Severe disturbances in speech, swallowing, and gait following stereotactic infrathalamic lesions in Gilles de la Tourette's syndrome

Abstract

A 40-year-old man with severe Gilles de la Tourette's syndrome characterized by forceful self-injurious motor tics, coprolalia, and obsessive-compulsive disorder had bilateral anterior cingulotomies and bilateral infrathalamic lesions placed stereotactically during two neurosurgical procedures. During the second procedure, the patient acutely developed a marked dysarthria. Postoperatively, he manifested a severe gait disturbance with postural instability, bradykinesia, axial rigidity, micrographia, and a profound swallowing disorder. MRI showed asymmetric (left > right) low-density areas in an infrathalamic region as well as low-density areas bilaterally in the anterior cingulate gyri. Although the patient's tic and obsessive-compulsive symptoms improved, the self-injurious motor tics along with other motor and phonic tics have recurred. The patient's speech remains largely unintelligible 8 months following the last surgical procedure, and the other neurologic deficits remain unchanged.

Efficient internal pallidal stimulation in Gilles de la Tourette syndrome: A case report

“…The rare follow-up studies give conflicting results. Although prefrontal leucotomy has been abandoned completely, the few series with thalamic/ infrathalamic lesions document a high risk of persisting disabling side effects [1][2][3][4] and it remains open if the therapeutic benefits outweigh these side effects. Recently, functional and neuroimaging studies in GTS have focused on abnormally functioning dopaminergic striatocortical circuits.…”

“…1 Detection of urinary and orthostatic dysfunction determines diagnostic certainty according to the consensus criteria. 2 Urinary retention is an autonomic feature that, if combined with a criterion and another feature from separate domains, qualifies for the diagnostic category of possible MSA. Assessment of retention can be done with sonography or catheterization and, thus, is relatively easy if compared with urodynamic measurements or sphincter electromyography (EMG).…”

Surgery for other movement disorders: dystonia, tics

“…The first patient treated with thalamic stimulation was reported almost 8 years ago [98]. In that study, the authors described a remarkable improvement in the number of tics.…”

“…Limbic leucotomy and cingulotomy were mainly reserved for patients with associated psychiatric features, such as OCD. Profound complications have been reported in silent Tourette's syndrome patients, raising major concerns about the use of lesioning procedures in treating the tics [98].…”

Deep Brain Stimulation for Tourette Syndrome

“…Nineteen months after surgery, however, there were no longer any signs of tics and the patient reported excellent improvement with regard to his obsessions. Leckman and associates [27] in 1993 reported on a 40-year-old man suffering from TS and OCB who underwent surgery. Disease onset was at the age of 3 years with motor tics.…”