Showing papers on "Tourette syndrome published in 1998"

Course of Tic Severity in Tourette Syndrome: The First Two Decades

Abstract: Objective. Prevalence studies indicate a 10-fold higher rate of Tourette syndrome (TS) among children compared with adults. The purpose of this investigation was to examine the course of tic severity during the first 2 decades of life. Method. A birth-year cohort of 42 TS patients followed at the Yale Child Study Center was recontacted an average of 7.3 years after their initial clinical evaluation. Data concerning the onset and course of tic severity until 18 years of age were available on 36 TS patients. A variety of statistical techniques were used to model aspects of the temporal patterning of tic severity. Results. Mean (SD) tic onset at 5.6 (2.3) years of age was followed by a progressive pattern of tic worsening. On average, the most severe period of tic severity occurred at 10.0 (2.4) years of age. In eight cases (22%), the frequency and forcefulness of the tics reached a severe level during the worst-ever period such that functioning in school was impossible or in serious jeopardy. In almost every case this period was followed by a steady decline in tic severity. By 18 years of age nearly half of the cohort was virtually tic-free. The onset of puberty was not associated with either the timing or severity of tics. Conclusions. A majority of TS patients displayed a consistent time course of tic severity. This consistency can be accurately modeled mathematically and may reflect normal neurobiological processes. Determination of the model parameters that describe each patient9s course of tic severity may be of prognostic value and assist in the identification of factors that differentially influence the course of tic severity.

A functional magnetic resonance imaging study of tic suppression in Tourette syndrome.

Abstract: Background: The inability to inhibit unwanted behaviors and impulses produces functional debility in a broad range of neuropsychiatric disorders. A potentially important model of impulse control is volitional tic suppression in Tourette syndrome. Methods Tic suppression was studied in 22 adult subjects with Tourette syndrome by using functional magnetic resonance imaging. Images acquired during periods of voluntary tic suppression were compared with images acquired when subjects allowed the spontaneous expression of their tics. The magnitudes of signal change in the images were then correlated with measures of the severity of tic symptoms. Conclusions Significant changes in signal intensity were seen in the basal ganglia and thalamus and in anatomically connected cortical regions believed to subserve attention-demanding tasks. The magnitudes of regional signal change in the basal ganglia and thalamus correlated inversely with the severity of tic symptoms. These findings suggest that the pathogenesis of tics involves an impaired modulation of neuronal activity in subcortical neural circuits.

Inhibitory Deficits in Tourette Syndrome: A Function of Comorbidity and Symptom Severity

Abstract: This study examined central inhibitory function in children with Tourette syndrome (TS; N = 46) and normally developing controls (N = 22) matched on age, gender, and IQ. A negative priming task measured the ability to inhibit processing of irrelevant distractor stimuli presented on a visual display. Initial analyses indicated that participants with Tourette syndrome did not differ significantly in inhibitory function from controls. However, when the large Tourette syndrome sample was separated into subgroups, one without evidence of comorbidity (N = 23) and the other meeting research criteria for either AD/HD, OCD, or both (N = 23), it became evident that individuals with Tourette syndrome with comorbid conditions tended to perform less well than the control group, whereas those without comorbidity performed much like controls. Similarly, when the large Tourette syndrome sample was divided into two subgroups on the basis of severity of symptomatology (N = 23 in each), those with more numerous and severe symptoms of Tourette syndrome, AD/HD, and OCD performed significantly less well than both controls and Tourette syndrome subjects with fewer and less severe symptoms. This suggests that neuropsychological impairment occurs as a function of comorbidity and symptom severity in Tourette syndrome. It also suggests that categorical diagnoses alone may be less useful than dimensional methods for predicting cognitive impairment in individuals with Tourette syndrome.

Visual-motor integration functioning in children with Tourette syndrome.

Abstract: A neuropsychological model of visual-motor integration skill was proposed and tested in 50 children with Tourette syndrome (TS) and 23 unaffected control children matched for age. Children with TS performed significantly worse than control children on the Beery Visual-Motor Integration (VMI) Test. Consistent with the proposed model, visuoperceptual and fine-motor coordination subprocesses were significant predictors of VMI scores. However, the subprocesses did not fully account for the diagnostic group difference on the VMI. These results suggest that the integration of visual inputs and organized motor output is a specific area of neuropsychological weakness among individuals with TS.

Cannabinoids: possible role in patho‐physiology and therapy of Gilles de la Tourette syndrome

Abstract: High densities of cannabinoid receptors were found in the basal ganglia and hippocampus, indicating a putative functional role of cannabinoids in movement and behaviour. Anecdotal reports suggested beneficial effects of marijuana in Tourette's syndrome (TS). We therefore interviewed 64 TS patients with regard to use of marijuana and its influence on TS symptomatology. Of 17 patients (27%) who reported prior use of marijuana, 14 subjects (82%) experienced a reduction or complete remission of motor and vocal tics and an amelioration of premonitory urges and obsessive-compulsive symptoms. Our results provide more evidence that marijuana improves tics and behavioural disorders in TS. It can be speculated that cannabinoids might act through specific receptors, and that the cannabinoid system might play a major role in TS pathology.

Abnormal cerebral activation associated with a motor task in Tourette syndrome.

Abstract: BACKGROUND AND PURPOSE In Gilles de la Tourette syndrome, PET scanning and EEG suggest an abnormal organization of the sensorimotor cortex and basal ganglia. The purpose of this study was to use functional MR imaging to study activation in the sensorimotor cortex in patients with Tourette syndrome. METHODS From echo-planar images acquired during intermittent performance of a finger-tapping task, the location of activated pixels was determined by means of conventional signal processing methods. In five patients with Tourette syndrome and five healthy volunteers, the number of activated pixels in the sensorimotor cortices and supplementary motor areas were counted. The area over which the activation was distributed was calculated. RESULTS In the five patients, the average number of pixels activated during the finger-tapping task in the sensorimoter cortices and supplementary motor area (69.4 pixels) exceeded that in the volunteers (49.2 pixels). The difference was significant. The area over which the pixels was distributed was significantly larger (25.4 vs 13.8 cm2). CONCLUSION Motor function is organized differently in patients with Tourette syndrome than in healthy subjects.

Clinical Features Distinguishing Patients With Tourette's Syndrome and Obsessive-Compulsive Disorder From Patients With Obsessive-Compulsive Disorder Without Tics

Abstract: Objective It is not clear whether obsessive-compulsive disorder (OCD) in the context of Tourette's syndrome (TS) is the same as that disorder found in patients with OCD alone. This study evaluated the severity and characteristics of the obsessive-compulsive symptoms in adult patients with OCD and TS compared to adult patients with OCD alone. Method Thirteen subjects with both DSM-III-R TS and OCD and 13 subjects with OCD alone were recruited. Obsessive-compulsive severity was determined by using the Yale-Brown Obsessive Compulsive Scale. The Tourette Syndrome Association Unified Tic Rating Scale was administered to determine tic severity, and the adult version of the Attention Deficit and Hyperactivity Checklist was used to detect a history of childhood attention-deficit hyperactivity disorder (ADHD). Results Subjects with OCD alone had very few obsessions and compulsions that were not also experienced by subjects with both TS and OCD. In contrast, subjects with TS and OCD were significantly more likely to report obsessions involving nonviolent images, excessive concern with appearance, and need for symmetry. Touching, blinking or staring, and counting compulsions were also significantly more common in this group. Eight subjects with OCD and TS had a childhood history of ADHD, compared to none of the pure OCD subjects. Conclusion There are subtle but definite differences in symptomatology of subjects with pure OCD compared to those with OCD and TS consistent with putative differences in pathophysiology between the 2 groups, i.e., abnormalities in the serotonergic system in OCD patients and serotonergic and dopaminergic abnormalities in those with OCD and TS. These observations may be consistent with genetic heterogeneity within both OCD and TS.

Hyperkinetic movement disorders misdiagnosed as tics in Gilles de la Tourette syndrome

Abstract: Objective: To describe the gamut of movements misdiagnosed as tic exacerbations in Gilles de la Tourette syndrome (GTS) in a referral tertiary-care center. Background: Movements seen in GTS can be classified as: (a) tics; (b) movements related to conditions associated with GTS, specifically obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and antisocial behaviors; and (c) movements secondary to treatment. Methods: We reviewed a videotape database and patient records from a tertiary treatment center for GTS and collected GTS cases referred for disease exacerbation who had both tics and non-tic movements thought by the referring physician, the patient, and the family to be an exacerbation of tics. Results: Of 373 GTS cases, 12 had movement disorders secondary to treatment, and six had non-tic movements related to conditions commonly associated with GTS. In the former group, there were 7 patients with acute akathisia, 3 with acute dystonia, 1 with tardive chorea, 1 with withdrawal emergent chorea, and 5 with tardive dystonia. Six had movement disorders related to non-tic conditions commonly associated with GTS: four patients had movements associated with OCD, one with ADHD and antisocial behavior, respectively. Conclusion: There is a broad spectrum of movements in GTS that are not tics but can be misdiagnosed as tics. Clinical awareness of these movements is paramount to proper diagnosis and pharmacologic intervention.

Gender Study of Neuropsychological and Neuromotor Function in Children With Tourette Syndrome With and Without Attention-Deficit Hyperactivity Disorder

Abstract: Neuropsychological and neuromotor functions were compared between boys and girls with Tourette syndrome (TS only), attention-deficit hyperactivity disorder (ADHD only), Tourette syndrome with ADHD (TS+ADHD), and a comparison group, in an age (mean = 10 years) and IQ (Wechsler Full-Scale mean = 111) matched sample (n = 116). There were no timed-task neuromotor differences among the groups. Analyses of variance revealed a group x gender interaction for Letter Word Fluency and the Rapid Automatized Naming test. Girls with ADHD only were faster than boys on both tasks. When data for girls only were analyzed, girls with Tourette syndrome with ADHD had the greatest variability of reaction time on the Test of Variables of Attention, and were slowest on Letter Word Fluency. Girls with TS only were slower than girls in the other three groups on Letter Word Fluency. Poor Letter Word Fluency is explained as a linguistic executive dysfunction involving speed and efficiency of memory search in this bright group of girls with Tourette syndrome, not otherwise at risk for linguistic difficulties.

Sustained Attention and Impulsivity in Children with Tourette Syndrome: Comorbidity and Confounds

Abstract: We sought to determine whether Tourette syndrome (TS) was related to attentional disturbance independent of Attention Deficit Hyperactivity disorder (ADHD) and obsessive-compulsive symptoms (OCS), two comorbid conditions associated with attentional problems in other populations. Participants were 74 children [21 with uncomplicated TS (TS-Only), 14 with TS and ADHD (TS-ADHD), 21 with ADHD, and 18 controls]. Impaired sustained attention and impulsivity on a Continuous Performance Task were uncommon in the TS-Only group, but common in TS-ADHD and ADHD. The TS-ADHD group was less impulsive than the ADHD group, but had a higher rate of whole-body tics than the TS-Only group, raising questions about the diagnosis of ADHD in TS. OCS was not an independent risk factor for attention problems. However, the association of tic severity and impulsivity was consistent with the theory that TS involves dysfunction in cortical-subcortical circuits mediating behavioral inhibition.

Mutation screening of the dopamine D1 receptor gene in Tourette's syndrome and alcohol dependent patients.

Abstract: We report a single stranded conformational polymorphism (SSCP) analysis of the coding region of the dopamine D1 receptor (DRD1) in Tourette's syndrome (n = 50) and control (n = 50) subjects. Tourette's syndrome populations with comorbidity for attention deficit-hyperactivity disorder (AD-HD) (n = 35) and obsessive compulsive disorder (OCD) (n = 30) were also screened. As a related study, we also screened patients diagnosed with alcohol dependence (n = 72). The present study discovered no DRD1 coding region mutations in any of the Tourette's syndrome or alcohol dependent patients. One silent mutation, a C for a T at Ile49, was discovered in one control subject. The non-polymorphic structure of the DRD1 gene among the Tourette's syndrome, Tourette's syndrome comorbid with AD-HD and OCD and the alcohol dependent populations screened by SSCP suggests that coding region mutations of the DRD1 gene are unlikely to contribute to the inheritance of these disorders.

'prevalence of tourette syndrome in a mainstream school population'. authors' reply

Abstract: The aim of this study was to ascertain accurately the prevalence of Tourette syndrome (TS) in a mainstream school population. All year 9 pupils (aged 13 to 14 years) in a mainstream secondary school were investigated using a two-stage procedure. Standardized questionnaires were completed by parents, teachers, and pupils. Class observations were also carried out to identify tics. Those pupils identified as having tics underwent a semistructured interview to determine whether they had TS according to DSM-III–R criteria. Data were available from at least one source (parent, teacher, or self-reports) on 166 of the 167 pupils in the year. Five subjects were identified as having TS according to DSM-III-R criteria, yielding a prevalence estimate of 299 per 10 000 pupils in this age group. The results of this study suggest that TS in the community as a whole is more common and milder than those prevalence estimates and descriptions of the disorder based on TS encountered in secondary or tertiary health-care service settings.

Neuroimaging in child neuropsychiatric disorders

Abstract: This text presents the main morphological and functional brain imaging methods that we can use in the child. Two main applications are developed: physiopathological and therapeutical interest. The physiopathological approach is of a great interest, coupled with clinical evaluation in psychomotor disorders like hyperkinetic or Tourette syndrome, and in developmental disorders like autistic syndrome, mental retardation and Rett syndrome.

Tourette Syndrome: The Facts

Abstract: Introducing three cases Questions and answers about Tourette Syndrome How the diagnosis is made Coping with the news Education and Tourette Syndrome: what can be done? Appendix 1 - International agencies supporting Tourette Syndrome Appendix 2 - Bibliography and further reading

Tic disorders: new developments in Tourette syndrome and related disorders.

Abstract: The constellation of motor and vocal tics and certain of the other neuropsychiatric symptoms seen in Tourette syndrome are thought to have an organic basis, although the nature of the neurobiological lesion is uncertain. The syndrome is usually familial but the presumed genetic substrate has not been identified. A number of models currently under debate include a proposed autoimmune contribution. Curr Opin Neurol 11:373–380. © 1998 Lippincott–Raven Publishers

Olanzapine in Tourette syndrome.

Abstract: Sir: Poor or partial response and sideeffects hamper the use of conventional neuroleptics in Tourette syndrome. Since onset at age five, a 16-year-old girl has had several motor tics; vocalisation started aged 11 and coprolalia at 14. She has palilalia, forced touching and several compulsive-type behaviours. Her tics are severe enough for her to cause self-injury. Her diagnosis was confirmed at a major specialist centre for tic disorder, where in 1996 she scored 48 on the Yale Global Tic Severity Rating Scale. From presentation three-and-a-half years ago, she has been on haloperidol, pimozide and risperidone. All were discontinued due to either poor control of her symptoms or side-effects. After informed consent all medication was withdrawn. The patient and her mother rated her tics at 10+ over a two-week drug-free period, on a scale of 0-10. She was started on olanzapine 5 mg daily, raised to 10 mg daily after one week. Over nine weeks of treatment a partial control of the tic symptoms has been achieved, with the patient and parent rating fluctuating between 4 and 8. Increased appetite lasted four weeks. Drowsiness improved when the medication was taken at night. A degree of tiredness, not interfering with daily activities, including school, continues. I am not aware of any published reports of the use of olanzapine in Tourette disorder. The effects of the newer antipsychotics on dopaminergic, serotonergic and adrenergic systems, implicated in the pathophysiology of Tourette syndrome may suggest a useful role for these medications (Chappell et al, 1997). It would be at considerable theoretical interest if drugs with less potent action at dopaminergic sites were shown to be effective in diverse disorders considered to be associated with dopaminergic dysfunction at different brain sites.

The Bal I and Msp I polymorphisms in the dopamine D3 receptor gene display, linkage disequilibrium with each other but no association with Tourette syndrome

Abstract: The D3-dopamine receptor gene, DRD3, has been considered as a candidate gene in several disorders in which the dopaminergic system has been implicated including Tourette syndrome and schizophrenia. The DRD3 studies to date have all used as the gene marker a Bal I polymerase chain reaction restriction fragment length polymorphism (PCR RFLP). There have been recent reports on a second marker, an Msp I PCR RFLP, that lies 40 kb downstream. We have typed a sample of 16 Tourette syndrome families with both markers and observed significant linkage disequilibrium between the two markers but no apparent association of either marker with Tourette syndrome.

Novel substituted pyridine compounds useful as modulators of acetylcholine receptors

Abstract: In accordance with the present invention, a novel class of substituted pyridine compounds, optionally containing ether, ester, amide, ketone or thioether substitutions, that promote the release of ligands involved in neurotransmission have been discovered. The compounds of the present invention are capable of modulating acetylcholine receptors. Therapeutic indications for compounds with activity at acetylcholine receptors include diseases of the central nervous system such as Alzheimer's disease and other diseases involving memory loss and/or dementia, cognitive dysfunction; disorders of extrapyramidal motor function such as Parkinson's disease. Gilles de la Tourette syndrome and tardive dyskinesia, mood and emotional disorders such as depression, anxiety and psychosis, substance abuse including withdrawal symptoms and substitution therapy; neurocrine disorders and dysregulation of food intake, including bulimia and anorexia; disorders or nociception and control of pain; autonomic disorders including dysfunction of gastrointestinal motility and function such as inflammatory bowel disease, irritable bowel syndrome, diarrhea, constipation, gastric acid secretion and ulcers, pheochromocytoma, cardiovascular dysfunction including hypertension and cardiac arrhythmias, as well as co-medication uses in surgical applications.

Clinical characteristics of Tourette syndrome

Abstract: The aim of the present study was to examine the clinical characteristics of Tourette syndrome (TS) in terms of symptomatology, outcome and organic and genetic factors, and to compare these with results of previous studies on TS in Western countries and in Japan, on the basis of precise information taken from a large number of TS patients under psychiatric treatment in Japan. There was a total of 64 TS patients (55 males and nine females) selected from those who visited our outpatient clinic from 1974 to 1993 and were found to meet the criteria for Tourette's disorder of DSM-III-R. The mean patient age at entry to the present study was 17.4 years (SD: 7.2). All data were collected through a systematic chart review of subjects, including data on tic symptoms and the course of their development; complications and developmental histories; family histories; medical and psychological examinations; treatment; severity and outcome. A check of the data showed that the mean age at onset was 6.9 years (SD: 2.7). An analysis of the progression of the symptoms revealed that 'generalized tics' afflicting the entire body were found in 64.1% of subjects and coprolalia was found in 50%. The main complications were obsessive-compulsive symptoms (OCS) in 62.5% of patients and attention deficit hyperactivity disorder (ADHD) in 17.2%. Of their parents, 7.0% had tic disorders except TS and 1.6% had TS. Contrary to results from previous studies of TS, our study revealed that at least the incidence of coprolalia in TS patients in Japan is not lower than in Western countries. However, the frequency of familial cases seemed to be lower than previously reported for Western patients. Outcome was fairly related with 'generalized tics,' OCS, aggressiveness and ADHD.

An Overview of Medications Commonly Used to Treat Behavioral Disorders Associated with Autism, Tourette Syndrome, and Pervasive Developmental Disorders

Abstract: There are 10 major classes of medications that have been used to treat children who display learning or behavioral disorders associated with autism, Tourette syndrome, or pervasive developmental di...

Directed Attention in Gilles de la Tourette Syndrome

Abstract: Gilles de la Tourette syndrome (TS) is a basal ganglia (BG) disorder, associated not only with hyperkinetic movements but also with attentional impairments This experiment sought to ascertain whether overt direct visual attention would influence tactile attentional performance in TS, via the use of a vibrotactile choice reaction time procedure involving biased probabilities of event occurrence Participants were required to look (ie, direct gaze) either at the hand receiving the most (expected) vibrations, or the hand less often stimulated (the unexpected), for both crossed and uncrossed arm postures Contrary to our predictions, gaze did not influence attentional performance in TS patients Furthermore, patients were found not to be sensitive to distributions of event probability; that is, they did not demonstrate normal expectancy effects like controls Attentional deficits in TS (as in Parkinson’s disease, another BG disorder) may pertain more to difficulties in holding rather than in shifting the focus of attention Moreover, directing attention towards the unexpected locus in the crossed arm posture improved overall performance in both patients and controls, suggesting that increased task demands (eg, crossed arm posture), and/or unexpected stimulus location, may be alleviated by directed attention These impairments may stem from dysfunction in the circuits linking the frontal lobes with the BG

Unrecognized Tourette Syndrome in Adult Patients Referred for Psychogenic Tremor

Abstract: Background The diagnosis of Tourette syndrome may be overlooked in patients with severe psychopathologic disorder but mild motor manifestations of Tourette syndrome. Objective To describe 4 patients with long-lasting general psychopathologic disorder and previously unrecognized mild motor and phonic tics exacerbated during adulthood by the onset of tremor; all of the patients had been referred for the evaluation of psychogenic tremor. Subjects Four adult patients, with previous psychiatric diagnoses of depression (2 cases), generalized anxiety disorder (3 cases), malingering (1 case), and conversion disorder (3 cases). Methods Single case studies. Results Clinical interviews disclosed that the 4 patients had positive family histories of Tourette syndrome, and all had mild motor and phonic tics that had started before the age of 18 years. On neurologic examination, 2 patients had bilateral postural tremor of the hands that varied in frequency, rhythmicity, and amplitude, and the other 2 had resting tremor mimicking parkinsonism. All 4 patients described involuntary somatic sensations of the affected limbs, which they attempted to alleviate by executing movements. No consistent positive placebo response was observed, but in all patients tremoric movements improved with haloperidol. Conclusions These cases illustrate an unusual movement disorder (tremor as a "tic equivalent") in adults with Tourette syndrome and emphasize that cases of the syndrome with mild tics often go unrecognized, precluding adequate treatment.

Tourette syndrome in Japan: A nationwide questionnaire survey of psychiatrists and pediatricians

Abstract: In order to shed light on the clinical picture of patients with Tourette syndrome (TS) treated at medical institutions in Japan, a nationwide survey covering both pediatric patients and psychiatric patients was conducted. We mailed 316 questionnaires on experience in treating TS cases and the patients' present conditions etc. to specialists such as psychiatrists and pediatricians. A total of 164 responded. The survey found 154 TS patients being treated at the time of survey, 45 (29.2%) had obsessive–compulsive symptoms (OCS), and 10 (6.5%) had family histories of TS. It was suggested that TS is often associated with OCS and that familial cases of TS are slightly less common in Japan than they are in the USA. Of the 116 respondents who described their experiences, 85 (73.2%) said that they had treated one or more patients displaying the symptoms of frequent coprolalia, and 42 (36.2%) said that they had treated one or more patients suffering from developmental disorders. Based on these findings, we speculated that the rate of coprolalia in Japan is a little higher than the previously reported 4% and that TS is often associated with developmental disorders.