Tourette Syndrome and Tic Disorders

Tourette syndrome (TS), the most severe end of the spectrum of tic disorders, is characterized by episodic motor and vocal tics and attendant sensory phenomena. It is commonly comorbid with attention deficit disorder and obsessive-compulsive disorder. Functional imaging studies have implicated dysregulation of cortico-basal ganglia circuitry. TS is genetically complex; recent findings have identified several rare contributing mutations, and the heterogeneous genetic architecture of the condition is slowly coming into focus. Post-mortem findings have identified abnormalities of specific populations of interneurons that have led to new insight into the circuit-level disruptions of information processing that underlie this condition, though the etiology of interneuronaldysregulationremains unclear. Dysregulated immune-brain interactions, may contribute to a subset of cases. These varied sources of insight into the condition are gradually converging on informative models of tic disorder pathophysiology.

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Pharmacotherapy for tics in adult patients with Tourette syndrome and other tic disorders

Neurological Sciences ◽

10.1007/s10072-020-04327-3 ◽

2020 ◽

Vol 41 (7) ◽

pp. 1923-1926

Author(s):

James Badenoch ◽

Andrea E. Cavanna

Keyword(s):

Obsessive Compulsive Disorder ◽

Tourette Syndrome ◽

Group Analysis ◽

Adult Patients ◽

Tic Disorders ◽

Obsessive Compulsive ◽

Tic Disorder ◽

Compulsive Disorder ◽

Hyperactivity Disorder ◽

The Uk

Abstract Background Tourette syndrome (TS) and persistent motor/vocal tic disorders are neurodevelopmental conditions characterised by the chronic presence of motor and/or vocal tics. Patients with TS often present with co-morbid disorders, especially attention-deficit and hyperactivity disorder (which tends to improve after childhood), and obsessive-compulsive disorder (which can persist in adulthood). We set out to explore pharmacotherapy for tics in adult patients with TS and persistent motor/vocal tic disorders, as well as its relationship with the presence of co-morbid conditions. Methods We retrospectively reviewed the clinical characteristics and pharmacotherapy of 192 adult patients with TS (n = 187), persistent motor tic disorder (n = 3) and persistent vocal tic disorder (n = 2) attending a specialist clinic in the UK. Results Anti-dopaminergic medications (n = 65) and alpha-2-agonists (n = 50) were the most commonly prescribed pharmacotherapy for tic management. A sub-group analysis revealed that co-morbid obsessive-compulsive disorder and sub-threshold obsessive-compulsive behaviours were significantly more common in patients treated with anti-dopaminergic medications than patients taking alpha-2-agonists (p = 0.013 and p = 0.047, respectively). Conclusions The use of pharmacotherapy options for tic management observed at a specialist clinic for adults with TS reflects guideline recommendations. We found that the presence of co-morbid obsessive-compulsive disorder/behaviours correlates with the choice of anti-dopaminergic medications over alpha-2-agonists, in line with available evidence on the efficacy of anti-dopaminergic medications for the treatment of specific tic–related behavioural symptoms.

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Parental age and the risk of obsessive compulsive disorder and Tourette syndrome / chronic tic disorder in a nationwide population-based sample

Journal of Affective Disorders ◽

10.1016/j.jad.2017.07.033 ◽

2017 ◽

Vol 223 ◽

pp. 101-105 ◽

Cited By ~ 5

Author(s):

Roshan Chudal ◽

Susanna Leivonen ◽

Hanna Rintala ◽

Susanna Hinkka-Yli-Salomäki ◽

Andre Sourander

Keyword(s):

Obsessive Compulsive Disorder ◽

Tourette Syndrome ◽

Population Based ◽

Parental Age ◽

Obsessive Compulsive ◽

Tic Disorder ◽

Compulsive Disorder ◽

Chronic Tic Disorder

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Inheritance Patterns in Tourette Syndrome

Pediatrics in Review ◽

10.1542/pir.13.12.460 ◽

1992 ◽

Vol 13 (12) ◽

pp. 460-474

Keyword(s):

Tourette Syndrome ◽

Tic Disorders ◽

Obsessive Compulsive ◽

Tic Disorder ◽

Detailed History ◽

Inheritance Patterns ◽

Motor Movements ◽

Chronic Tic Disorders ◽

Obsessive Compulsive Disorders ◽

Compulsive Disorders

The spectrum of tic disorders in children is neither so uncommon nor transient that pediatricians can disregard or take lightly a parent's or teacher's observations about a child's involuntary motor movements or vocal utterances. Rather, such information warrants a more detailed history about the child and family, especially as it pertains to other members who have tics or obsessive-compulsive disorders, particularly when they are chronic. The combination of an uncontrollable chronic motor tic disorder with vocal tics that are manifested by echolalia, coprolalia, or echokinesis suggests Tourette syndrome. This is by far the most serious of the chronic tic disorders, with a prevalence of 1 in 2000.

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Candidate locus for Gilles de la Tourette syndrome/obsessive compulsive disorder/chronic tic disorder at 18q22

American Journal of Medical Genetics ◽

10.1002/ajmg.a.30066 ◽

2004 ◽

Vol 130A (1) ◽

pp. 37-39 ◽

Cited By ~ 35

Author(s):

Adam Cuker ◽

Matthew W. State ◽

Robert A. King ◽

Nicole Davis ◽

David C. Ward

Keyword(s):

Obsessive Compulsive Disorder ◽

Tourette Syndrome ◽

Obsessive Compulsive ◽

Candidate Locus ◽

Tic Disorder ◽

Compulsive Disorder ◽

Chronic Tic Disorder

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Obsessive-Compulsive Disorder and Tic Disorder/Tourette Syndrome

10.1093/med-psych/9780197527931.003.0004 ◽

2021 ◽

pp. 41-60

Author(s):

Ashley M. Shaw ◽

Elizabeth R. Halliday

Keyword(s):

Randomized Controlled Trial ◽

Emotional Disorders ◽

Obsessive Compulsive Disorder ◽

Tourette Syndrome ◽

Controlled Trial ◽

Habit Reversal ◽

Obsessive Compulsive ◽

Tic Disorder ◽

Transdiagnostic Treatment ◽

Compulsive Disorder

The Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) have clinical relevance for youth with obsessive-compulsive disorder (OCD) and Tourette syndrome, particularly when comorbid anxiety and depression are present. Within this population, the UP-C/A can be applied either as standalone interventions or in conjunction with exposure and response prevention or habit reversal techniques. However, their efficacy and utility in these populations have never been examined in a randomized controlled trial. This chapter outlines recommendations for how to apply the UP-C/A to youth with OCD and related disorders. For example, applying module content in a flexible order is recommended, such as generating a list of emotional behaviors early in treatment, and checking in about opposite actions throughout treatment. Introducing nonjudgmental awareness and exposures early in treatment is also recommended.

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Trichotillomania, Obsessive-Compulsive Disorder, and Tourette Syndrome: Comorbid Relationships and Risks for Expression

CNS Spectrums ◽

10.1017/s1092852900006659 ◽

1998 ◽

Vol 3 (10) ◽

pp. 49-51 ◽

Cited By ~ 3

Author(s):

Richard L. O'Sullivan ◽

Euripedes C. Miguel ◽

Barbara Coffey ◽

Scott L. Rauch ◽

Cary Savage ◽

...

Keyword(s):

Obsessive Compulsive Disorder ◽

Tourette Syndrome ◽

Phenomenological Study ◽

Tic Disorders ◽

Dopamine Antagonists ◽

Hair Pulling ◽

Structured Interviews ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Neuroimaging Data

AbstractTrichotillomania (TTM, repetitive hair pulling) is a complex underdiagnosed syndrome that often causes considerable psychological distress and physical disfigurement. Although many aspects of hair pulling bear similarity to compulsions of obsessive-compulsive disorder (OCD), TTM lacks obsessions associated with OCD. The phenomenology of TTM also is similar to tics in Tourette Syndrome (TS) and overlaps with TS in both limited structural neuroimaging data and in terms of treatment response to pharmacotherapy with dopamine antagonists.In order to study potential comorbid relationships between TTM, TS, and OCD, a total of 61 patients with either TS, OCD, or OCD comorbid with TS were assessed using structured interviews as part of a phenomenological study of these groups. Post hoc analyses indicated significantly higher proportions of hair pulling in those subjects with OCD comorbid with TS compared to subjects with either OCD or TS alone.These data, in conjunction with clinical phenomenology, neuroimaging results, and response to pharmacotherapy suggest the possibility that some forms of TTM may be more closely related to tic disorders than OCD. Futher research is needed to clarify and confirm these observations of putative relationships between TTM and TS and potential treatment implications.

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Elevated Expression of SLC6A4 Encoding the Serotonin Transporter (SERT) in Gilles de la Tourette Syndrome

Genes ◽

10.3390/genes12010086 ◽

2021 ◽

Vol 12 (1) ◽

pp. 86

Author(s):

Mathis Hildonen ◽

Amanda M. Levy ◽

Christina Dahl ◽

Victoria A. Bjerregaard ◽

Lisbeth Birk Møller ◽

...

Keyword(s):

Tourette Syndrome ◽

Serotonin Transporter ◽

Neurodevelopmental Disorder ◽

Control Group ◽

Obsessive Compulsive ◽

Expression Levels ◽

Compulsive Disorder ◽

Hyperactivity Disorder ◽

Elevated Expression ◽

Gene Expression Levels

Gilles de la Tourette syndrome (GTS) is a complex neurodevelopmental disorder characterized by motor and vocal tics. Most of the GTS individuals have comorbid diagnoses, of which obsessive-compulsive disorder (OCD) and attention deficit-hyperactivity disorder (ADHD) are the most common. Several neurotransmitter systems have been implicated in disease pathogenesis, and amongst these, the dopaminergic and the serotonergic pathways are the most widely studied. In this study, we aimed to investigate whether the serotonin transporter (SERT) gene (SLC6A4) was differentially expressed among GTS individuals compared to healthy controls, and whether DNA variants (the SERT-linked polymorphic region 5-HTTLPR, together with the associated rs25531 and rs25532 variants, and the rare Ile425Val variant) or promoter methylation of SLC6A4 were associated with gene expression levels or with the presence of OCD as comorbidity. We observed that SLC6A4 expression is upregulated in GTS individuals compared to controls. Although no specific genotype, allele or haplotype was overrepresented in GTS individuals compared to controls, we observed that the LAC/LAC genotype of the 5-HTTLPR/rs25531/rs25532 three-locus haplotype was associated with higher SLC6A4 mRNA expression levels in GTS individuals, but not in the control group.

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Comorbid chronic tic disorder and tourette syndrome in children requiring inpatient mental health treatment

Clinical Child Psychology and Psychiatry ◽

10.1177/13591045211007918 ◽

2021 ◽

pp. 135910452110079

Author(s):

Shaheen Zinna ◽

Rebecca Luxton ◽

Efstathios Papachristou ◽

Danai Dima ◽

Marinos Kyriakopoulos

Keyword(s):

Mental Health ◽

Tourette Syndrome ◽

Mental Health Treatment ◽

Autism Spectrum ◽

Continuous Variables ◽

Tic Disorder ◽

Exact Test ◽

Compulsive Disorder ◽

Inpatient Mental Health ◽

Chronic Tic Disorder

Objective: Children needing admission to an inpatient mental health unit often present with severe neuropsychiatric disorders characterised by complex psychopathology. We aimed to examine all admitted children with comorbid chronic tic disorder (CTD) and Tourette syndrome (TS) over a 10-year period and determine the clinical significance of these diagnoses. Method: A retrospective, naturalistic study was conducted, comparing children with and without CTD/TS in terms of co-morbid diagnoses, medication use, access to education, aggression contributing to the admission, duration of admission, functional outcomes and satisfaction with treatment. Data were analysed using Chi-square/Fisher’s exact test and t-test for categorical and continuous variables, respectively, and subsequently with unadjusted and adjusted linear and logistic regression analyses. Results: A relatively high proportion of children had co-morbid CTD/TS (19.7%). There was a significant association with co-morbid obsessive-compulsive disorder, intellectual disability and autism spectrum disorder but not attention deficit hyperactivity disorder. CTD/TS were associated with longer admissions even after adjustments for confounding but did not seem to be independently associated with other examined clinical characteristics. Conclusions: The prevalence of CTD/TS in children needing inpatient treatment is significant. In our sample, comorbid CTD/TS seem to represent a marker of overall symptom severity as evidenced by longer admissions.

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Disturbed Monitoring and Response Inhibition in patients with Gilles De La Tourette Syndrome and Co-Morbid Obsessive Compulsive Disorder

Behavioural Neurology ◽

10.1155/2003/832906 ◽

2003 ◽

Vol 14 (1-2) ◽

pp. 29-37 ◽

Cited By ~ 45

Author(s):

Sandra Verena Müller ◽

Sönke Johannes ◽

Berdieke Wieringa ◽

Axel Weber ◽

Kirsten Müller-Vahl ◽

...

Keyword(s):

Executive Functions ◽

Obsessive Compulsive Disorder ◽

Tourette Syndrome ◽

Response Inhibition ◽

Error Detection ◽

Neuropsychological Tests ◽

Cognitive Domain ◽

Control Group ◽

Obsessive Compulsive ◽

Compulsive Disorder

Objective:Fronto-striatal dysfunction has been discussed as underlying symptoms of Tourette syndrome (TS) with co-morbid Obsessive Compulsive Disorder (OCD). This suggests possible impairments of executive functions in this disorder, which were therefore targeted in the present study.Results:A comprehensive series of neuropsychological tests examining attention, memory and executive functions was performed in a group of 14 TS/OCD in co-occurrence with OCD patients and a matched control group.Results:While attentional and memory mechanisms were not altered, TS/OCS patients showed deficits in executive functions predominately in the areas of response inhibition and action monitoring.Conclusions:These findings provide further evidence for a substantial impairment of the frontal-striatal-thalamic-frontal circuit. We propose that the deficits in monitoring, error detection and response inhibition constitute the major impairment of TS/OCD patients in the cognitive domain.

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