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Severe disturbances in speech, swallowing, and gait following stereotactic infrathalamic lesions in Gilles de la Tourette's syndrome

Child Study Center, the General Clinical Research Center, and the Departments of Psychiatry, Pediatrics, Otolaryngology, Neurosurgery, and Neurology, Yale University School of Medicine and Haskins Laboratories, New Haven, CT.

A 40-year-old man with severe Gilles de la Tourette's syndrome characterized by forceful self-injurious motor tics, coprolalia, and obsessive-compulsive disorder had bilateral anterior cingulotomies and bilateral infrathalamic lesions placed stereotactically during two neurosurgical procedures. During the second procedure, the patient acutely developed a marked dysarthria. Postoperatively, he manifested a severe gait disturbance with postural instability, bradykinesia, axial rigidity, micrographia, and a profound swallowing disorder. MRI showed asymmetric (left > right) low-density areas in an infrathalamic region as well as low-density areas bilaterally in the anterior cingulate gyri. Although the patient's tic and obsessive-compulsive symptoms improved, the self-injurious motor tics along with other motor and phonic tics have recurred. The patient's speech remains largely unintelligible 8 months following the last surgical procedure, and the other neurologic deficits remain unchanged.

Address correspondence and reprint requests to Dr. J.F. Leckman, Rm. 1-269 SHM, Child Study Center, Yale University School of Medicine P O Box 3333, New Haven, CT 06510

Supported in part by grants MH49351, MH44843, MH30929, and RR00125 from the National Institute of Mental Health and the National Institutes of Health and by the National Parkinson Foundation.

Received August 5, 1992. Accepted for publication in final form September 15,1992.

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