Deep brain stimulation for Gilles de la Tourette syndrome

Gilles de la Tourette syndrome (GTS) is a chronic neurodevelopmental condition characterised by multiple motor and phonic tics and is associated with a spectrum of behavioral symptoms. In most cases, GTS can be adequately managed with conventional pharmacological and psycho-behavioral treatments. However, there are a minority of patients presenting with severe and treatment-refractory symptoms, which can compromise health-related quality of life and prompt consideration of neurosurgical interventions. Compared to ablative procedures, deep brain stimulation (DBS) has been increasingly advocated as a reversible and controllable procedure for selected cases of GTS. Over the last decade, up to 122 cases of DBS in GTS have been described in published reports. Consensus guidelines upon what patients with GTS should be treated with DBS and which neuroanatomical site within the basal ganglia is to be target are still lacking, mainly due to varying selection criteria, stimulation targets and assessment protocols being employed in studies. In this chapter, the current evidence for both patient and target selection will be reviewed and critically discussed.