SEVERE DISTURBANCES IN SPEECH, SWALLOWING, AND GAIT FOLLOWING STEREOTAXIC INFRATHALAMIC LESIONS IN GILLES-DE-LA-TOURETTES SYNDROME

A 40-year-old man with severe Gilles de la Tourette's syndrome charact erized by forceful self-injurious motor tics, coprolalia, and obsessiv e-compulsive disorder had bilateral anterior cingulotomies and bilater al infrathalamic lesions placed stereotactically during two neurosurgi cal procedures. During the second procedure, the patient acutely devel oped a marked dysarthria. Postoperatively, he manifested a severe gait disturbance with postural instability, bradykinesia, axial rigidity, micrographia, and a profound swallowing disorder. MRI showed asymmetri c (left > right) low-density areas in an infrathalamic region as well as low-density areas bilaterally in the anterior cingulate gyri. Altho ugh the patient's tic and obsessive-compulsive symptoms improved, the self-injurious motor tics along with other motor and phonic tics have recurred. The patient's speech remains largely unintelligible 8 months following the last surgical procedure, and the other neurologic defic its remain unchanged.