Tourette syndrome is a childhood-onset disorder characterized by a combination of motor and
vocal tics, often associated with psychiatric comorbidities including attention deficit and hyperactivity disorder and
obsessive-compulsive disorder. Despite an onset early in life, half of patients may present symptoms in adulthood, with variable degrees of severity. In select cases, the syndrome may lead to significant physical and social impairment, and a worrisome risk for self injury. Evolving research has provided evidence supporting the idea that the pathophysiology of
Tourette syndrome is directly related to a disrupted circuit involving the cortex and subcortical structures, including the basal ganglia, nucleus accumbens, and the amygdala. There has also been a notion that a dysfunctional group of neurons in the putamen contributes to an abnormal facilitation of competing motor responses in basal ganglia structures ultimately underpinning the generation of
tics. Surgical
therapies for
Tourette syndrome have been reserved for a small group of patients not responding to behavioral and pharmacological
therapies, and these
therapies have been directed at modulating the underlying pathophysiology. Lesion
therapy as well as
deep brain stimulation has been observed to suppress
tics in at least some of these cases. In this article, we will review the clinical aspects of
Tourette syndrome, as well as the evolution of surgical approaches and we will discuss the evidence and clinical responses to
deep brain stimulation in various brain targets. We will also discuss ongoing research and future directions as well as approaches for open, scheduled and closed loop feedback-driven electrical stimulation for the treatment of
Tourette syndrome.