Strelko Oleksandr, Burritt St Angelo Maria I, Ghannad Andrew S, Sloane Dayna C, Verducci Chloe, Luy Diego D, Pecoraro Nathan C, Cecia Arba, Simon Joshua E, Iordanou Jordan C, Cass Daryn K, Germanwala Anand V, Anderson Douglas E
Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States.
Department of Neurosurgery, Loyola University Medical Center, Maywood, IL, United States.
Surg Neurol Int. 2025 May 30;16:206. doi: 10.25259/SNI_379_2025. eCollection 2025.
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.
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.
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.
抽动秽语综合征（TS）是一种常见的神经疾病，其特征为频繁且致残的运动性或发声性抽动。对于TS治疗，患者对深部脑刺激（DBS）的反应差异已有广泛报道。然而，多焦点DBS植入的潜在协同效应在年轻患者群体中尚未得到广泛探索。
我们的患者是一名19岁男性，有显著的TS病史及共病心理障碍。尽管接受了药物治疗，患者的暴力抽动从简单的背部伸展运动性抽动发展为剧烈且攻击性的行为。他寻求了多个意见并尝试了多种药物治疗，但均未成功。他最终被转介进行神经外科评估，以植入DBS，选定的靶点为双侧伏隔核（NAcc）和双侧丘脑中央中核以植入电极。主刀医生使用耶鲁全球抽动严重程度量表评估显示，从术前到术后56个月，患者的基线抽动及整体生活质量有显著改善。在多焦点DBS电极植入后，患者在低至中等剂量的氟哌啶醇治疗下抽动得到良好控制。据报告，他的情绪不稳定现在变得不那么易变和极端。他变得更加善于社交且健谈。
植入DBS后，患者术前的暴力行为和情绪不稳定有了显著改善。该病例提供了证据，表明双电极DBS结合适当的药物管理，是改善患有使人衰弱的TS症状的个体生活质量的一种安全有效的方法。
