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The authors thank Margarida Ayres Basto, Paulo Linhares, Carina Reis, and Maria José Rosas (Movement Disorders and Functional Surgery Unit, Centro Hospitalar São João), for their outstanding commitment managing this especially challenging case.
Conflicts of interest
João Massano received advisor honoraria from Bial, and grant support from the Centro de Investigação Clínica, Centro Hospitalar São João. Tom Foltynie has received grant support from Parkinson’s UK, Cure Parkinson’s Trust, Brain Research Trust and the EU-FP7. He has received honoraria/support for speaking at meetings from Abbvie, Novartis, Genus, Medtronic and St. Jude Medical. Marwan Hariz and Ludvic Zrinzo are supported by the UK Parkinson Appeal and the Monument Trust. They have received from Medtronic and St. Jude Medical travel expenses and honoraria for speaking at meetings. Cláudia Sousa and Rui Vaz declare they have no conflicts of interest. This work received no funding from any agency in the public, commercial or not-for-profit sectors.
Electronic supplementary material
Below is the link to the electronic supplementary material.
DBS in Tourette syndrome: 2-year follow-up. Depictions of pre- and post-op periods. Video speed is always 100 %.
Segment 1: eight months before DBS. Jumping and pelvic thrusting while sitting is the first tic to appear; after some time the patient becomes visibly distressed due to the demanding physical effort. The second tic involves violent hitting of the chin with the right knee, followed by a combined movement with jumping on the chair. Afterwards, the patient repeatedly hits the forehead with the right knee until relief of inner tension, but causing pain and distress.
Segment 2: six months before DBS. A combination of tics is seen: jumping on the chair, right knee hitting the chin and a brief but slower tic with posturing of the trunk and upper limbs. The second combination of tics involves small intense on-site running and chin-hitting with the knee.
Segment 3: day before DBS, during relaxed chat with doctor. Various tics seen, including chin hitting with knee, neck hyperextension and forehead hitting knee. The hyper flexed position of the right lower limb is used by the patient as a trick to inhibit the tics. The final seconds of the video show part of a long sequence of several tics, including a “touching tic” with the left upper limb.
Segment 4: three months after DBS. Patient gives an account on his own status (subtitled).
Segment 5: two years after DBS. Note that the patient resists performing tics despite provocation by the examiner (subtitled).
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Massano, J., Sousa, C., Foltynie, T. et al. Successful pallidal deep brain stimulation in 15-year-old with Tourette syndrome: 2-year follow-up. J Neurol 260, 2417–2419 (2013). https://doi.org/10.1007/s00415-013-7049-1
- Deep Brain Stimulation
- Tourette Syndrome
- Stimulation Parameter
- Internal Pallidal