Immediate and long term outcome after infrathalamic and thalamic lesioningfor intractable Tourette's syndrome

Objective-The surgical treatment of intractable Tourette's syndrome is cont roversial. Experience with 17 consecutive patients treated between 1970 and 1998 is reviewed and the efficacy and safety Of surgical treatment is asse ssed. Methods-These patients mere retrospectively reclassified into subtypes acco rding to the protocol of the Tourette's Syndrome Study Group. One patient w as excluded from the study. Ventriculography based stereotactic zona incert a (ZI) and ventrolateral/ lamella medialis thalamotomy (VL/LM) were perform ed on ah patients. The preoperative, postoperative, and late tic severities were assessed by the tie severity rating scale. The median follow up of II patients (65%) was 7 years (range 3.5-17 years) and six patients were lost to long term follow up. Results-Median age was 23 years (range 11-40) at the time of surgery. Media n duration of illness was 14 years (range 3-33). The mean preoperative moto r and vocal tic severities were estimated to be 4.44 (SD 0.63) and 3.81 (SD 0.66), respectively. Unilateral ZI lesioning and VL/LM lesioning selected by asymmetry of symptoms provide an effective control of tie severity (p mo tor and vocal < 0.001). In attenuation of contralateral symptoms, a second surgical intervention in the relevant side could reduce tic severity suffic iently (g motor < 0.01; p vocal < 0.005). Transient complications occurred in 68% of patients. Only one permanent complication was registered in sir; patients followed up after unilateral surgery. Two out of five patients fol lowed up after bilateral surgery had disabling side effects of surgery Conclusions-ZI and VL/LM lesioning provide a significant long term reductio n of tie severity in intractable Tourette's syndrome. Adequate selection of the side of first intervention might prevent the patient from increased ri sk of bilateral surgery.