Surgeons explore new treatment for Tourette syndrome
Patient experiences significant resolution of symptoms following
brain surgery
NOTE: THIS RELEASE HAS BEEN UPDATED SINCE ITS ORIGINAL POSTING
CLEVELAND, April 1, 2004: A neurosurgical team at University
Hospitals of Cleveland (UHC) has, for the first time in North
America, applied a new surgical approach to the treatment of
Tourette syndrome, resulting in the immediate and nearly complete
resolution of symptoms for the patient, who has suffered from this
neurologic disorder since he was a child.

"We were genuinely amazed at the patient's response," says Robert J.
Maciunas, MD, neurosurgeon at UHC and professor at Case Western
Reserve University School of Medicine. He has used the technique
called deep brain stimulation (DBS) for the treatment of Parkinson's
disease and tremor, and was impressed with this patient's dramatic
reaction: the disappearance of the jerking motions, muscle tics and
grunting associated with his Tourette's. "This technique holds great
promise for patients suffering from this movement disorder, which
often is diagnosed in childhood or early adolescence and can be
completely debilitating."

Jeff Matovic, a Lyndhurst, Ohio, resident who grew up in Bay
Village, was six years old when he was diagnosed with Tourette
syndrome, a neurobehavioral disorder characterized by sudden,
repetitive muscle movements (motor tics) and vocalizations (vocal
tics). Though standard therapy with medication controlled his
movements for much of his boyhood, his condition severely worsened
with age.

"I had to drink with a sippy cup; otherwise, I would spill liquid
all over and even break glass or plastic cups with the severity of
the muscle spasms that were so forceful and unpredictable," says
Jeff, now age 31. "To grow up being made fun of, always feeling
different, and then, as an adult, unable to hold a job and support a
family, I was feeling devastated by my Tourette's. I had heard about
deep brain stimulation for other movement disorders. I knew that
brain surgery was risky, and the doctors could not guarantee any
positive outcome, but I wanted them to take a chance on me. And I'm
so grateful that they did."

Prior to brain surgery, physicians at University Hospitals Movement
Disorders Center mapped out regions of Jeff's brain, through MRI
(magnetic resonance imaging) scans and 3-D computer images. Their
goal was to locate the safest and most direct route to reach the
cells inside the thalamus portion of the brain, involved in
controlling Jeff's movements. By placing electrodes around those
cells to deliver continuous high-frequency electrical stimulation,
control messages are rebalanced throughout the movement centers in
the brain. The electrodes are connected from the brain through wires
under the skin (beneath the scalp, neck and upper chest) to an
implanted battery just beneath the collarbone. In Jeff's case, since
both sides of his body were affected by the movement disorder, he
has electrodes implanted on both sides of his brain and tiny battery
packs implanted on each side of his chest.

The doctors at University Hospitals of Cleveland are careful to
point out that not everyone with Tourette syndrome requires
treatment. The first line of treatment is medication, which can be
very effective. Surgical treatment is considered a last resort, and
it is not clear how effective deep brain stimulation will ultimately
prove for patients with this particular disorder.

In the United States, the Food and Drug Administration has approved
deep brain stimulation for the treatment of Parkinson's disease,
essential tremor and dystonia. "We've seen very positive responses
in patients with Parkinson's disease. Studies of the DBS technique
show that this stimulation can significantly reduce tremor and other
symptoms in about three quarters of appropriately selected patients
with Parkinson's." says Brian N. Maddux, MD, PhD, Jeff's neurologist
at UHC and assistant professor at Case School of Medicine. "Patients
with a different movement disorder called dystonia can take three
months to respond to the electrical stimulation. We didn't know how
Jeff would respond. Within hours after the stimulator was turned on,
we observed the ceaseless movements become completely relaxed and he
was able to walk normally. We were awestruck."

Physicians at University Hospitals of Cleveland have submitted a
report of this case for consideration for publication in a peer-
reviewed journal. They hope to further explore the application of
DBS to other patients with Tourette syndrome. It is estimated that
approximately 200,000 Americans have Tourette syndrome, though
experts believe it is a movement disorder that often remains
undiagnosed.


###
For more information about the surgery, go to http://www.uhhs.com.
For more information about Tourette syndrome, go to http://www.tsa-
usa.org.

University Hospitals Health System (UHHS) is the region's premier
healthcare delivery system, serving patients at more than 150
locations throughout northern Ohio.

The System's 947-bed, tertiary medical center, University Hospitals
of Cleveland (UHC), is the primary affiliate of Case Western Reserve
University (CWRU). Together, they form the largest center for
biomedical research in the State of Ohio. The System provides the
major clinical base for translational researchers at the Case
Research Institute, a partnership between UHC and CWRU School of
Medicine, as well as a broad and well-characterized patient
population for clinical trials involving the most advanced
treatments. Included in UHC are Rainbow Babies & Children's
Hospital, among the nation's best children's hospitals; Ireland
Cancer Center, designated by the National Cancer Institute as a
Comprehensive Cancer Center (the nation's highest designation); and
MacDonald Women's Hospital, Ohio's only hospital for women.

Source
http://www.eurekalert.org/pub_releases/2004-04/uhoc-sen033104.php

`Sky's the Limit, Now'
Experimental Surgery Zaps Tics for Longtime Sufferer of Tourette
Syndrome

By Dr. Tim Johnson
ABCNEWS Medical Editor


C L E V E L A N D, April 1 — For nearly all of his 31 years, Jeff
Matovic lived his life in a body out of control.

Talking was often painfully difficult for him, and simple movements
nearly impossible. His greatest wish was a simple one.

"It would just be really nice to be still for, you know, a period of
time," Matovic said.

The quiet peace of sitting still was an unknown dream for Matovic,
who has Tourette syndrome, a disorder that affects 100,000
Americans, according to the National Tourette Syndrome Association.

Many people think of Tourette patients as people who uncontrollably
sputter out obscene language. But that particular symptom of the
disease, known as coprolalia, only affects 15 percent of Tourette
patients, and Matovic is not among them.

"Tourette syndrome is a disorder of tics," said Dr. Brian Maddux, a
neurologist from the University Hospitals of Cleveland. "There's
usually several such movements — including the production of sound —
so somebody may grunt, or cough or sniff, sometimes actually say
words."

For Matovic, just trying to say the simple sentence, "It's a sunny
day in Cleveland, Ohio," would send him into a fit of flailing and
grunting in an effort to get the words out. When he was asked to put
his arms out in front of him, it seemed an impossible task. But that
was before.

Under Control

Thanks to an experimental surgery, Matovic's once uncontrollable
body is now controlled to the point that he can operate a computer,
play video games and even challenge his stepchildren to a game of
basketball at their home in Lyndhurst, a suburb of Cleveland.

"My outlook on life in general is truly — the sky's the limit now,"
said Matovic, who, along with his doctors, spoke exclusively to Good
Morning America.

Jeff Matovic first showed symptoms of Tourette syndrome when he was
just 3 years old. Pictures showing the little boy smiling belie the
fact that his childhood was often frustrating and lonely.

"I wondered, why do I have to be home ticking, lying in bed, trying
to calm myself when everyone else is out having fun?"

Having fun wasn't his only challenge. Matovic's tics made finishing
high school and college relentlessly difficult.

"I mean, can you imagine trying to read something and you're
constantly doing this?" he said, arms moving. "And your eyes are
fluttering and you're losing your place every two seconds."

Much Trial and Error

He tried medication after medication, and they all helped control
his movements — but only for a while.

His wife, Deborah, says she watched her husband's abilities to move
and accomplish day-to-day activities disintegrate.

"Over the past year, when the medication stopped working — Jeff, he
just stopped being able to do almost anything," she said.

By last year, no pill was working. Jeff Matovic could not hold a
glass without breaking it, he couldn't work, he couldn't play with
his stepchildren and he described every day as sheer torture.

"And when it came to the kids — oh, man — it tore my heart out,
because it couldn't be," Deborah said, starting to cry. "He couldn't
go out and play basketball. He couldn't."

With no options left, Matovic began doing research on a procedure
called deep brain stimulation, or DBS.

It involves having two electrodes placed in the brain and attached
to a sort of pacemaker for several years. The procedure has been
used to control the symptoms of patients with tremors, Parkinson's
disease and other movement disorders.

So Matovic approached doctors at the University Hospitals. The only
problem was that deep brain stimulation had never been used before
on a Tourette patient in the United States.

"When Jeff came to see us for the first time — it wasn't clear
really that we knew what the target should be for Tourette," Maddux
said.

"We pored over what we could do, what we couldn't do — what I could
promise and what I couldn't promise," said Dr. Robert Maciunas, a
neurosurgeon at the hospital.

A Groundbreaking Experiment

The team in Cleveland agreed to try this groundbreaking experiment
on Matovic, knowing there were no guarantees. This past February,
using a sophisticated system for mapping the brain, surgeons
precisely inserted the electrodes, and later attached them to the
pacemakers, hoping it would fix the impulses causing his tics.

But the big question was — would it work? It did. Matovic can walk
easily down a hallway, and the sentence, "It's a sunny day in
Cleveland," is no longer a problem for him to say. The arm motions
are under control. Even his doctors were stunned at the operation's
success.

"We were basically dragging our jaws on the floor," Maddux said.

The procedure had been tried three times in Cleveland, and the
results have been good, but those surgeries were only done a few
years ago, so no one really knows how effective it is over the long
term. Still, doctors in Cleveland are hopeful because of the success
of DBS in treating other movement disorders.

In addition to the surprise over the operation's success, there were
plenty of tears.

"We were all just crying — everyone's mouth dropped — Dr. Maddox's
mouth just hit the floor," Jeff Matovic said. "Nobody expected this
result, especially this quickly."

"I was like, 'This isn't real, I'm dreaming, this isn't real,' and
he came up and put a big old hug around me and it was real," Deborah
Matovic said. "I didn't feel him shaking or quivering or anything
like that."

Hands that once couldn't hold a glass will be holding a brand new
baby in eight months. Deborah just found out she is pregnant.

"I'm looking forward to this with open arms and open heart — to be
able to bring a child into this world and really just be a part of
it like I've always envisioned," Matovic said.

Unlike Matovic, whose problems are primarily physical, many Tourette
patients suffer physical, neurological and psychological problems as
well. The Cleveland team said the procedure would only work for that
segment of Tourette patients who have primarily physical symptoms —
but that could still offer hope to many thousands of people. And
although he is the country's first Tourette patient to get this
procedure, Matovic is hoping he won't be the last.

"There is hope," he said. "The results that I have seen — the
feelings that I have felt — they're out there for other people too."

For more on the University Hospitals of Cleveland, go to
www.uhhs.com.To find out more about Tourette syndrome, go to the
National Tourette Syndrome Association's web site at www.tsa-
usa.org/.

Thea Trachtenberg produced this story for Good Morning America.

Source
http://abcnews.go.com/sections/GMA/DrJohnson/Tourette_syndrome_040401
-1.html


+++++++++++Sencond Story Same Topic++++++++++++

Surgeons explore new treatment for Tourette syndrome
Patient experiences significant resolution of symptoms following
brain surgery
NOTE: THIS RELEASE HAS BEEN UPDATED SINCE ITS ORIGINAL POSTING
CLEVELAND, April 1, 2004: A neurosurgical team at University
Hospitals of Cleveland (UHC) has, for the first time in North
America, applied a new surgical approach to the treatment of
Tourette syndrome, resulting in the immediate and nearly complete
resolution of symptoms for the patient, who has suffered from this
neurologic disorder since he was a child.

"We were genuinely amazed at the patient's response," says Robert J.
Maciunas, MD, neurosurgeon at UHC and professor at Case Western
Reserve University School of Medicine. He has used the technique
called deep brain stimulation (DBS) for the treatment of Parkinson's
disease and tremor, and was impressed with this patient's dramatic
reaction: the disappearance of the jerking motions, muscle tics and
grunting associated with his Tourette's. "This technique holds great
promise for patients suffering from this movement disorder, which
often is diagnosed in childhood or early adolescence and can be
completely debilitating."

Jeff Matovic, a Lyndhurst, Ohio, resident who grew up in Bay
Village, was six years old when he was diagnosed with Tourette
syndrome, a neurobehavioral disorder characterized by sudden,
repetitive muscle movements (motor tics) and vocalizations (vocal
tics). Though standard therapy with medication controlled his
movements for much of his boyhood, his condition severely worsened
with age.

"I had to drink with a sippy cup; otherwise, I would spill liquid
all over and even break glass or plastic cups with the severity of
the muscle spasms that were so forceful and unpredictable," says
Jeff, now age 31. "To grow up being made fun of, always feeling
different, and then, as an adult, unable to hold a job and support a
family, I was feeling devastated by my Tourette's. I had heard about
deep brain stimulation for other movement disorders. I knew that
brain surgery was risky, and the doctors could not guarantee any
positive outcome, but I wanted them to take a chance on me. And I'm
so grateful that they did."

Prior to brain surgery, physicians at University Hospitals Movement
Disorders Center mapped out regions of Jeff's brain, through MRI
(magnetic resonance imaging) scans and 3-D computer images. Their
goal was to locate the safest and most direct route to reach the
cells inside the thalamus portion of the brain, involved in
controlling Jeff's movements. By placing electrodes around those
cells to deliver continuous high-frequency electrical stimulation,
control messages are rebalanced throughout the movement centers in
the brain. The electrodes are connected from the brain through wires
under the skin (beneath the scalp, neck and upper chest) to an
implanted battery just beneath the collarbone. In Jeff's case, since
both sides of his body were affected by the movement disorder, he
has electrodes implanted on both sides of his brain and tiny battery
packs implanted on each side of his chest.

The doctors at University Hospitals of Cleveland are careful to
point out that not everyone with Tourette syndrome requires
treatment. The first line of treatment is medication, which can be
very effective. Surgical treatment is considered a last resort, and
it is not clear how effective deep brain stimulation will ultimately
prove for patients with this particular disorder.

In the United States, the Food and Drug Administration has approved
deep brain stimulation for the treatment of Parkinson's disease,
essential tremor and dystonia. "We've seen very positive responses
in patients with Parkinson's disease. Studies of the DBS technique
show that this stimulation can significantly reduce tremor and other
symptoms in about three quarters of appropriately selected patients
with Parkinson's." says Brian N. Maddux, MD, PhD, Jeff's neurologist
at UHC and assistant professor at Case School of Medicine. "Patients
with a different movement disorder called dystonia can take three
months to respond to the electrical stimulation. We didn't know how
Jeff would respond. Within hours after the stimulator was turned on,
we observed the ceaseless movements become completely relaxed and he
was able to walk normally. We were awestruck."

Physicians at University Hospitals of Cleveland have submitted a
report of this case for consideration for publication in a peer-
reviewed journal. They hope to further explore the application of
DBS to other patients with Tourette syndrome. It is estimated that
approximately 200,000 Americans have Tourette syndrome, though
experts believe it is a movement disorder that often remains
undiagnosed.


###
For more information about the surgery, go to http://www.uhhs.com.
For more information about Tourette syndrome, go to http://www.tsa-
usa.org.

University Hospitals Health System (UHHS) is the region's premier
healthcare delivery system, serving patients at more than 150
locations throughout northern Ohio.

The System's 947-bed, tertiary medical center, University Hospitals
of Cleveland (UHC), is the primary affiliate of Case Western Reserve
University (CWRU). Together, they form the largest center for
biomedical research in the State of Ohio. The System provides the
major clinical base for translational researchers at the Case
Research Institute, a partnership between UHC and CWRU School of
Medicine, as well as a broad and well-characterized patient
population for clinical trials involving the most advanced
treatments. Included in UHC are Rainbow Babies & Children's
Hospital, among the nation's best children's hospitals; Ireland
Cancer Center, designated by the National Cancer Institute as a
Comprehensive Cancer Center (the nation's highest designation); and
MacDonald Women's Hospital, Ohio's only hospital for women.

Source
http://www.eurekalert.org/pub_releases/2004-04/uhoc-sen033104.php



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