Deep Brain Stimulation (DBS) has been tapped upon as a surgical procedure for Tourette syndrome. This procedure is considered to be potentially dangerous and very expensive. Because of those reasons, DBS will not likely to be considered as an option for treatment for the majority of people who have Tourettes. According to the Tourette Syndrome Association in the US, DBS should be considered only as an experimental treatment modality for only a small minority of people or those that only have extreme cases of TS. There were actually two programs which aired last 2006 (Discovery Health Cable Channel and Miracle Workers on ABC) that featured DBS for two patients who have extreme cases of Tourette syndrome. One is a 50 year old male and a 19 year old female who both underwent Deep Brain Stimulation.
What is Deep Brain Stimulation? DBS is a surgical procedure which involves the implantation of a medical device called a brain pacemaker which primary function is to send impulses to specific parts of the brain. As a procedure it was approved for the treatment of essential tremors by the Food and Drug Administration (FDA) in 1997, for parkinsons in 2002 and dystonia in 2003 taking note that it hasn't been approved for Tourette syndrome.
"The deep brain stimulation system consists of three components: the implanted pulse generator (IPG), the lead, and the extension. The IPG is a battery powered neurostimulator encased in a titanium housing, which sends electrical pulses to the brain to interfere with neural activity at the target site. The lead is a coiled wire insulated in polyurethane with four platinum iridium electrodes and is placed in one of three areas of the brain. The lead is connected to the IPG by the extension, an insulated wire that runs from the head, down the side of the neck, behind the ear to the IPG, which is placed subcutaneously below the clavicle or in some cases, the abdomen.[4] The IPG can be calibrated by a neurologist, nurse or trained technician to optimize symptom suppression and control side effects.[citation needed] DBS leads are placed in the brain according to the type of symptoms to be addressed. For essential tremor and Parkinsonian tremors, the lead is placed in the thalamus. For dystonia and symptoms associated with Parkinson's disease (rigidity, bradykinesia/akinesia and tremor), the lead may be placed in either the globus pallidus or subthalamic nucleus.[5] All three components are surgically implanted inside the body. The right side of the brain is stimulated to address symptoms on the left side of the body and vice versa." (Wikipedia, July, 2007)
The actual procedure of DBS involves pre-operative preparations such us identifying the neurosurgical target with the use of an MRI (magnetic resonance imaging) or CT Scan (computed tomography scan). During operation, the patient is placed on a local anesthesia and the patient remains awake all through out the procedure. A craniotomy is then performed and a DBS lead is placed in the target area unilaterally or bilaterally depending on the patient's symptoms. Then the IPG and the extension are connected to the lead. These fixtures all work to promote effectiveness of the surgery performed. It is programmed to further maximized its effectiveness. The battery life usually lasts up to 3-5 years and needs to be replaced.
The DBS procedures already done documented successful outcomes for TS patients but up to this point this specific procedure is still on experimental status. Since 2006, there has only been 5 published reports on DBS, all of them documened significant reduction in tics and in symptoms of obsessive- compulsiveness.
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