Dwarakanath S, Hegde A, Ketan J, Chandrajit P, Yadav R, Keshav K, Sampath S, Pal P K, Reddy Y C J
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Neurol India. 2017 Jan-Feb;65(1):99-102. doi: 10.4103/0028-3886.198188.
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.
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).
After failure of multiple combinations of medicines, repetitive transcranial magnetic stimulation, and behavioural therapies, he successfully underwent DBS to bilateral anteromedial globus pallidus interna.
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.
图雷特综合征（TS）是一种复杂的神经精神疾病，其特征是存在多种运动性和发声性抽动。在此，我们报告一例患有严重TS的年轻男性病例，该患者对多种药物治疗均无效，随后接受了脑深部电刺激（DBS）治疗，该治疗成功地显著改善了他的抽动症状。据我们所知，这是来自印度和南亚的首例此类报告。
一名18岁右利手男性患者在10岁时被诊断为TS。他有面部和眼部抽动。他还会用拳头捶打胸部并大声说脏话。这些症状在他醒着的每一个小时都会出现，最长无抽动间隔时间为15 - 20分钟。这些症状常常导致自我伤害或物体损坏。他经常哭泣、发怒，并有想死的念头。由于抽动症状变得非常明显且在社交场合不适当，他辍学了，并且在前一年几乎完全足不出户。经评估，他在耶鲁全球抽动严重程度量表（YGTSS）上的得分是96分（抽动严重程度子量表46分，损害子量表50分），满分100分。
在多种药物组合、重复经颅磁刺激和行为疗法均失败后，他成功接受了双侧内侧苍白球腹内侧核的DBS治疗。
术后抽动严重程度大幅降低，YGTSS评分提高超过72%。这些改善在随访中得以维持，患者成功重返大学。据我们所知，这是来自印度和南亚的首例此类报告。
