Influence of sex on tic severity and psychiatric comorbidity profile in patients with pediatric tic disorder

Background: Treatment guidelines recommend behaviour therapy (BT) as the first-line intervention for patients with Tourette syndrome (TS) and chronic tic disorder (CTD). The efficacy of BT has been documented in randomised controlled trials (RCTs), but it is unclear to what extent these results are generalisable to real-world clinical settings, and whether the therapeutic gains are maintained long-term.Methods: In this naturalistic study, 74 young people with TS/CTD (aged 6 to 17) received BT (including psychoeducation, exposure with response prevention, habit reversal training or a combination of these treatments) at a specialist clinic in Stockholm, Sweden. Data were routinely collected at baseline, post-treatment, and at 3-, 6-, and 12-month follow-ups. Measures included the clinician-rated Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impression – Improvement scale (CGI-I), amongst others.Results: Tic severity and tic-related impairment (as measured by the YGTSS) improved significantly after treatment, with large within-group effect sizes (d=1.03 for the YGTSS Total Tic Severity Score, and d=1.37 for the YGTSS Impairment Score). At post-treatment, 57% of the participants were classified as treatment responders according to the CGI-I. Both tic severity and tic-related impairment continued to improve further through the follow-up, with 75% of the participants being rated as responders 12 months after the end of treatment. Significant improvements were also observed across a range of secondary measures.Conclusions: BT is an effective and durable treatment for young people with TS/CTD in a real-world clinical setting, with effects comparable to those reported in RCTs.

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Hippocampal Volume in Provisional Tic Disorder Predicts Tic Severity at 12-Month Follow-up

Journal of Clinical Medicine ◽

10.3390/jcm9061715 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1715

Author(s):

Soyoung Kim ◽

Deanna J. Greene ◽

Carolina Badke D’Andrea ◽

Emily C. Bihun ◽

Jonathan M. Koller ◽

...

Keyword(s):

Symptom Severity ◽

Structural Mri ◽

Hippocampal Volume ◽

Subcortical Structures ◽

Tic Disorder ◽

Tic Severity ◽

Mri Scans ◽

One Year ◽

Important Marker

Previous studies have investigated differences in the volumes of subcortical structures (e.g., caudate nucleus, putamen, thalamus, amygdala, and hippocampus) between individuals with and without Tourette syndrome (TS), as well as the relationships between these volumes and tic symptom severity. These volumes may also predict clinical outcome in Provisional Tic Disorder (PTD), but that hypothesis has never been tested. This study aimed to examine whether the volumes of subcortical structures measured shortly after tic onset can predict tic symptom severity at one-year post-tic onset, when TS can first be diagnosed. We obtained T1-weighted structural MRI scans from 41 children with PTD (25 with prospective motion correction (vNavs)) whose tics had begun less than 9 months (mean 4.04 months) prior to the first study visit (baseline). We re-examined them at the 12-month anniversary of their first tic (follow-up), assessing tic severity using the Yale Global Tic Severity Scale. We quantified the volumes of subcortical structures using volBrain software. Baseline hippocampal volume was correlated with tic severity at the 12-month follow-up, with a larger hippocampus at baseline predicting worse tic severity at follow-up. The volumes of other subcortical structures did not significantly predict tic severity at follow-up. Hippocampal volume may be an important marker in predicting prognosis in Provisional Tic Disorder.

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Botulinum Toxin for the Treatment of Motor and Phonic Tics: A Case Report

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419898211 ◽

2020 ◽

Vol 129 (6) ◽

pp. 625-627

Author(s):

Nikita Kohli ◽

Andrew Blitzer

Keyword(s):

Case Report ◽

Daily Life ◽

Severity Scale ◽

Level Of Evidence ◽

Tic Disorder ◽

Novel Approach ◽

Onabotulinum Toxin A ◽

Tic Severity ◽

Unique Approach ◽

Effective Use

Objective: To present a unique approach to the treatment of motor and phonic tics. Patient: A 26-year-old male presented with motor and phonic tics including grunting, coughing, and throat clearing. Intervention: The patient was treated with 2.5 units of onabotulinum toxin A (BoNT) to the facial mimetic musculature and 2.5 units to each supraglottic musculature via a transthyrohyoid membrane approach under fiberoptic visualization. Results: The patient experienced reduction in the frequency, intensity, and interference with daily life of motor and phonic tics on the Yale Global Tic Severity Scale (YGTSS). Conclusion: This patient experienced subjective and objective decreases in tic severity using a unique approach in the treatment of phonic tics. Results suggest a novel approach in the treatment of phonic tics and bolster the data regarding safe and effective use of BoNT for tic disorder. Level of evidence: Level V, case report.

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Peer Victimization in Youth with Tourette’s Syndrome and Chronic Tic Disorder: Relations with Tic Severity and Internalizing Symptoms

Journal of Psychopathology and Behavioral Assessment ◽

10.1007/s10862-007-9050-4 ◽

2007 ◽

Vol 29 (4) ◽

pp. 211-219 ◽

Cited By ~ 42

Author(s):

Eric A. Storch ◽

Tanya K. Murphy ◽

Rhea M. Chase ◽

Mary Keeley ◽

Wayne K. Goodman ◽

...

Keyword(s):

Peer Victimization ◽

Internalizing Symptoms ◽

Tourette's Syndrome ◽

Tourette’S Syndrome ◽

Tic Disorder ◽

Chronic Tic Disorder ◽

Tic Severity

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Evaluation of a cognitive psychophysiological model for management of tic disorders: an open trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.154518 ◽

2016 ◽

Vol 209 (1) ◽

pp. 76-83 ◽

Cited By ~ 26

Author(s):

Kieron O'Connor ◽

Marc Lavoie ◽

Pierre Blanchet ◽

Marie-Ève St-Pierre-Delorme

Keyword(s):

Tourette Syndrome ◽

Self Esteem ◽

Current Treatment ◽

Open Trial ◽

Tic Disorders ◽

Tic Disorder ◽

Chronic Tic Disorder ◽

Tic Severity ◽

Sensorimotor Processes

BackgroundTic disorders, in particular chronic tic disorder and Tourette syndrome, affect about 1% of the population. The current treatment of choice is pharmacological or behavioural, addressing tics or the premonitory urges preceding tic onset.AimsThe current study reports an open trial evaluating the effectiveness of a cognitive psychophysiological treatment addressing Tourette-specific sensorimotor activation processes rather than the tic.MethodForty-nine people with Tourette syndrome and 36 people with chronic tics completed 10 weeks of individual cognitive psychophysiological therapy. Outcome measures included two tic severity scales and psychosocial measures.ResultsPost-treatment both groups had significantly improved on the tic scales with strong effect sizes across tic locations and complex and simple tics, maintained at 6-month follow-up with further change in perfectionism and self-esteem.ConclusionsThe cognitive psychophysiological approach targeting underlying sensorimotor processes rather than tics in Tourette's and chronic tic disorder reduced symptoms with a large effect size.

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Role of Perinatal Adversities on Tic Severity and Symptoms of Attention Deficit/Hyperactivity Disorder in Children and Adolescents With a Tic Disorder

Journal of Developmental & Behavioral Pediatrics ◽

10.1097/dbp.0b013e3181cc7cbc ◽

2010 ◽

Vol 31 (2) ◽

pp. 100-106 ◽

Cited By ~ 15

Author(s):

Netty G. P. Bos-Veneman ◽

Anne Kuin ◽

Ruud B. Minderaa ◽

Pieter J. Hoekstra

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Children And Adolescents ◽

Attention Deficit ◽

Tic Disorder ◽

Hyperactivity Disorder ◽

Tic Severity

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Neurophysiological Determinants of Tic Severity in Children with Chronic Motor Tic Disorder

Applied Psychophysiology and Biofeedback ◽

10.1007/s10484-011-9155-0 ◽

2011 ◽

Vol 36 (2) ◽

pp. 121-127 ◽

Cited By ~ 3

Author(s):

Michael Siniatchkin ◽

Andrea Kuppe

Keyword(s):

Tic Disorder ◽

Tic Severity

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Predicting Clinical Course from Subcortical Shape in Provisional Tic Disorder

10.1101/2021.11.04.21265815 ◽

2021 ◽

Author(s):

Tiffanie Che ◽

Soyoung Kim ◽

Deanna J. Greene ◽

Ashley Heywood ◽

Jimin Ding ◽

...

Keyword(s):

Tic Disorders ◽

Healthy Controls ◽

Linear Regression Models ◽

Tic Disorder ◽

Surface Maps ◽

Chronic Tic Disorder ◽

Tic Severity ◽

Group A ◽

Diffeomorphic Metric Mapping

The ongoing NewTics study examines children who have had tics for less than 9 months (NT group) - a population on which little research exists. Here, we further investigate relationships between subcortical shape and tic symptom outcomes. 138 children were assessed at baseline and a 12-month follow-up: 79 with NT, 27 tic-free healthy controls (HC), and 32 with chronic tic disorder or Tourette syndrome (TS), using T1-weighted MRI and total tic scores (TTS) from the Yale Global Tic Severity Scale to evaluate symptom change. Subcortical surface maps were generated using FreeSurfer-initialized large deformation diffeomorphic metric mapping, and linear regression models were constructed to correlate structural shapes with TTS while accounting for covariates, with relationships mapped onto structure surfaces. When compared to healthy controls, smaller mean volumes were found in the TS group for the caudate, nucleus accumbens, pallidum, and thalamus. NT had smaller mean volumes than controls in the caudate, pallidum, and thalamus. Surface maps illustrate distinct patterns of inward deformation (localized volume loss) in the TS group compared to NT children. In the NT group, a larger hippocampus at baseline significantly correlated with the worsening of tic symptoms at 12 months. Outward deformation in the hippocampus and inward deformation in the accumbens at baseline are also related to worsening tic symptoms at follow-up. Since the NT group has had tics only for a few months, we can rule out the possibility that these subcortical volume differences are caused by living with tics for years; they are more likely related to the cause of tics. These observations constitute some of the first prognostic biomarkers for tic disorders and suggest localized circuitry that may be associated with outcome of tic disorders.

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