Dual bilateral stimulation of the nucleus accumbens and the centromedian thalamus for treatment of intractable Tourette syndrome.

Background: Tourette syndrome (TS) is a common neurological disorder characterized by frequent and disabling motor or vocal tics. There has been widely reported variation in patient responses to deep brain stimulation (DBS) for TS treatment. However, the potentially synergistic effects of multifocal DBS placements have not been extensively explored in younger patient populations. Case Description: Our patient is a 19-year-old male with a medical history significant for TS and comorbid psychological disorders. Despite medical treatment, the patient's violent tics progressed from simple back extension motor tics to vigorous and aggressive behaviors. He received multiple opinions and trialed numerous pharmacological therapies without success. He was ultimately referred for neurosurgical evaluation for placement of DBS with selected targets of the bilateral nucleus accumbens (NAcc) and bilateral centromedian thalamus for lead implantation. The Yale Global Tic Severity Scale rated by the attending surgeon demonstrated a significant improvement in the patient's baseline tics and overall quality of life from preoperatively to 56 months postoperatively. With multifocal DBS leads in place, the patient's tics are well controlled on a low-moderate dosage of haloperidol. His emotional lability is now reported as less volatile and less extreme. He has become considerably more sociable and talkative. Conclusion: Following DBS placement, the patient experienced substantial improvement from his preoperative violent behavior and mood lability. This case provides evidence that dual electrode DBS, in conjunction with appropriate medical management, is a safe and effective way to improve life quality in individuals struggling with debilitating TS symptoms.