Introduction Tourette Syndrome (TS) is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation (DBS) may be considered. Methods and Results We discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects. Discussion Specific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication. Conclusion Clinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals.

Background: Qualitative motion analysis revealed that the cervical spine moves according to a consistent pattern. This analysis calculates the relative rotation between vertebral segments to determine the sequence in which they contribute to extension, demonstrating a mean sensitivity of 90% and specificity of 85%. However, the extensive time that is required limits its applicability. This study investigated the feasibility of implementing a deep-learning model to analyze qualitative cervical motion. Methods: A U-Net architecture was implemented as 2D and 2D+t models. Dice similarity coefficient (DSC) and Intersection over Union (IoU) were used to assess the performance of the models. Intraclass Correlation Coefficient (ICC) was used to compare the relative rotation of individual vertebrae and segments to the ground truth. Results: IoU ranged from 0.37 to 0.74 and DSC ranged from 0.53 to 0.80. The ICC scores for relative rotation ranged from 0.62 to 0.96 for individual vertebrae and from 0.28 to 0.72 for vertebral segments. For segments, 2D+t models presented higher ICC scores compared to 2D models. Conclusions: This study showed the feasibility of implementing deep-learning models to analyze qualitative cervical motion in dynamic X-ray recordings. Future research should focus on improving model segmentation by enhancing recording contrast and applying post-processing methods. Improved segmentation accuracy will enable routine use of the analysis of motion patterns in clinical research. The absence or presence of a motion pattern, or identification of new patterns has the potential to aid in clinical decision-making.

Background: Several case reports about spinal cord compression due to hyperostosis at the craniocervical junction are available. However, compression at C1-C2 solely due to ossification of the posterior longitudinal ligament (OPLL) is rare. Case Description: A 50-year-old Asian male, with a history of lumbar spinal canal stenosis, presented with a progressive quadriparesis within 3 months. Imaging showed central OPLL at the C1-C2 level contributing to severe spinal cord compression. The patient improved neurologically after a C1-C2 laminectomy. Conclusion: A patient presented with a progressive Brown-Séquard syndrome due to OPLL at the craniocervical junction (C1-C2 level) and improved following a decompressive laminectomy.