What is the role of stereotactic neurosurgery in the treatment of Tourette syndrome (TS) and other tic disorders?

Updated: May 30, 2019
  • Author: William C Robertson, Jr, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP  more...
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Answer

Stereotactic neurosurgery, either to place deep brain stimulators or to ablate tissue, is indicated only rarely for the treatment of obsessions, compulsions, and possibly tics. Case reports suggest deep brain stimulation (DBS) in various sites may be helpful.

A double-blind, randomized, cross-over trial by Ackermans et al determined that stimulation of the centromedian nucleus–substantia periventricularis–nucleus ventro-oralis internus crosspoint in the thalamus may reduce tic severity in refractory TS. [215] The study was limited by small size and unique indication.

This approach is limited to patients with exceptionally debilitating symptoms and those in whom prior, thorough trials of less dramatic interventions were ineffective. Such surgery should be carried out only in referral centers experienced with these procedures and after multispecialty evaluation of the patient.


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