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Deep Brain Stimulation for Tourette syndrome
Dr. Travis Stork: And we are very lucky today because Dr. Alain de Lotbiniere is here. He is actually Tyler’s neurosurgeon. Thanks for being with us.
Dr. Alain de Lotbiniere: Thank you.
Dr. Travis Stork: Let’s talk about options available for someone like Tyler.
Dr. Alain de Lotbiniere: One has to first realize that this is probably the most severe form of tourettes disease that I have personally seen and I’ve seen dozens of patients who are in the most severe category. So, for someone like this before these more recent developments, there was actually very little. So, a little over ten years ago based on the work in Parkinson’s disease where deep brain stimulation had been shown to be of benefit in certain individuals. A neurosurgeon based actually not in this country but in Netherlands thought “Well if I could not insert an electrode into the area of the thalamus that seemed to produce a benefit then maybe I can reproduce the effect of the oblation but without the side effects”.
Dr. Travis Stork: So, instead of destroying the thalamus, this tissue which is very important area of the brain. You use deep brain stimulation and with deep brain stimulation, the surgeon targets the thalamus on the brain. The first thing the patient wears a frame and that helps to target the point for the implantation.
After a small incision is made, the surgeon next takes an electrode and that electrode is carefully implanted in the thalamus. And once it’s there, they have to use electricity to stimulate certain parts of the thalamus trying to target the area that will improve symptoms is the most. And then last but not the least, a battery is implanted into the chest and then the wiring is run up through the device that was earlier implanted. And this is all done while the patient is awake and responsive. And Tyler had this done.
And I just want to show everyone on this model, how deep in the brain Dr. Alain de Lotbiniere is talking about. So, this is the brain cut in cross section and this is an area of the thalamus that you’ve see here. You have to go through all the brain tissue to get to these areas. So, you can imagine this precious real state, all to get down to this area. You see the blue there? Right through here is the thalamus. And the idea is to somehow interrupt to all that hyperactivity that occurs in the thalamus in someone like Tyler.
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