scholarly journals A clinical inventory of moderators of tic severity in Tourette's Syndrome

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S245-S246
Author(s):  
Francesca Conti ◽  
Himanshu Tyagi
Keyword(s):  
Thematic Analysis ◽  
Subjective Effects ◽  
Tourette's Syndrome ◽  
Tourette’S Syndrome ◽  
Moderating Variables ◽  
Mesh Terms ◽  
Academic Activities ◽  
Tic Severity ◽  
Peer Victimisation ◽  
Watching Tv

AimsChanges in the severity of tics in Tourette's syndrome (TS), as seen with variations in the intensity or frequency of tics, can be moderated by a variety of independent factors such as external or internal stimuli. Identifying such moderators has important clinical implications as it can aid clinicians in adjusting interventions. Hence, based on our previous review of tic-severity moderators, we developed a clinical inventory of moderating variables for motor and vocal tics for inclusion in the new version of the Queen Square Proforma for Tourette's Syndrome to aid initial assessments in the National Tourette Syndrome Service's Outpatient Clinic for Adults.MethodA review of tic-severity moderators was previously carried out by the authors to investigate the kinds of moderators and their worsening, improving or neutral effects on tic severity. Based on this a semantic thematic analysis of the identified moderators was carried out and themes were developed based on appropriate and relevant MeSH terms in order to create the categories and items of the clinical inventory.ResultSeventy-three different tic severity moderators were identified, the most common being exercise, sleep, peer victimisation, psychosocial stress, watching TV, academic activities and distraction. Twenty-nine themes emerged from the thematic analysis which were then used to update the clinical inventory of tic severity moderators. The review also highlighted the subjectivity of these moderators’ effects on tic severity as some moderators were tic-worsening in some individuals and tic-improving or neutral in others, which is contrary to the current dichotomous understanding.ConclusionThe updated clinical inventory of tic severity moderators invites researchers and clinicians to be more aware of the existence, variability and subjective effects of these tic severity moderators in individuals with TS, as these have been previously looked in a dichotomous way. By better identifying tic-severity moderators and their worsening, improving or neutral effects on tic severity this clinician rated inventory will have potentially important, direct implications for the management and treatment of tics.

Pilot study of effect of emotional stimuli on tic severity in children with Tourette's syndrome

2003 ◽  
Vol 18 (11) ◽  
pp. 1392-1395 ◽  
Author(s):  
Beatrice L. Wood ◽  
Kendra Klebba ◽  
Olufowbi Gbadebo ◽  
David Lichter ◽  
Roger Kurlan ◽  
...  
Keyword(s):  
Pilot Study ◽  
Tourette's Syndrome ◽  
Tourette’S Syndrome ◽  
Emotional Stimuli ◽  
Tic Severity

#3118 Tic-severity moderators: a systematic review on the subjectivity of external and internal factors in moderating tic-severity in Tourette’s syndrome

2021 ◽  
Vol 92 (8) ◽  
pp. A10.2-A11
Author(s):  
Francesca Conti ◽  
Himanshu Tyagi
Keyword(s):  
Meta Analysis ◽  
Subjective Effects ◽  
Holistic Approach ◽  
Research Literature ◽  
Future Research ◽  
Internal Factors ◽  
Moderating Variables ◽  
Assessment And Treatment ◽  
Tic Severity ◽  
Neutral Effect

ObjectivesChanges in the severity of tics in Tourettes syndrome (TS), as seen with variations in the intensity or frequency of tics, can be moderated by a variety of independent simple or complex factors suchasexternalorinternalstimulioverlaidwithpsychologicalandphysiological variables. Identifying such moderators has important clinical implications as it can aid clinicians in adjusting interventions. Here we review research literature related to tic-severity moderators and their tic-worsening, tic-improving and neutral effects in individuals with TS with the aim to create a clinical inventory of moderating variables.MethodsA literature search using terms relating to tic severity, tic frequency, factors and moderators was conducted on Ovid Medline, Psych Info, APA Psych Articles, ProQuest,Scopus and PubMed following PRISMA guidelines. The criteria for this review included any published study, review and meta-analysis after the last review in 2008, investigating external and internal factors that had a tic-worsening, improving or neutral effect on children, adolescents or adults with TS and comorbidities.Results225 studies were initially identified after deduplication. A variety of tic severity moderators were identified with the most prominent being the effects of exe, sleep, distraction and comorbidities such as ADHD. However, an interesting finding was the high variability in these tic-moderating effects, as the same factor was tic-worsening in some patients and tic-improving in others, highlighting the subjectivity of these effects on tic severity. It was also noted that most of there viewed research did not report the possibility of a neutral effect.ConclusionsAs previous research has looked at these moderators in a dichotomous way, clinicians and researchers should be made more aware of the existence and variability of these tic severity moderators and of their highly subjective effects. This also has important, direct implications for the psychological assessment and treatment of tics. This review invites future research and clinicians to take this holistic approach on the effects ontic severity into consideration.

Differential effects of transdermal nicotine on microstructured analyses of tics in Tourette's syndrome: an open study

1997 ◽  
Vol 27 (2) ◽  
pp. 483-487 ◽  
Author(s):  
SERDAR M. DURSUN ◽  
MICHAEL A. REVELEY
Keyword(s):  
Open Study ◽  
Nicotine Patch ◽  
Tourette's Syndrome ◽  
Tourette’S Syndrome ◽  
Transdermal Nicotine ◽  
Tic Severity ◽  
Structured Analysis ◽  
Transdermal Nicotine Patch ◽  
Haloperidol Treatment

Background. The treatment of Tourette's syndrome (TS) is often unsatisfactory. However, there is some evidence that transdermal nicotine patch (TNP) application may improve tics of non-smoking TS patients who are refractory to haloperidol treatment.Methods. In this open study we applied two 10 mg TNP for 2 consecutive days to four TS patients whose symptoms were not controlled by haloperidol and to a never-medicated TS patient, all of whom are non-smokers. The Yale Global Tic Severity Scale (YGTSS) and a quantified video-taped micro-structured analysis of tics (head-shake tics, eye-blinks, vocal tics, facial grimace and other body tics) were both carried out to assess the change after the application of TNP.Results. TNP application significantly reduced the YGTSS by an average of 50%, with no reported side-effects, for up to 4 weeks but not 16 weeks, as compared with TNP-free period. Consistent with these results, the total counts of tics also showed a significant decrease for up to 4 weeks after the TNP application.Conclusion. TNP application differentially affected individually quantified tics, which may suggest a differential role of nicotinic receptors in the generation of different tics.

scholarly journals A Process-Oriented View of Procedural Memory Can Help Better Understand Tourette’s Syndrome

2021 ◽  
Vol 15 ◽  
Author(s):  
Bence Cs. Farkas ◽  
Eszter Tóth-Fáber ◽  
Karolina Janacsek ◽  
Dezso Nemeth
Keyword(s):  
Neurodevelopmental Disorders ◽  
Neurodevelopmental Disorder ◽  
Procedural Memory ◽  
Tourette's Syndrome ◽  
Tourette’S Syndrome ◽  
Complex Profile ◽  
Repetitive Movements ◽  
Tic Severity ◽  
Process Oriented ◽  
Atypical Development

Tourette’s syndrome (TS) is a neurodevelopmental disorder characterized by repetitive movements and vocalizations, also known as tics. The phenomenology of tics and the underlying neurobiology of the disorder have suggested that the altered functioning of the procedural memory system might contribute to its etiology. However, contrary to the robust findings of impaired procedural memory in neurodevelopmental disorders of language, results from TS have been somewhat mixed. We review the previous studies in the field and note that they have reported normal, impaired, and even enhanced procedural performance. These mixed findings may be at least partially be explained by the diversity of the samples in both age and tic severity, the vast array of tasks used, the low sample sizes, and the possible confounding effects of other cognitive functions, such as executive functions, working memory or attention. However, we propose that another often overlooked factor could also contribute to the mixed findings, namely the multiprocess nature of the procedural system itself. We propose that a process-oriented view of procedural memory functions could serve as a theoretical framework to help integrate these varied findings. We discuss evidence suggesting heterogeneity in the neural regions and their functional contributions to procedural memory. Our process-oriented framework can help to deepen our understanding of the complex profile of procedural functioning in TS and atypical development in general.

scholarly journals Targeted Interventions in Tourette’s using Advanced Neuroimaging and Stimulation (TITANS): study protocol for a double-blind, randomised controlled trial of transcranial magnetic stimulation (TMS) to the supplementary motor area in children with Tourette’s syndrome

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e053156
Author(s):  
Cynthia K Kahl ◽  
Rose Swansburg ◽  
Adam Kirton ◽  
Tamara Pringsheim ◽  
Gabrielle Wilcox ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Health Research ◽  
Magnetic Stimulation ◽  
Supplementary Motor Area ◽  
Controlled Trial ◽  
Motor Area ◽  
Tourette's Syndrome ◽  
Tourette’S Syndrome ◽  
Double Blind ◽  
Tic Severity

IntroductionTourette’s syndrome (TS) affects approximately 1% of children. This study will determine the efficacy and safety of paired comprehensive behavioural intervention for tics (CBIT) plus repetitive transcranial magnetic stimulation (rTMS) treatment in children with Tourette’s syndrome. We hypothesise that CBIT and active rTMS to the supplementary motor area (SMA) will (1) decrease tic severity, and (2) be associated with changes indicative of enhanced neuroplasticity (eg, changes in in vivo metabolite concentrations and TMS neurophysiology measures).Methods and analysisThis study will recruit 50 youth with TS, aged 6–18 for a phase II, double-blind, block randomised, sham-controlled trial comparing active rTMS plus CBIT to sham rTMS plus CBIT in a 1:1 ratio. The CBIT protocol is eight sessions over 10 weeks, once a week for 6 weeks and then biweekly. The rTMS protocol is 20 sessions of functional MRI-guided, low-frequency (1 Hz) rTMS targeted to the bilateral SMA over 5 weeks (weeks 2–6). MRI, clinical and motor assessments and neurophysiological evaluations including motor mapping will be performed 1 week before CBIT start, 1 week after rTMS treatment and 1 week after CBIT completion. The primary outcome measure is Tourette’s symptom change from baseline to post-CBIT treatment, as measured by the Yale Global Tic Severity Scale. Secondary outcomes include changes in imaging, neurophysiological and behavioural markers.Ethics and disseminationEthical approval by the Conjoint Health Research Ethics Board (REB18-0220). The results of this study will be published in peer-reviewed scientific journals, on ClinicalTrials.gov and shared with the Tourette and OCD Alberta Network. The results will also be disseminated through the Alberta Addictions and Mental Health Research Hub.Trial registrationNCT03844919.

Tourette’s Syndrome

2008 ◽  
Author(s):  
John T. Walkup ◽  
Benjamin N. Schneider
Keyword(s):  
Young Adulthood ◽  
Epidemiologic Studies ◽  
Tourette's Syndrome ◽  
Cervical Disc ◽  
Tourette’S Syndrome ◽  
Physical Injury ◽  
Prevalence Estimates ◽  
Tic Severity ◽  
Muscle Groups ◽  
The Many

Tourette’s syndrome (TS) is a neuropsychiatric disorder of childhood onset characterized by the presence of motor and vocal tics for a duration of at least 1 year. Tics are typically brief and stereotypical movements (eg, eye blinking, head jerks) or vocalizations (eg, throat clearing, grunting), but they can also be more complex movements involving multiple muscle groups and combinations of movements and sounds. There is a great range of tic severity. Tics can be so subtle or occur so infrequently as to be unnoticeable, even to the person with the tics. However, tics can also be so intense and frequent that they are readily noticeable by others, and they can be disruptive of daily activities. Indeed, in some cases (eg, severe head jerks), tics can cause pain or physical injury (eg, cervical disc and spine damage). Tics usually begin in childhood; the average age at diagnosis is 7 years. They reach peak severity in the early teen years and then lessen in intensity and frequency during young adulthood (Leckman et al., 2001). Tics wax and wane in severity, worsening with excitement and stress and improving during calm, focused activities. Coprolalia and its motor counterpart copropraxia (uttering obscene words or making obscene gestures, respectively) are uncommon symptoms, occurring in less than 10% of patients with TS and are not required for a diagnosis of TS (Robertson and Stern, 1998). Many patients describe a sensation or urge prior to tic occurrence, commonly referred to as a premonitory sensation or urge (Miguel et a1., 2000). Even though tics are considered involuntary, they can be voluntarily suppressed for short periods of time. Prevalence estimates of TS have varied and depend a great deal on the threshold for diagnosis and setting in which cases are identified. A review of the many epidemiologic studies suggests that 0.1% to 1% of people are affected with TS (Scahill et al., 2005). Despite this variability in specific rates, epidemiologic studies have consistently identified that males are more commonly affected than females, children are more frequently affected than adults, and that milder forms of TS are more common than severe forms.

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