title: "I swear, I can't stop it!" - A case of severe Tourette's syndrome treated with deep brain stimulation of anteromedial globus pallidus interna.
abstract: BACKGROUND
  Tourette's syndrome (TS) is a complex neuropsychiatric disorder characterized by the presence of multiple motor and vocal tics. Here, we report the case of a young man with severe TS refractory to multiple medications who underwent deep brain stimulation (DBS), which was successful in substantially ameliorating his tics. To our knowledge, this is the first such report from India and South Asia.
  
  
  METHODS
  An 18-year-old right-handed male patient was diagnosed with TS at the age of 10 years. He had facial and ocular tics. He was also hitting his fist against his chest and shouting obscenities. The manifestations would be present in every waking hour with a maximum tic free interval of 15-20 minutes. They would often result in self-injury or damage to objects. He would have frequent crying spells, anger outbursts, and death wishes. As tics became highly conspicuous and socially inappropriate, he dropped out of school and remained almost completely house-bound for the preceding year. On evaluation, he scored 96 (46 on tic-severity subscale and 50 on impairment subscale) of a maximum of 100 on the Yale Global Tic Severity Scale. (YGTSS).
  
  
  RESULTS
  After failure of multiple combinations of medicines, repetitive transcranial magnetic stimulation, and behavioural therapies, he successfully underwent DBS to bilateral anteromedial globus pallidus interna.
  
  
  CONCLUSIONS
  Tic severity reduced substantially post-surgery, with the YGTSS score improving by more than 72%. These improvements were sustained on follow-up visits with the patient successfully returning to join college. To our knowledge, this is the first such report from India and South Asia.
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: S
authors.initials: S
authors.lastname: Dwarakanath
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: A
authors.initials: A
authors.lastname: Hegde
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: J
authors.initials: J
authors.lastname: Ketan
authors.affiliation: Department of Neuroradiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: P
authors.initials: P
authors.lastname: Chandrajit
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: R
authors.initials: R
authors.lastname: Yadav
authors.affiliation: Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: K
authors.initials: K
authors.lastname: Keshav
authors.affiliation: Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: S
authors.initials: S
authors.lastname: Sampath
authors.affiliation: Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: P K
authors.initials: PK
authors.lastname: Pal
authors.affiliation: Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
authors.forename: Y C J
authors.initials: YC
authors.lastname: Reddy
mesh_terms: D000293:Adolescent; D046690:Deep Brain Stimulation / Q000379:methods*; D005917:Globus Pallidus / Q000601:surgery; D006801:Humans; D008297:Male; D005879:Tourette Syndrome / Q000601:surgery / Q000628:therapy*