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Behavioral and Motor Improvement After Deep Brain Stimulation of the Globus Pallidus Externus in a Case of Tourette's Syndrome

Authors

  • Fabián Piedimonte MD,

    Corresponding author
    1. Instituto de Morfologia J.J. Naon, Facultad de Medicina de la Universidad de Buenos Aires (UBA), Argentina
    • Fundacion CENIT para la Investigación en Neurociencias, Buenos Aires, Argentina
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  • Juan Carlos M. Andreani MD,

    1. Instituto de Neuro-rehabilitación en Argentina (INEUREA), Buenos Aires, Argentina
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  • Leandro Piedimonte MD,

    1. Fundacion CENIT para la Investigación en Neurociencias, Buenos Aires, Argentina
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  • Pablo Graff MD,

    1. Fundacion CENIT para la Investigación en Neurociencias, Buenos Aires, Argentina
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  • Valeria Bacaro PhD,

    1. Fundacion CENIT para la Investigación en Neurociencias, Buenos Aires, Argentina
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  • Federico Micheli MD,

    1. Programa de Parkinson y Movimientos Anormales, Hospital de Clínicas “José de San Martin”, Universidad de Buenos Aires (UBA), Argentina
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  • Osvaldo Vilela Filho MD, PhD

    1. Servicio de Neurocirugía Funcional y Estereotaxia, Hospital das Clinicas, Medical School, Universidad Federal de Goias, Goias, Brasil
    2. Instituto Neurológico de Goiania, Goias, Brasil
    3. Escuela de Medicina, Universidad Catolica de Goias, Goias, Brasil
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  • Conflict of Interest: Dr. Fabián C. Piedimonte is the president of the Argentinean Neuromodulation Society (SANE) and treasurer of INS. He serves on speaker programs for Medtronic and St. Jude Medical. Dr. Juan Carlos M. Andreani is the vice president of SANE. Dr. Leandro R. Piedimonte is the treasurer of SANE. Dr. Osvaldo Vilela Filho is the president of Brazilian Neuromodulation Society. Drs. Pablo E. Graff, Lic. Valeria Bacaro, and Prof. Federico Micheli reported no conflicts of interest.
  • For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to http://www.wiley.com/bw/submit.asp?ref=1094-7159&site=1

Address correspondence to: Fabián Piedimonte, MD, Fundación CENIT para la Investigación en Neurociencias—Neurosurgery, Juncal 2222 1° P, Buenos Aires C1125ABD, Argentina. Email: fabian@piedimonte.com.ar

Abstract

Objectives

The objective of our paper is to show the partial decrease of therapeutic effect with battery exhaustion in a previously successfully treated patient with refractory Tourette's syndrome (TS).

Materials and Methods

We present a 47-year-old patient diagnosed with TS based on the TS Study Group Criteria and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Surgery was considered based on refractoriness to conservative management. Presurgical evaluation included magnetic resonance imaging (MRI), positron emission tomography scan, and neuropsychologic, neurologic, and psychiatric tests utilizing Yale Brown Obsessive Compulsive Scale, Yale Global Tics Severity Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Global Assessment of Functioning Scale, and Mini-mental State Examination. Target coordinates were obtained from inversion recovery MRI. Quadripolar deep brain stimulation (DBS) electrodes were implanted bilaterally in the globus pallidus externus (GPe) and connected to the pulse generator in the same procedure. To determine the clinical response to DBS, the scores of the scales obtained preoperatively were compared with those obtained postoperatively.

Results

No surgical complications were detected and according to the clinical scales the patient experienced a marked improvement of his symptoms, although he never showed obsessive-compulsive disorder components of any type. The battery was exhausted after two years with the subsequent significant partial loss of therapeutic effect.

Conclusions

GPe seems to be a highly promising target of DBS for the treatment of medically refractory TS. After battery exhaustion, the patient experienced a marked partial decrease in the therapeutic effect, which confirms the beneficial action of this method.

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