Long-term outcome of thalamic deep brain stimulation in two patients with Tourette syndrome
Résumé
ABSTRACT Objective: Thalamic deep brain stimulation for intractable Tourette Syndrome has been introduced in 1999 by Vandewalle et al. In this follow-up study we report on the long-term (6 and 10 years) outcome in terms of tic reduction, cognition and mood and side-effects of medial thalamic DBS in two previously described Tourette patients. Methods: We compared the outcome of two patients at 6 and 10 years after surgery with their preoperative status and after 8 months and 5 years of treatment, respectively. Standardized video recordings were scored by three independent investigators. Both patients underwent (neuro)psychological assessment at all time points of follow-up. Results: Tic improvement observed at 5 years in patient 1 (90.1%) was maintained at 10 years (92.6%). In patient 2 the tic improvement at 8 months (82%) was slightly decreased at 6 years (78%). During follow-up, case 1 revealed no changes in cognition, but case 2 showed a decrease in verbal fluency and learning which was in line with his subjective reports. Case 2 showed a slight decrease in depression but overall psychopathology was still high at 6 years after surgery with an increase in anger and aggression together with difficulties in social adaptation. Besides temporary hardware related complications no distressing adverse effects were observed. Conclusion: Bilateral thalamic stimulation may provide sustained tic benefit after at least 6 years but overall improvement is not obvious. To maximize overall outcome attention is needed for postoperative psychosocial adaptation, already prior to surgery.
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