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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1993 Sep;56(9):1016–1019. doi: 10.1136/jnnp.56.9.1016

The metabolic effects of limbic leucotomy in Gilles de la Tourette syndrome.

G V Sawle 1, A J Lees 1, N F Hymas 1, D J Brooks 1, R S Frackowiak 1
PMCID: PMC489741  PMID: 8410025

Abstract

Regional cerebral oxygen metabolism was measured before and after limbic leucotomy in a patient with Gilles de la Tourette syndrome, obsessive compulsive disorder, and obsessional slowness. The preoperative scan showed hypermetabolism in the caudate nuclei, which normalised after operation. It is proposed that the beneficial effects of this operation on both tics and obsessive compulsive behaviour are mediated by disruption of abnormal neural activity in basal ganglia-thalamocortical loops.

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Selected References

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  1. Alexander G. E., Crutcher M. D., DeLong M. R. Basal ganglia-thalamocortical circuits: parallel substrates for motor, oculomotor, "prefrontal" and "limbic" functions. Prog Brain Res. 1990;85:119–146. [PubMed] [Google Scholar]
  2. Ballantine H. T., Jr, Bouckoms A. J., Thomas E. K., Giriunas I. E. Treatment of psychiatric illness by stereotactic cingulotomy. Biol Psychiatry. 1987 Jul;22(7):807–819. doi: 10.1016/0006-3223(87)90080-1. [DOI] [PubMed] [Google Scholar]
  3. Baxter L. R., Jr, Phelps M. E., Mazziotta J. C., Guze B. H., Schwartz J. M., Selin C. E. Local cerebral glucose metabolic rates in obsessive-compulsive disorder. A comparison with rates in unipolar depression and in normal controls. Arch Gen Psychiatry. 1987 Mar;44(3):211–218. doi: 10.1001/archpsyc.1987.01800150017003. [DOI] [PubMed] [Google Scholar]
  4. Baxter L. R., Jr, Schwartz J. M., Phelps M. E., Mazziotta J. C., Guze B. H., Selin C. E., Gerner R. H., Sumida R. M. Reduction of prefrontal cortex glucose metabolism common to three types of depression. Arch Gen Psychiatry. 1989 Mar;46(3):243–250. doi: 10.1001/archpsyc.1989.01810030049007. [DOI] [PubMed] [Google Scholar]
  5. Chase T. N., Foster N. L., Fedio P., Brooks R., Mansi L., Kessler R., Di Chiro G. Gilles de la tourette syndrome: studies with the fluorine-18-labeled fluorodeoxyglucose positron emission tomographic method. Ann Neurol. 1984;15 (Suppl):S175–S175. doi: 10.1002/ana.410150733. [DOI] [PubMed] [Google Scholar]
  6. Devinsky O. Neuroanatomy of Gilles de la Tourette's syndrome. Possible midbrain involvement. Arch Neurol. 1983 Aug;40(8):508–514. doi: 10.1001/archneur.1983.04210070048013. [DOI] [PubMed] [Google Scholar]
  7. Frackowiak R. S., Lenzi G. L., Jones T., Heather J. D. Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using 15O and positron emission tomography: theory, procedure, and normal values. J Comput Assist Tomogr. 1980 Dec;4(6):727–736. doi: 10.1097/00004728-198012000-00001. [DOI] [PubMed] [Google Scholar]
  8. Hassler R., Dieckmann G. Traitement stéréotaxique des tics et cris inarticulés ou coprolaliques considérés comme phénomène d'obsession motrice au cours de la maladie de Gilles de la Tourette. Rev Neurol (Paris) 1970 Aug;123(2):89–100. [PubMed] [Google Scholar]
  9. Hymas N., Lees A., Bolton D., Epps K., Head D. The neurology of obsessional slowness. Brain. 1991 Oct;114(Pt 5):2203–2233. doi: 10.1093/brain/114.5.2203. [DOI] [PubMed] [Google Scholar]
  10. Kurlan R., Kersun J., Ballantine H. T., Jr, Caine E. D. Neurosurgical treatment of severe obsessive-compulsive disorder associated with Tourette's syndrome. Mov Disord. 1990;5(2):152–155. doi: 10.1002/mds.870050211. [DOI] [PubMed] [Google Scholar]
  11. Kurlan R. The pathogenesis of Tourette's syndrome. A possible role for hormonal and excitatory neurotransmitter influences in brain development. Arch Neurol. 1992 Aug;49(8):874–876. doi: 10.1001/archneur.1992.00530320106020. [DOI] [PubMed] [Google Scholar]
  12. Kurlan R. Tourette's syndrome: current concepts. Neurology. 1989 Dec;39(12):1625–1630. doi: 10.1212/wnl.39.12.1625. [DOI] [PubMed] [Google Scholar]
  13. Modell J. G., Mountz J. M., Curtis G. C., Greden J. F. Neurophysiologic dysfunction in basal ganglia/limbic striatal and thalamocortical circuits as a pathogenetic mechanism of obsessive-compulsive disorder. J Neuropsychiatry Clin Neurosci. 1989 Winter;1(1):27–36. doi: 10.1176/jnp.1.1.27. [DOI] [PubMed] [Google Scholar]
  14. Nordahl T. E., Benkelfat C., Semple W. E., Gross M., King A. C., Cohen R. M. Cerebral glucose metabolic rates in obsessive compulsive disorder. Neuropsychopharmacology. 1989 Mar;2(1):23–28. doi: 10.1016/0893-133x(89)90003-1. [DOI] [PubMed] [Google Scholar]
  15. Pauls D. L., Leckman J. F. The inheritance of Gilles de la Tourette's syndrome and associated behaviors. Evidence for autosomal dominant transmission. N Engl J Med. 1986 Oct 16;315(16):993–997. doi: 10.1056/NEJM198610163151604. [DOI] [PubMed] [Google Scholar]
  16. Robertson M., Doran M., Trimble M., Lees A. J. The treatment of Gilles de la Tourette syndrome by limbic leucotomy. J Neurol Neurosurg Psychiatry. 1990 Aug;53(8):691–694. doi: 10.1136/jnnp.53.8.691. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Singer H. S., Hahn I. H., Krowiak E., Nelson E., Moran T. Tourette's syndrome: a neurochemical analysis of postmortem cortical brain tissue. Ann Neurol. 1990 Apr;27(4):443–446. doi: 10.1002/ana.410270415. [DOI] [PubMed] [Google Scholar]
  18. Swedo S. E., Rapoport J. L., Cheslow D. L., Leonard H. L., Ayoub E. M., Hosier D. M., Wald E. R. High prevalence of obsessive-compulsive symptoms in patients with Sydenham's chorea. Am J Psychiatry. 1989 Feb;146(2):246–249. doi: 10.1176/ajp.146.2.246. [DOI] [PubMed] [Google Scholar]
  19. Swedo S. E., Schapiro M. B., Grady C. L., Cheslow D. L., Leonard H. L., Kumar A., Friedland R., Rapoport S. I., Rapoport J. L. Cerebral glucose metabolism in childhood-onset obsessive-compulsive disorder. Arch Gen Psychiatry. 1989 Jun;46(6):518–523. doi: 10.1001/archpsyc.1989.01810060038007. [DOI] [PubMed] [Google Scholar]
  20. de Divitiis E., D'Errico A., Cerillo A. Stereotactic surgery in Gilles de la Tourette syndrome. Acta Neurochir (Wien) 1977;(Suppl 24):73–73. doi: 10.1007/978-3-7091-8482-0_12. [DOI] [PubMed] [Google Scholar]

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