Patterned changes in urge ratings with tic suppression in youth with chronic tic disorders

2016 ◽  
Vol 50 ◽  
pp. 162-170 ◽  
Author(s):  
Laurel A. Brabson ◽  
Jessica L. Brown ◽  
Matthew R. Capriotti ◽  
Krishnapriya Ramanujam ◽  
Michael B. Himle ◽  
...  
Keyword(s):  
Tic Disorders ◽  
Tic Suppression ◽  
Chronic Tic Disorders

scholarly journals Comparing fixed-amount and progressive-amount DRO Schedules for tic suppression in youth with chronic tic disorders

2016 ◽  
Vol 50 (1) ◽  
pp. 106-120 ◽  
Author(s):  
Matthew R. Capriotti ◽  
Jennifer E. Turkel ◽  
Rachel A. Johnson ◽  
Flint M. Espil ◽  
Douglas W. Woods
Keyword(s):  
Tic Disorders ◽  
Fixed Amount ◽  
Tic Suppression ◽  
Chronic Tic Disorders

scholarly journals Altered urinary tetrahydroisoquinoline derivatives in patients with Tourette syndrome: reflection of dopaminergic hyperactivity?

2020 ◽  
Author(s):  
Philipp Capetian ◽  
Veit Roessner ◽  
Caroline Korte ◽  
Susanne Walitza ◽  
Franz Riederer ◽  
...  
Keyword(s):  
Tourette Syndrome ◽  
Diagnostic Value ◽  
Tic Disorders ◽  
Operating Characteristics ◽  
Roc Curve Analysis ◽  
Two Phase ◽  
Dopaminergic Neurotransmission ◽  
Hyperactivity Disorder ◽  
The Central Nervous System ◽  
Chronic Tic Disorders

AbstractTetrahydroisoquinolines (TIQs) such as salsolinol (SAL), norsalsolinol (NSAL) and their methylated derivatives N-methyl-norsalsolinol (NMNSAL) and N-methyl-salsolinol (NMSAL), modulate dopaminergic neurotransmission and metabolism in the central nervous system. Dopaminergic neurotransmission is thought to play an important role in the pathophysiology of chronic tic disorders, such as Tourette syndrome (TS). Therefore, the urinary concentrations of these TIQ derivatives were measured in patients with TS and patients with comorbid attention-deficit/hyperactivity disorder (TS + ADHD) compared with controls. Seventeen patients with TS, 12 with TS and ADHD, and 19 age-matched healthy controls with no medication took part in this study. Free levels of NSAL, NMNSAL, SAL, and NMSAL in urine were measured by a two-phase chromatographic approach. Furthermore, individual TIQ concentrations in TS patients were used in receiver-operating characteristics (ROC) curve analysis to examine the diagnostic value. NSAL concentrations were elevated significantly in TS [434.67 ± 55.4 nmol/l (standard error of mean = S.E.M.), two-way ANOVA, p < 0.0001] and TS + ADHD patients [605.18 ± 170.21 nmol/l (S.E.M.), two-way ANOVA, p < 0.0001] compared with controls [107.02 ± 33.18 nmol/l (S.E.M.), two-way ANOVA, p < 0.0001] and NSAL levels in TS + ADHD patients were elevated significantly in comparison with TS patients (two-way ANOVA, p = 0.017). NSAL demonstrated an AUC of 0.93 ± 0.046 (S.E.M) the highest diagnostic value of all metabolites for the diagnosis of TS. Our results suggest a dopaminergic hyperactivity underlying the pathophysiology of TS and ADHD. In addition, NSAL concentrations in urine may be a potential diagnostic biomarker of TS.

scholarly journals The CANNA-TICS Study Protocol: A Randomized Multi-Center Double-Blind Placebo Controlled Trial to Demonstrate the Efficacy and Safety of Nabiximols in the Treatment of Adults With Chronic Tic Disorders

2020 ◽  
Vol 11 ◽  
Author(s):  
Ewgeni Jakubovski ◽  
Anna Pisarenko ◽  
Carolin Fremer ◽  
Martina Haas ◽  
Marcus May ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Alternative Treatment ◽  
Tic Disorders ◽  
Driving Ability ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Psychiatric Comorbidities ◽  
Double Blind Placebo ◽  
Cannabis Extract ◽  
Chronic Tic Disorders

Background: Gilles de la Tourette syndrome (TS) is a chronic neuropsychiatric disorder characterized by motor and vocal tics. First-line treatments for tics are antipsychotics and tic-specific behavioral therapies. However, due to a lack of trained therapists and adverse events of antipsychotic medication many patients seek alternative treatment options including cannabis. Based on the favorable results obtained from case studies on different cannabis-based medicines as well as two small randomized controlled trials using delta-9-tetrahydrocannabinol (THC), we hypothesize that the cannabis extract nabiximols can be regarded as a promising new and safe treatment strategy in TS.Objective: To test in a double blind randomized clinical trial, whether treatment with the cannabis extract nabiximols is superior to placebo in patients with chronic tic disorders.Patients and Methods: This is a multicenter, randomized, double-blind, placebo controlled, parallel-group, phase IIIb trial, which aims to enroll 96 adult patients with chronic tic disorders (TS or chronic motor tic disorder) across 6 centers throughout Germany. Patients will be randomized with a 2:1 ratio into a nabiximols and a placebo arm. The primary efficacy endpoint is defined as tic reduction of at least 30% (compared to baseline) according to the Total Tic Score of the Yale Global Tic Severity Scale (YGTSS-TTS) after 13 weeks of treatment. In addition, several secondary endpoints will be assessed including changes in different psychiatric comorbidities, quality of life, driving ability, and safety assessments.Discussion: This will be the first large, controlled study investigating efficacy and safety of a cannabis-based medicine in patients with TS. Based on available data using different cannabis-based medicines, we expect not only a reduction of tics, but also an improvement of psychiatric comorbidities. If the cannabis extract nabiximols is proven to be safe and effective, it will be a valuable alternative treatment option. The results of this study will be of high health-economic relevance, because a substantial number of patients uses cannabis (illegally) as self-medication.Conclusion: The CANNA-TICS trial will clarify whether nabiximols is efficacious and safe in the treatment of patients with chronic tic disorders.Clinical Trial Registration: This trial is registered at clinicaltrialsregister.eu (Eudra-CT 2016-000564-42) and clinicaltrials.gov (NCT03087201).

scholarly journals Empiric Recurrence Risk Estimates for Chronic Tic Disorders: Implications for Genetic Counseling

2020 ◽  
Vol 11 ◽  
Author(s):  
Gary A. Heiman ◽  
Jessica Rispoli ◽  
Christine Seymour ◽  
James F. Leckman ◽  
Robert A. King ◽  
...  
Keyword(s):  
Genetic Counseling ◽  
Recurrence Risk ◽  
Tic Disorders ◽  
Risk Estimates ◽  
Chronic Tic Disorders

scholarly journals Impaired automatic but intact volitional inhibition in primary tic disorders

Brain ◽  
2020 ◽  
Vol 143 (3) ◽  
pp. 906-919 ◽  
Author(s):  
Vishal Rawji ◽  
Sachin Modi ◽  
Anna Latorre ◽  
Lorenzo Rocchi ◽  
Leanne Hockey ◽  
...  
Keyword(s):  
Masked Priming ◽  
Tic Disorders ◽  
Stop Signal Task ◽  
Movement Preparation ◽  
Motor Inhibition ◽  
Priming Task ◽  
Tic Suppression ◽  
Initial Excitation ◽  
Tic Severity ◽  
Healthy Control

Abstract The defining character of tics is that they can be transiently suppressed by volitional effort of will, and at a behavioural level this has led to the concept that tics result from a failure of inhibition. However, this logic conflates the mechanism responsible for the production of tics with that used in suppressing them. Volitional inhibition of motor output could be increased to prevent the tic from reaching the threshold for expression, although this has been extensively investigated with conflicting results. Alternatively, automatic inhibition could prevent the initial excitation of the striatal tic focus—a hypothesis we have previously introduced. To reconcile these competing hypotheses, we examined different types of motor inhibition in a group of 19 patients with primary tic disorders and 15 healthy volunteers. We probed proactive and reactive inhibition using the conditional stop-signal task, and applied transcranial magnetic stimulation to the motor cortex, to assess movement preparation and execution. We assessed automatic motor inhibition with the masked priming task. We found that volitional movement preparation, execution and inhibition (proactive and reactive) were not impaired in tic disorders. We speculate that these mechanisms are recruited during volitional tic suppression, and that they prevent expression of the tic by inhibiting the nascent excitation released by the tic generator. In contrast, automatic inhibition was abnormal/impaired in patients with tic disorders. In the masked priming task, positive and negative compatibility effects were found for healthy controls, whereas patients with tics exhibited strong positive compatibility effects, but no negative compatibility effect indicative of impaired automatic inhibition. Patients also made more errors on the masked priming task than healthy control subjects and the types of errors were consistent with impaired automatic inhibition. Errors associated with impaired automatic inhibition were positively correlated with tic severity. We conclude that voluntary movement preparation/generation and volitional inhibition are normal in tic disorders, whereas automatic inhibition is impaired—a deficit that correlated with tic severity and thus may constitute a potential mechanism by which tics are generated.

scholarly journals Sleep difficulties in children with Tourette syndrome and chronic tic disorders: a systematic review of characteristics and associated factors

SLEEP ◽  
2019 ◽  
Vol 43 (6) ◽  
Author(s):  
Charlotte Hibberd ◽  
Tony Charman ◽  
Raj Seraya Bhatoa ◽  
Sinem Tekes ◽  
Tammy Hedderly ◽  
...  
Keyword(s):  
Young People ◽  
Tourette Syndrome ◽  
Neurodevelopmental Disorders ◽  
Sleep Problems ◽  
Medication Use ◽  
Tic Disorders ◽  
Research Quality ◽  
Children And Young People ◽  
Chronic Tic Disorders ◽  
Sleep Difficulties

Abstract Sleep difficulties are common in children and young people with Tourette syndrome and chronic tic disorders (TS/CTD). However, it is unclear whether sleep problems can be considered typical of the TS/CTD phenotype or whether they reflect concomitant factors such as individual patient characteristics (e.g. medication use), underlying neurodevelopmental disorders and/or co-occurring psychiatric symptoms. To help address this question, this review systematically explored types and frequency of sleep problems in children and young people with TS/CTD, while also examining the heterogeneity and methodological quality of studies. Psycinfo, Ovid Medline, Embase, and Web of Science databases were searched using a range of terms relating to tics, sleep and co-occurring psychopathology. Studies were considered that included a sample of children with TS/CTD (n &gt; 5) for whom sleep difficulties were measured. Eighteen studies met criteria for inclusion in the review. Findings supported the high prevalence of sleep difficulties in children with TS/CTD, though estimates of sleep difficulties ranged from 9.7% to 80.4%. Twelve studies reported on other factors affecting sleep in this patient group including tic severity, comorbid psychopathological or neurodevelopmental disorders and medication use. Studies varied in terms of methodology, sample characteristics and research quality, but most concluded that children with TS/CTD experienced high levels of sleep difficulties with children with co-occurring anxiety most at risk. The current review highlights the need for further empirical investigation of sleep in children with TS/CTS, with a view to informing understanding and clinical management.

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