The usefulness of deep brain stimulation (DBS) of thalamic nuclei in Gilles de la Tourette syndrome (GTS) has recently been advocated. We report on a 14-month follow-up study of a patient with intractable GTS in whom bilateral DBS of the internal globus pallidus was carried out. Tic frequency per minute decreased by 73% in the postoperative phase and in particular the vocal tics became less intense. Pronation/ supination bradykinesia of the left extremities was a well-tolerated, permanent side effect. Pallidal DBS could become a valuable rescue therapy for otherwise intractable GTS.

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Deep brain stimulation of the subthalamic nucleus is an effective treatment for advanced Parkinson's disease. There is some evidence that subthalamic stimulation not only affects motor function, but also mood, behaviour and cognition. In the present study we investigated the effects of subthalamic stimulation on psychiatric symptoms and psychosocial functioning in a consecutive series of patients with Parkinson's disease. 33 patients were assessed three times prior to surgery and at three, nine weeks as well as three, six and twelve months after surgery. We found significant improvements in depression, anxiety, psychological symptoms and distress after surgery. In most cases the amelioration followed surgery and was stable in the course of time. Individual analysis indicated deterioration in three patients despite motor improvement. The results suggest that stimulation of the subthalamic nucleus has a positive influence on psychiatric symptoms, psychosocial functioning and distress. We observed a decline in a minority of patients.

This study analyzed subjective sensations caused by DBS pulse-generator and lead-extensions in relation with objectively measured parameters. In 50 patients implant-related sensations were evaluated. The pulse-generator mobility was video-analyzed. Insufficient lead-extension/pulse-generator tolerability (72%/84%) was documented. Furthermore, 54% of the patients described movement impairments and 48% cosmetic deformity. High body mass index (BMI) was associated with low lead-extension related pain (P < 0.001). High generator mobility resulted in high lead-extension related pain (P < 0.001). Compared with lead-extension type 7482, type 7495 showed less lead-extension related pain (P = 0.0138), we suppose secondary to surgical tunneling instruments with a larger tip diameter. The lead-extension path with one tissue tunnel for both lead-extensions had 36% lead-extension related pain versus 11% for the path with one single tunnel for each lead-extension. Smaller pulse-generators for better cosmetic results, surgical procedures using larger tunneling instruments and one single tunnel for each lead-extension would provide better results for patients with BMI <30.

BRCA1 mutation carriers should be informed of the fact that pre-malignant and even malignant changes are frequently found in PM specimens despite normal radiological findings.

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