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Neurology

Tic Status in Tourette Syndrome Due to Depletion of the Deep Brain Stimulation Battery

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JAMA Neurology

Published Online: January 3, 2023

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Article Information and Disclosures

Jacy Bezerra Parmera, MD, PhD¹;

Joyce Yuri Silvestre Yamamoto, MD¹;

Rubens Gisbert Cury, MD, PhD¹

Author Affiliations

¹Movement Disorders Center, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil

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A 29-year-old, right-handed, otherwise healthy man developed severe lifelong Tourette syndrome (TS) beginning at the age of 6 years. Due to its refractory pattern, he underwent deep brain stimulation (DBS) implantation at the centromedian-parafascicular complex thalamic (Figure) when he was 23 years old. His symptoms significantly improved with a Yale Global Tic Severity Scale score reduction from 95 to 28¹ (Video 1). Improvement was clinically sustained over time using high stimulation parameters (ventral contacts bilaterally with 3 mA, 90 μs, and 160 Hz). However, after a while, he stopped attending proper follow-up appointments until his condition markedly worsened, which led him to return to our hospital.

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Article Information

Corresponding Author: Jacy Bezerra Parmera, MD, PhD, Movement Disorders Center, Department of Neurology, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar, 255, 5th Floor, Room 5140, São Paulo 05403000, Brazil (jacy.parmera@hc.fm.usp.br).

Published Online: January 3, 2023. doi:10.1001/jamaneurol.2022.4774

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References

Cury RG , Lopez WO , Dos Santos Ghilardi MG , et al. Parallel improvement in anxiety and tics after DBS for medically intractable Tourette syndrome: a long-term follow-up. Clin Neurol Neurosurg. 2016;144:33-35. doi:10.1016/j.clineuro.2016.02.030 PubMed Google Scholar Crossref

Kovacs N , Herold R , Janszky J , Komoly S , Nagy F . Tics status: a movement disorder emergency: observations. J Neurol. 2011;258(1):143-145. doi:10.1007/s00415-010-5680-7 PubMed Google Scholar Crossref

Kimura Y , Iijima K , Takayama Y , et al. Deep brain stimulation for refractory Tourette syndrome: electrode position and clinical outcome. Neurol Med Chir (Tokyo). 2021;61(1):33-39. doi:10.2176/nmc.oa.2020-0202 PubMed Google Scholar Crossref

Sobstyl M , Ząbek M , Kmieć T , Sławek J , Budohoski KP . Status dystonicus due to internal pulse generator depletion in a patient with primary generalized dystonia. Mov Disord. 2014;29(2):188-189. doi:10.1002/mds.25553 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.