DBSmanagementofTourettes.pptVIP

Matthew Spreadbury DBS management of Tourettes What is it really? “A neurological disorder characterized by involuntary tics and vocalizations and often the compulsive utterance of obscenities.” /watch?v=KtCG0wG-5E0 A debilitating disease which often leads to self harm, reduced social interaction, reduced opportunities to work and the ability to receive a full education. Pathophysiology? The pathophysiology of TS is still unclear. Thalamocortical drive? CM/Pf loops to the motor striatum and the substantia- periventricularis Routine medication Clonidine, guanfacine, clonazepam, haloperidol, pimozide, quetiapine, and olanzapine. High refractory rates to original symptoms. Psychiatric and behavioral therapy can be useful. Measurement of severity and suitability for surgery. Yale Global Tic Severity Scale 1-100 Psychiatric assessment Subjective patient assessment Patient age?? Surgical procedures? Ablation therapy. Target areas: Centromedian thalamus, the internal globus pallidus, the external globus pallidus, and the anterior limb of the internal capsule Thalamic CM/Pf, 5 mm lateral and 8 mm posterior to the mid-commissural point (MCP) along the superior-inferior plane of the anterior commissure-posterior commissure line. Anatomical location Bilateral thalamic centromedian/parafascicular complex (CM/Pf) Case studies 1. A 17-year-old boy with a 12-year history of TS Jaw-clenching/teeth-grinding tics forceful enough to have caused dental fractures on several occasions. On psychiatric evaluation, his comorbid depression and obsessive-compulsive disorder (OCD) were judged to be stable, and he was approved for bilateral CM/Pf stimulation. The patient had modest early improvement in tics, and it took 6 months before optimal stimulating parameters were found. YGTSS score 6 months post operation was reduced by 60% Case studies 2. A 35 year old woman with a 9-year history of TS and comorbid OCD and ADHD symptoms presented to our center fo