A 2-year longitudinal follow-up of quantitative assessment neck tics in Tourette’s syndrome

Background Neck motor tics in Tourette’s syndrome can cause severe neck complications. Although addressed in a few longitudinal studies, the clinical course of Tourette’s syndrome has not been quantitatively assessed. We had previously developed a method for quantifying the angular movements of neck tics using a compact gyroscope. Here, we present a follow-up study aimed at elucidating the clinical course of neck tics at both the group and individual levels. Methods Eleven patients with Tourette’s syndrome from our previous study participated in the present study, and their neck tics were recorded during a 5-min observation period. The severity of neck symptoms was assessed using the Yale Global Tic Severity Scale. The peak angular velocities and accelerations, tic counts, and severity scores in our previous study (baseline) and the present study (2-year follow-up) were compared at the group and individual levels. The individual level consistency between baseline and follow-up were calculated using intra-class correlation coefficients (ICCs, one-way random, single measure). Results At the group level, no significant change was observed between baseline and follow-up. At the individual level, angular velocity (ICC 0.73) and YGTSS scores (ICC 0.75) had substantial consistency over the two time points, and angular acceleration (ICC 0.59) and tic counts (ICC 0.69) had moderate consistency. Conclusions The intensity and frequency of neck tics did not change over time. Therefore, quantification of angular neck motor tics will aid in identifying patients with neck tics at high risk for severe neck complications.

Stigma and Adults with Tourette’s Syndrome: “Never Laugh at Other People’s Disabilities, Unless they have Tourette’s—Because How Can You Not?”

Tourette’s syndrome (TS) is a condition that has been stigmatised and mocked in contemporary society, yet little is known about the subjective experience of those directly affected by it. Guided by Public and Patient Involvement (PPI) a mixed method design was used for this study to explore the experience of stigma in adults living with TS in the UK. A total of one hundred and ninety-nine adults participated in a cross-sectional online survey using an adapted version of the Discrimination and Stigma Scale (DISC-12) and the Perceived Quality of Life (PQoL) scale, twenty of whom were also interviewed using a semi-structured interview schedule. Quantitative findings indicated that participants experienced discrimination in numerous life domains; most prominently in education (75.4%), social life (71.4%), public transport (60.8%) and employment (54.3.%). The PQoL of adults with Tourette’s was found to be negatively correlated with both Enacted and Anticipated Discrimination from the DISC-12 scale. Qualitative findings illustrated the pervasive nature of TS stigma, which expanded beyond micro-interactions, and which could be observed at a structural level. The peculiar impact of disparagement humour in the construction and promulgation of “othering” individuals with TS was also highlighted. Concealment and self-stigma were mechanisms commonly utilised by individuals to manage their “spoiled identity”, inhibiting active and collective responses to stigmatisation. The study highlights how TS stigma acts as a barrier to social and economic participation for adults with the condition and helps identify factors that need to be considered when developing anti-stigma strategies.

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

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.

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

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.

Association of Prenatal Maternal Anemia with Tics and Tourette’s Syndrome in Offspring

Iron deficiency anemia (IDA) accounts for most of the anemia in pregnancy, and iron is essential for neurodevelopment. Tics and Tourette’s syndrome (TS) are neurodevelopmental disorders that manifest in childhood. A few studies reported an inconclusive association between iron deficiency and tics in children. No study has investigated the relationship between prenatal maternal anemia and tics in children. We aimed to assess the relationship between prenatal anemia exposure and the incidence of tics or TS in offspring. We linked the Taiwan National Health Insurance Research Database to the Maternal and Child Health Database for the analysis and identified 153,854 children with prenatal anemia exposure and 2,014,619 children without prenatal anemia exposure from 2004 to 2016 and followed them through 2017. Cox regression models were applied to compare the risk of tics or TS between the exposed and nonexposed groups. Among the exposed group, 37,832 were exposed at ≤12 weeks of gestational age (GA) and 116,022 at >12 weeks of GA. We observed an increased risk of tics and TS in those exposed at ≤12 weeks compared with the nonexposed group (adjusted hazard ratio (aHR) = 1.23, 95% confidence interval (CI): 1.12–1.34). The result remained consistent after adjusting for birth year, sex, birth order, maternal age, low-income levels, gestational age, birth weight, and alcohol use and smoking during pregnancy (aHR = 1.16, CI: 1.04–1.28). Fetuses exposed to maternal anemia at ≤12 weeks of GA are at high risk of tics or TS. However, this effect was attenuated to insignificance in the sibling comparison. Our study highlights the importance of detection of anemia during pregnancy and proper timing of iron supplementation.

The Cannabis Extraction Product as an Adjuvant Treatment in Tourette’s Syndrome: A Case Report

Tourette’s syndrome (TS) is a pediatric onset of neuropsychiatric disorder characterized by motor and vocal tics. First line medication is dopaminergic blocking agents. Yet, these drugs are not effective in all patients and sometimes the side effects are intolerance. Cannabis and its derivatives are to use as an adjuvant treatment. They are used to improve tics in TS patients who failed from the first line treatment. The aim of the present report was to describe the clinical course after using the Government Pharmaceutical Organization (GPO) medical cannabis extraction product as an adjuvant treatment in TS patient. Here, the researchers reported a case of a 26-year-old female patient who had TS. She had received sublingual medical cannabis product. The clinical course and disease severity were recorded before and during the administration of the medical cannabis extraction product using several standards severity score: The Yale Global Tic Severity Scale (YGTSS), Tourette’s Syndrome Severity Scale (TSSS), Turette’s Disorder Scale (TODS), and quality of life using a standardized measure of health-related quality of life developed by the Euro Quality of life group (EQ-5D-5L). The researchers’ observation showed that sublingual administration of medical cannabis extraction product [tetrahydrocannabinol (THC):cannabidiol (CBD) 1:1 and THC enriched] improved both motor and vocal tics without significant adverse effect that came out to be improving the patient’s quality of life as a whole. Keywords: Tourette’s Syndrome (TS); The Government Pharmaceutical Organization (GPO); Medical cannabis extraction product; Cannabidiol; Tetrahydrocannabinol

Understanding the Pathophysiology of Tourette’s Syndrome: A Review

Tourette’s syndrome (TS) is a neuropsychiatric and neurodevelopment disease typified by deterioration of motor and vocal tics which leads to neuropsychiatric symptoms and impaired motor activities manifestation. Several lines of study indicate the interplay of genetic and environmental factors to be involved in this complex neuropsychiatric syndrome. Approximately 1% people are affected worldwide from this syndrome. In this review, a concise outline presented on the classification, its clinical features and neuropsychiatric co-morbidities linked with this syndrome. This paper also highlights the neurochemistry, dysfunction of (Cortioc-Striato-Thalamo-Cortical) CSTC circuits in TS and an overview on the management approach towards the prevention of TS. Regardless of the major improvements in the understanding of exact cellular and molecular basis of TS, the various evidence indicate that the various neurotransmitter such as dopamine, glutamate, gamma- aminobutyric acid (GABA), serotonin, noradrenergic, cholinergic system, serotonergic system and histaminergic pathways play a major role in pathogenesis of TS. Several research indicates that the dysfunction of CSTS circuits occurred in this complex syndrome These areas of research have contributed to the therapeutic approach towards the management of TS and also provide the basis for future progress of the therapeutic strategies. Thus, tics generated in TS, which affect the social and academic life of patients and disruptive or troubling the family of patients. Patients existing with this syndrome have to face difficulties integrating into social life and coping with day to day basis activities, as a consequence of the syndrome.