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Neurosurgical strategies for Gilles de la Tourette’s syndrome

Authors Karim Mukhida, Matthew Bishop, Murray Hong, Ivar Mendez

Published 5 December 2008 Volume 2008:4(6) Pages 1111—1128

DOI http://dx.doi.org/10.2147/NDT.S4160

Review by Single-blind

Peer reviewer comments 4

Karim Mukhida1,2, Matthew Bishop2, Murray Hong2, Ivar Mendez2

1Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; 2Departments, of Anatomy and Neurobiology and Surgery (Neurosurgery), Dalhousie University, Halifax, Nova Scotia, Canada

Abstract: Tourette’s syndrome (TS) is a neurological disorder characterized by motor and vocal tics that typically begin in childhood and often are accompanied by psychiatric comorbidities. Symptoms of TS may be socially disabling and cause secondary medical complications. Pharmacological therapies remain the mainstay of symptom management. For the subset of patients in whom TS symptoms are medically recalcitrant and do not dissipate by adulthood, neurosurgery may offer an alternative treatment strategy. Greater understanding of the neuroanatomic and pathophysiologic basis of TS has facilitated the development of surgical procedures that aim to ameliorate TS symptoms by lesions or deep brain stimulation of cerebral structures. Herein, the rationale for the surgical management of TS is discussed and neurosurgical experiences since the 1960s are reviewed. The necessity for neurosurgical strategies to be performed with appropriate ethical considerations is highlighted.

Keywords: tourette’s syndrome, neurosurgery, deep brain stimulation, thalamus

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