia periventricularis and nucleus ventro-oralis internus cross point of the thalamus. The effect on tics and side effects were evaluated with a variable follow-up duration of 12 to 78 months.
  
  
  RESULTS
  Patient 1 and 2 showed good tic improvements of 81.6% (60 months) and 50% (36 months), respectively. However, side effects like reducing levels of energy and visual disturbances increased. In patient 1, the target was changed to the anterior part of the internal pallidum and patient 2 switched the stimulator permanently off. Patient 3 experiences still satisfying results with a tic improvement of 88.9% (78 months). Patient 4 and 7 showed minor tic improvements of 34% (16 months) and 9% (60 months), respectively. In both patients side effects became more severe and the target was changed to the anterior part of the internal pallidum. Patient 5 showed a tic improvement of 27.5% (12 months) and went abroad for stimulation of the external globus pallidus. Patient 6 developed cerebellar atrophy. He experienced several nonstimulation related side effects and turned the stimulator off.
  
  
  CONCLUSIONS
  There seems to be an increasing disbalance of therapeutic effects and side effects at long-term follow-up, often leading to either switching the stimulator off or new surgery with a different neuro-anatomic target.
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Anouk Y J M
authors.initials: AYJM
authors.lastname: Smeets
authors.affiliation: Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Annelien A
authors.initials: AA
authors.lastname: Duits
authors.affiliation: Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Albert F G
authors.initials: AFG
authors.lastname: Leentjens
authors.affiliation: Mondriaan Zorggroep, Academic Anxiety Centre, Maastricht, The Netherlands.
authors.forename: Koen
authors.initials: K
authors.lastname: Schruers
authors.affiliation: Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Vivianne
authors.initials: V
authors.lastname: van Kranen-Mastenbroek
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany.
authors.forename: Veerle
authors.initials: V
authors.lastname: Visser-Vandewalle
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Temel
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Linda
authors.initials: L
authors.lastname: Ackermans
mesh_terms: D000328:Adult; D015331:Cohort Studies; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013788:Thalamus / Q000502:physiology*; D013997:Time Factors; D005879:Tourette Syndrome / Q000628:therapy*; D016896:Treatment Outcome
keywords: Deep brain stimulation; Tourette syndrome; long-term outcome; thalamus; tics