Table 1
Tourette Patient Medications.
| Treatment at the time of DBS placement* | Prior treatment trials | Reason(s) for discontinuing medications |
|---|---|---|
| – Amantadine 100 mg three times daily | Haloperidol | Aggression and dystonia |
| Pimozide | Dystonia | |
| – Atorvastatin 10 mg every night | Risperidone | Dystonia |
| – Guanfacine 1 mg every morning and 2 mg every evening | Aripiprazole | Not effective even at 20mg daily dose |
| – Olanzapine 20 mg every night | Pergolide | Withdrawn from the market, psychosis |
| – Paroxetine 20 mg every morning and 60 mg every evening | Clonidine | Severe hypotension, lethargy, and drowsiness |
| Benztropine | Blurry vision | |
| Clonazepam | Excessive drowsiness | |
| Topiramate | Not effective, dry mouth, and swelling in feet |
[i] * Medications did not change between the two surgeries discussed in this case report.
Figure 1
A) Yale Global Tic Severity Scale (YGTSS) of the patient prior to DBS surgery, the clinical outcome with initial lead location, and the clinical outcome after lead repositioning surgery. The tic scale was reduced by only 8% following the initial bilateral surgery and reduced by 30% post-repositioning. B) The patient’s T1-MRI in AC-PC coordinate space. The thalamus (blue outline), VIM nucleus (cyan outline), and CM nucleus region (yellow outline) are shown based on the modified digital Schaltenbrand-Bailey atlas. The red dot denotes the location of the electrode prior to repositioning and the green dot denotes the location of electrode following lead repositioning. The stereotactic coordinates of the original placement were: Anterior-Posterior (AP) –7.21 mm, Lateral (LT) 6.18 mm, and Axial (AX) 0.50 mm from midcommissural point with AC-PC plane entry angle of 54 and a central plane entry angle of 19. The stereotactic coordinate of the revised placement was: AP –9.77 mm, LT 5.57 mm, and AX –0.35 mm from the mid-commissural point with an AC-PC plane entry angle of 56 and a central plane entry angle of 27. C) The 3-D reconstruction of the atlas and DBS lead in its initial location and post-repositioning location is provided in a top-down view.
Figure 2
Comparison of neural features during voluntary movement. The average VIM spectrogram was collected in a previous ET study (conducted at UF Health) with leads implanted in the VIM thalamic nucleus (n = 2). Also, we provide data on the average CM spectrogram that was collected from other TS patients (n = 3) in the same study as the current case report. A) The spectrogram during voluntary movement with initial lead location shows strong beta desynchronization around the beta band (12Hz–30Hz), which disappears following the revision surgery. B) Prior to lead revision surgery, strong PAC was observed between the thalamic beta phase and cortical gamma (>40 Hz) amplitude, and this feature disappeared following revision surgery.