The use of brain surgery to treat TS receives a lot of media attention; however, this coverage most often doesn’t go into detail about who is the right fit for it. There are a lot of factors to consider beyond simply whether or not a person’s tics are really severe.
According to a recent article published in the Journal of Movement Disorders, there are nine or more important considerations made regarding the suitability of a candidate for Deep Brain Stimulation or DBS:
- Tics result in severe distress, self-injury, incapacitation, and/or disruption of quality of life.
- The patient is over age 25 (except in exceptional cases).
- Medication (usually at least three different types) has been tried and has failed.
- Patient hasn’t undergone treatment for any associated conditions or other medical condition(s) during the previous 6 months.
- Botox injections have been considered, if possible.
- Any psychiatric disorders, including anxiety, depression and bipolar disorder, have been treated and stabilized.
- Patient has undergone screening for possible cognitive dysfunction and dementia.
- An expert, such as a psychiatrist or neurologist, diagnosed the TS.
- Patients were informed about the behavioral therapy treatment approach.
According to a several DBS experts, having a team of professionals from different fields who have experience with movement disorders is also critical. This team might include: a psychiatrist, neurologist, neurosurgeon, neuropsychologist, and in some cases, a social worker, occupational or physical therapist, and speech therapist. Experts recommend that this team meet to discuss the results of imaging (e.g. Magnetic Resonance Imaging). This model is similar to an approach used in cancer treatment (medical oncology boards).
Lastly, it’s important to remember that DBS is time-intensive. A commitment to give a lot of time—not just due to the procedure itself, but also because of the pre- and post- operative workups—is important to strengthen the chances for success. Consider that on average, a patient may need to return for device re-programming 4-8 times in the first six months! In short, DSB treatment is still far from being over once the person undergoes the actually surgery.
Overall, while DBS for TS is promising in certain cases, it is still a work in progress. Some patients who undergo the procedure may not benefit significantly. On the bright side, as research on DBS continues (countless DBS studies were published this year alone), medical professionals will come to better understand who with TS might benefit from DBS.
“Deep Brain Stimulation for TS” by Okun & Ward et al. Published in A Family’s Guide to Tourette Syndrome. Walkup, Mink & McNaught(eds.), Bloomington IN: iUniverse, 2012.