Deep Brain Stimulation for Tourette Disorder
For young adults or adults with severe symptoms of Tourette disorder that are not adequately controlled with behavioral therapy or medication, an experimental new treatment called deep brain stimulation may offer some relief.
Deep brain stimulation works like a pacemaker, but it’s used in the brain instead of in the heart. This technique requires the surgical placement of a small conductor called an electrode in the brain. This conductor delivers electrical stimulation that blocks the nerve signals that cause tics. The procedure is typically offered to people older than age 20, but certain older teenagers may also be candidates, depending on the severity of their symptoms.
This experimental procedure is only appropriate for people with severe tics that have a significant impact on their daily lives, and it is not recommended for children. Although the U.S. Food and Drug Administration has not approved deep brain stimulation for the management of Tourette disorder, several clinical studies have shown it can be used safely and effectively in adults with severe symptoms.
NYU Langone experts at the Center for Neuromodulation perform more than 100 deep brain stimulation procedures each year and are actively researching, through clinical trials, the potential of deep brain stimulation to treat people with Tourette disorder. Our neurologists, neurosurgeons, and psychiatrists perform a thorough evaluation to choose the best candidates for this procedure.
Surgery to Implant the Deep Brain Stimulation Device
This treatment first requires surgery to implant the electrical device into the brain. Using MRI or CT scans, a neurosurgeon determines the exact location within the brain for implanting the electrode, based on a person’s symptoms.
When the location has been determined, the surgeon makes a small opening in the skull and inserts the electrode through a thin, insulated wire. The tip of the electrode is positioned in the brain at the precise area mapped by the surgeon. The insulated extension wire is then passed under the skin of the head, neck, and shoulder. Surgery to implant the electrode takes about four hours, is performed using general anesthesia, and requires an overnight stay in the hospital for monitoring and observation. During a second surgery the next day, the wires are connected to a pulse generator, a battery pack that is implanted under the skin near the collarbone. Most people can return home the same day as this surgery.
Several days after surgery, an office visit with the neurologist is needed to program the pulse generator. With the push of a button on an external remote control, electrical impulses are sent from the pulse generator along the extension wire to the electrode in the brain. These electrical impulses block the abnormal nerve signals that cause tics.
People with deep brain stimulation are able to control the strength of the electrical impulses on their own after working closely with a neurologist during several sessions to find the combination of settings that best controls their symptoms. Following this adjustment period, most people require only occasional maintenance visits.
Many people choose to use this deep brain stimulation system 24 hours a day, although some turn the system off before bedtime. Depending on the settings used, deep brain stimulation can significantly reduce motor tics in people with Tourette disorder.