Hemi tics and deep brain stimulation.

Deep brain stimulation of targets in both thalamus1 and globus pallidus interna (GPi)2 has been used successfully to control tics in severe cases of Tourette syndrome. Following placement of bilateral GPi stimulators, this 26-year-old-right handed man with a history of medically refractory motor and vocal tics experienced disappearance of vocal tics and marked improvement in neck movements. Months later the left stimulator lead was removed due to infection. The video demonstrates ongoing motor tics of right face and arm (ipsilateral to the functioning GPi stimulator) with absence of left sided tics. This observation strongly supports lateralized dysfunction of basal ganglia networks in the genesis of tic.3