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Kurvits L, Stenner MP, Guo S, Neumann WJ, Haggard P, Ganos C. Rapid Compensation for Noisy Voluntary Movements in Adults with Primary Tic Disorders. Mov Disord 2024. [PMID: 38661451 DOI: 10.1002/mds.29775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/17/2024] [Accepted: 02/22/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND It has been proposed that tics and premonitory urges in primary tic disorders (PTD), like Tourette syndrome, are a manifestation of sensorimotor noise. However, patients with tics show no obvious movement imprecision in everyday life. One reason could be that patients have strategies to compensate for noise that disrupts performance (ie, noise that is task-relevant). OBJECTIVES Our goal was to unmask effects of elevated sensorimotor noise on the variability of voluntary movements in patients with PTD. METHODS We tested 30 adult patients with PTD (23 male) and 30 matched controls in a reaching task designed to unmask latent noise. Subjects reached to targets whose shape allowed for variability either in movement direction or extent. This enabled us to decompose variability into task-relevant versus less task-relevant components, where the latter should be less affected by compensatory strategies than the former. In alternating blocks, the task-relevant target dimension switched, allowing us to explore the temporal dynamics with which participants adjusted movement variability to changes in task demands. RESULTS Both groups accurately reached to targets, and adjusted movement precision based on target shape. However, when task-relevant dimensions of the target changed, patients initially produced movements that were more variable than controls, before regaining precision after several reaches. This effect persisted across repeated changes in the task-relevant dimension across the experiment, and therefore did not reflect an effect of novelty, or differences in learning. CONCLUSIONS Our results suggest that patients with PTD generate noisier voluntary movements compared with controls, but rapidly compensate according to current task demands. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lille Kurvits
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Department of Neurology, Charité University Hospital, Berlin, Germany
| | - Max-Philipp Stenner
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health, Jena-Magdeburg-Halle, Germany
| | - Siqi Guo
- Department of Neurology, Charité University Hospital, Berlin, Germany
| | | | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Christos Ganos
- Department of Neurology, Charité University Hospital, Berlin, Germany
- Movement Disorder Clinic, Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
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2
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Desai I, Kumar N, Goyal V. An Update on the Diagnosis and Management of Tic Disorders. Ann Indian Acad Neurol 2023; 26:858-870. [PMID: 38229610 PMCID: PMC10789408 DOI: 10.4103/aian.aian_724_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/14/2023] [Accepted: 10/06/2023] [Indexed: 01/18/2024] Open
Abstract
Tic disorders (TDs) are a group of common neuropsychiatric disorders of childhood and adolescence. TDs may impact the physical, emotional, and social well-being of the affected person. In this review, we present an update on the clinical manifestations, pathophysiology, diagnosis, and treatment of TDs. We searched the PubMed database for articles on tics and Tourette syndrome. More than 400 articles were reviewed, of which 141 are included in this review. TDs are more prevalent in children than in adults and in males than in females. It may result from a complex interaction between various genetic, environmental, and immunological factors. Dysregulation in the cortico-striato-pallido-thalamo-cortical network is the most plausible pathophysiology resulting in tics. TD is a clinical diagnosis based on clinical features and findings on neurological examination, especially the identification of tic phenomenology. In addition to tics, TD patients may have sensory features, including premonitory urge; enhanced and persistent sensitivity to non-noxious external or internal stimuli; and behavioral manifestations, including attention deficit hyperactivity disorders, obsessive-compulsive disorders, and autism spectrum disorders. Clinical findings of hyperkinetic movements that usually mimic tics have been compared and contrasted with those of TD. Patients with TD may not require specific treatment if tics are not distressing. Psychoeducation and supportive therapy can help reduce tics when combined with medication. Dispelling myths and promoting acceptance are important to improve patient outcomes. Using European, Canadian, and American guidelines, the treatment of TD, including behavioral therapy, medical therapy, and emerging/experimental therapy, has been discussed.
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Affiliation(s)
- Ishita Desai
- Department of Neurology, Teerthankar Mahaveer University, Moradabad, Uttar Pradesh, India
| | - Niraj Kumar
- Department of Neurology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Vinay Goyal
- Department of Neurology, Institute of Neurosciences, Medanta, Gurugram, Haryana, India
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3
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Kurvits L, Tozdan S, Mainka T, Münchau A, Müller-Vahl KR, Cavanna AE, Briken P, Ganos C. Compulsive sexual behavior and paraphilic interests in adults with chronic tic disorders and Tourette syndrome: a survey-based study. Int J Impot Res 2023:10.1038/s41443-023-00729-x. [PMID: 37468536 DOI: 10.1038/s41443-023-00729-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023]
Abstract
Early research suggested that compulsive sexual behavior (CSB) and paraphilic interests (PI) are more prevalent in adults with primary tic disorders compared to the general population. However, recent data on this topic remain scarce. We conducted an anonymous online survey capturing data on CSB and PI in adult patients with primary tic disorders. We also explored the role of antipsychotic tic medication and the impact of neuropsychiatric comorbidities like attention-deficit hyperactivity disorder and depression. In total, 62 participants (26 females/36 males) completed the survey. The prevalence of CSB and PI were 12.9% and 19.4%, respectively. There was no association with antipsychotic medication nor with symptoms of depression. However, the presence of attention-deficit hyperactivity disorder was associated with a higher prevalence of both CSB and PI. The current results contrast with earlier reports and show that in adults with primary tic disorders, the prevalence of CSB and PI is not overly prominent.
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Affiliation(s)
- Lille Kurvits
- Department of Neurology with Experimental Neurology, Charité University Medicine, Berlin, Germany.
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
| | - Safiye Tozdan
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tina Mainka
- Department of Neurology with Experimental Neurology, Charité University Medicine, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Kirsten R Müller-Vahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Andrea E Cavanna
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust and University of Birmingham, Birmingham, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
- University College London and Institute of Neurology, London, UK
- Department of Child Neuropsychiatry, University of Milano-Bicocca, Milan, Italy
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christos Ganos
- Department of Neurology with Experimental Neurology, Charité University Medicine, Berlin, Germany
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4
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Vilela-Filho O, Souza JT, Ragazzo PC, Silva DJ, Oliveira PM, Goulart LC, Reis MD, Piedimonte F, Ribeiro TM. Bilateral Globus Pallidus Externus Deep Brain Stimulation for the Treatment of Refractory Tourette Syndrome: An Open Clinical Trial. Neuromodulation 2023:S1094-7159(23)00646-3. [PMID: 37294231 DOI: 10.1016/j.neurom.2023.04.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We have previously proposed that Tourette syndrome (TS) is the clinical expression of the hyperactivity of globus pallidus externus (GPe) and various cortical areas. This study was designed to test this hypothesis by verifying the efficacy and safety of bilateral GPe deep brain stimulation (DBS) for treating refractory TS. MATERIALS AND METHODS In this open clinical trial, 13 patients were operated on. Target coordinates (center of GPe) were obtained by direct visualization. Physiological mapping was performed with macrostimulation and microrecording. Primary and secondary outcome measures were, respectively, responder and improvement rates of TS and comorbidities, according to pre- and postoperative scores on the following assessment instruments: Yale Global Tic Severity Scale, Yale-Brown Obsessive Compulsive Scale, Beck Depression Inventory/Hamilton Depression Rating Scale, Beck Anxiety Inventory/Hamilton Anxiety Rating Scale, and Concentrated Attention test. RESULTS Intraoperative stimulation (100 Hz/5.0V) did not produce any adverse effects or impact on tics. Microrecording revealed bursting cells discharging synchronously with tics in the central part of the dorsal half of GPe. Patients were followed up for a mean of 61.46±48.50 months. Responder rates were 76.9%, 75%, 71.4%, 71.4%, and 85.7%, respectively, for TS, obsessive-compulsive disorder (OCD), depression, anxiety, and attention deficit hyperactivity disorder. Mean improvements among responders in TS, OCD, depression, and anxiety were 77.4%, 74.7%, 89%, and 84.8%, respectively. After starting stimulation, tic improvement was usually delayed, taking up to ten days to manifest. Afterward, it increased over time, usually reaching its maximum at approximately one year postoperatively. The best stimulation parameters were 2.3V to 3.0V, 90 to 120 μsec, and 100 to 150 Hz, and the most effective contacts were the two dorsal ones. Two complications were registered: reversible impairment of previous depression and transient unilateral bradykinesia. CONCLUSIONS Bilateral GPe-DBS proved to be low risk and quite effective for treating TS and comorbidities, ratifying the pathophysiological hypothesis that led to this study. Moreover, it compared favorably with DBS of other targets currently in use.
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Affiliation(s)
- Osvaldo Vilela-Filho
- Division of Neurosurgery, Department of Surgery, Medical School, Federal University of Goiás, Goiânia, Goiás, Brazil; Nervous System Unity, Clinics Hospital, Medical School, Federal University of Goiás, Goiânia, Goiás, Brazil; Department of Stereotactic and Functional Neurosurgery, Goiânia Neurological Institute, Goiânia, Goiás, Brazil.
| | - Joaquim T Souza
- Nervous System Unity, Clinics Hospital, Medical School, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Paulo C Ragazzo
- Department of Neurology, Goiânia Neurological Institute, Goiânia, Goiás, Brazil
| | - Délson J Silva
- Nervous System Unity, Clinics Hospital, Medical School, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Paulo M Oliveira
- Department of Psychiatry, Medical School, Federal University of Goiás, Goiânia, Goiás, Brazil; Department of Psychiatry, Goiânia Neurological Institute, Goiânia, Goiás, Brazil
| | - Lissa C Goulart
- Nervous System Unity, Clinics Hospital, Medical School, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Manoel D Reis
- Department of Psychiatry, Goiânia Neurological Institute, Goiânia, Goiás, Brazil
| | - Fabian Piedimonte
- JJ Naon Institute of Morphology, Medical School, University of Buenos Aires, Buenos Aires, Argentina
| | - Telma M Ribeiro
- Department of Psychiatry, Goiânia Neurological Institute, Goiânia, Goiás, Brazil
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5
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Antolini G, Colizzi M. Where Do Neurodevelopmental Disorders Go? Casting the Eye Away from Childhood towards Adulthood. Healthcare (Basel) 2023; 11:healthcare11071015. [PMID: 37046942 PMCID: PMC10094062 DOI: 10.3390/healthcare11071015] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Neurodevelopmental disorders (NDDs) encompass a group of complex conditions with onset during the early developmental period. Such disorders are frequently associated with a number of neuropsychiatric features, the most prevalent ones being autism spectrum disorder, attention-deficit/hyperactivity disorder, intellectual disability, communication and specific learning disorders, and motor disorders. These conditions are characterized by wide genetic and clinical variability, and although they were previously conceptualized as childhood-limited disorders, NDDs are progressively being recognized as persistent conditions with a potentially relevant impact on the quality of life and overall functioning during adult life. In addition, emerging evidence seems to point towards the hypothesis of a neurodevelopmental continuum, according to which NNDs could portray different time-dependent outcomes, depending on the severity of the altered brain development. Despite representing lifelong phenotypes, they are often not promptly identified and/or managed in adulthood. In this regard, specific guidelines on clinical and therapeutic approaches for these conditions have not yet been delineated. In this view, future research investigations should be encouraged to broaden available knowledge, characterize the clinical course of NDDs across an individual’s lifespan, and better understand the patterns of aging-related concerns in adults with an NDD diagnosis. Additionally, considering the difficulties many young adults encounter while transitioning from childhood to adult mental health services, new, specific programs should be developed and existing programs should be implemented to improve the transition process and for the management of NDDs in adulthood.
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Affiliation(s)
- Giulia Antolini
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy
| | - Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
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6
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Paulus T, Wernecke L, Lundie A, Friedrich J, Verrel J, Rawish T, Weissbach A, Frings C, Beste C, Bäumer T, Münchau A. The Role of the Left Inferior Parietal Cortex in Gilles de la Tourette Syndrome—An rTMS Study. Biomedicines 2023; 11:biomedicines11030980. [PMID: 36979959 PMCID: PMC10046361 DOI: 10.3390/biomedicines11030980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/20/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Increased activity in the left inferior parietal cortex (BA40) plays a role in the generation of tics in the Gilles de la Tourette syndrome (GTS). Thus, inhibitory repetitive transcranial magnetic stimulation (rTMS) applied to BA40 was hypothesized to alleviate symptoms in GTS. We investigated the immediate effects of single-session 1 Hz rTMS and sham stimulation delivered to the left BA40 on tics assessed with the Rush video protocol in 29 adults with GTS. There were no significant effects on tic symptoms following rTMS or sham stimulation. Moreover, there was no difference when comparing the effects of both stimulation conditions. Bayesian statistics indicated substantial evidence against an intervention effect. The left BA40 appears not to be a useful target for 1 Hz rTMS to modulate tic symptoms in GTS patients.
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Affiliation(s)
- Theresa Paulus
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
- Department of Neurology, University of Lübeck, 23562 Lübeck, Germany
| | - Lynn Wernecke
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Annik Lundie
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Julia Friedrich
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Julius Verrel
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Tina Rawish
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, 23562 Lübeck, Germany
| | - Christian Frings
- Department of Cognitive Psychology, Faculty of Psychology, University of Trier, 54296 Trier, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- Neuropsychology Centre, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan 250014, China
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, 23562 Lübeck, Germany
- Correspondence: ; Tel.: +49-451-3101-8215
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7
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Defazio G, Belvisi D, Comella C, Hallett M, Jinnah HA, Cimino P, Latorre A, Mascia MM, Rocchi L, Gigante AF, Ercoli T, Berardelli A. Validation of a guideline to reduce variability in diagnosing cervical dystonia. J Neurol 2023; 270:2606-2612. [PMID: 36790546 PMCID: PMC10129917 DOI: 10.1007/s00415-023-11585-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Cervical dystonia is characterized by a variable pattern of neck muscle involvement. Due to the lack of a diagnostic test, cervical dystonia diagnosis is based on clinical examination and is therefore subjective. The present work was designed to provide practical guidance for clinicians in confirming or refuting suspected cervical dystonia. METHODS Participants were video recorded according to a standardized protocol to assess 6 main clinical features possibly contributing to cervical dystonia diagnosis: presence of repetitive, patterned head/neck movements/postures inducing head/neck deviation from neutral position (item 1); sensory trick (item 2); and red flags related to conditions mimicking dystonia that should be absent in dystonia (items 3-6). Inter-/intra-rater agreement among three independent raters was assessed by k statistics. To estimate sensitivity and specificity, the gold standard was cervical dystonia diagnosis reviewed at each site by independent senior neurologists. RESULTS The validation sample included 43 idiopathic cervical dystonia patients and 41 control subjects (12 normal subjects, 6 patients with isolated head tremor, 4 with chorea, 6 with tics, 4 with head ptosis due to myasthenia or amyotrophic lateral sclerosis, 7 with orthopedic/rheumatologic neck diseases, and 2 with ocular torticollis). The best combination of sensitivity and specificity was observed considering all the items except for an item related to capability to voluntarily suppress spasms (sensitivity: 96.1%; specificity: 81%). CONCLUSIONS An accurate diagnosis of cervical dystonia can be achieved if, in addition to the core motor features, we also consider some clinical features related to dystonia mimics that should be absent in dystonia.
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Affiliation(s)
- Giovanni Defazio
- Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, 09042, Cagliari, Italy.,Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, SS 554 km 4.500, 09042, Monserrato, Cagliari, Italy
| | - Daniele Belvisi
- IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell' Università, 30, 00185, Rome, Italy
| | | | - Mark Hallett
- Human Motor Control Section, NINDS, NIH, Bethesda, MD, USA
| | - Hyder A Jinnah
- Department of Neurology and Human Genetics, Emory University, Atlanta, GA, USA
| | - Paola Cimino
- Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, 09042, Cagliari, Italy
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marcello Mario Mascia
- Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, SS 554 km 4.500, 09042, Monserrato, Cagliari, Italy
| | - Lorenzo Rocchi
- Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, 09042, Cagliari, Italy.,Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, SS 554 km 4.500, 09042, Monserrato, Cagliari, Italy
| | | | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, 09042, Cagliari, Italy.
| | - Alfredo Berardelli
- IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell' Università, 30, 00185, Rome, Italy
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8
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Malaty IA, Anderson S, Bennett SM, Budman CL, Coffey BJ, Coffman KA, Greenberg E, McGuire JF, Müller-Vahl KR, Okun MS, Quezada J, Robichaux-Viehoever A, Black KJ. Diagnosis and Management of Functional Tic-Like Phenomena. J Clin Med 2022; 11:6470. [PMID: 36362696 PMCID: PMC9656241 DOI: 10.3390/jcm11216470] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 08/31/2023] Open
Abstract
Over the past 3 years, a global phenomenon has emerged characterized by the sudden onset and frequently rapid escalation of tics and tic-like movements and phonations. These symptoms have occurred not only in youth known to have tics or Tourette syndrome (TS), but also, and more notably, in youth with no prior history of tics. The Tourette Association of America (TAA) convened an international, multidisciplinary working group to better understand this apparent presentation of functional neurological disorder (FND) and its relationship to TS. Here, we review and summarize the literature relevant to distinguish the two, with recommendations to clinicians for diagnosis and management. Finally, we highlight areas for future emphasis and research.
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Affiliation(s)
- Irene A. Malaty
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL 32608, USA
| | | | - Shannon M. Bennett
- Department of Psychiatry, Weill Cornell Medicine/NewYork-Presbyterian, New York, NY 10065, USA
| | - Cathy L. Budman
- Department of Psychiatry, Northwell Health, Zucker School of Medicine, Hofstra/Northwell, Uniondale, NY 11549, USA
| | - Barbara J. Coffey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Keith A. Coffman
- Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA
| | - Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02129, USA
| | - Joseph F. McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Kirsten R. Müller-Vahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School (MHH), 30625 Hannover, Germany
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL 32608, USA
| | - Julio Quezada
- Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA
| | | | - Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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9
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Zea Vera A, Bruce A, Garris J, Tochen L, Bhatia P, Lehman RK, Lopez W, Wu SW, Gilbert DL. The Phenomenology of Tics and Tic-Like Behavior in TikTok. Pediatr Neurol 2022; 130:14-20. [PMID: 35303587 DOI: 10.1016/j.pediatrneurol.2022.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/06/2022] [Accepted: 02/20/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Pediatricians and pediatric subspecialists worldwide have reported a marked increase in functional (conversion) disorders with tic-like behaviors during the COVID-19 pandemic. These patients often report frequent viewing of Tourette syndrome (TS) TikTok videos, suggesting disease modeling. We aimed to evaluate tic phenomenology in videos posted on TikTok. METHODS The 100 most-viewed videos under #tourettes in TikTok were randomly assigned to two of three primary reviewers (<2 years independent practice), all pediatric neurologists specializing in movement disorders, for extraction and classification of tic phenomenology. Initial disagreements were solved by consensus. If not resolved, one of five senior reviewers (>2 years independent pediatric movement disorder practice) served as a tiebreaker. In addition, two primary and one senior reviewer rated each video on a Likert scale from 1 = "All the tics are typical of TS" to 5 = "None of the tics are typical of TS". Median scores and Spearman correlation between primary and senior reviewers were calculated. RESULTS Six videos without tic-like behaviors were excluded. Most videos depicted coprophenomena (coprolalia: 53.2%; copropraxia: 20.2%), often with unusual characteristics. Frequently, videos demonstrated atypical phenomenology such as very strong influence by the environment (motor: 54.3%; phonic: 54.3%), aggression (19.1%), throwing objects (22.3%), self-injurious behaviors (27.7%), and long phrases (>3 words; 45.7%). Most videos portrayed atypical, nontic behaviors (median [IQR] Likert ratings: 5 [4-5]). Primary vs. senior rater scores demonstrated moderate agreement (r = 0.46; P < 0.001). CONCLUSIONS TS symptom portrayals on highly viewed TikTok videos are predominantly not representative or typical of TS.
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Affiliation(s)
- Alonso Zea Vera
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Neurology, Children's National Hospital, Washington, District of Columbia.
| | - Adrienne Bruce
- Department of Pediatrics, Prisma Health, Greenville, South Carolina; University of South Carolina School of Medicine Greenville, Greenville, South Carolina
| | - Jordan Garris
- Department of Neurology, University of Virginia Medical Center, Charlottesville, Virginia
| | - Laura Tochen
- Department of Neurology, Children's National Hospital, Washington, District of Columbia
| | - Poonam Bhatia
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona
| | - Rebecca K Lehman
- Prisma Health-Midlands, Columbia, South Carolina; Department of Neurology, University of South Carolina, Columbia, South Carolina
| | - Wendi Lopez
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Steve W Wu
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Donald L Gilbert
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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10
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Burlo F, Barbi E, Carrozzi M, Zanus C. Case report: A relevant misdiagnosis: Photosensitive epilepsy mimicking a blinking tic. Front Pediatr 2022; 10:918420. [PMID: 36467468 PMCID: PMC9709211 DOI: 10.3389/fped.2022.918420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022] Open
Abstract
Blinking in children is most frequently a functional and transient symptom. Nonetheless, sometimes it is the first clinical manifestation of a neurological disorder. The differential diagnosis between voluntary actions, tics and other neurological disorders among which seizures may be challenging and misdiagnosis is common. A 6-year-old girl in good health was admitted for a recent history of bilateral eye blinking. Blinking did not interfere with the girl's activities. The patients reported that blinking seemed to be triggered by sunlight exposure and that girl sometimes seemed to be attracted by the sunlight. Ophthalmological diseases had been already excluded. The girl was addressed to our hospital for neurological consultation, as tic disease was considered the most probable hypothesis. Neurological examination was negative. In the field of differential diagnosis of photosensitive abnormal eyelid movements, the hypothesis of seizures was explored and further investigated with a video-EEG recording with light stimulation. This exam demonstrated a photoparoxysmal response (PPR) to intermittent photic stimulation with appearance on EEG of bilateral spike and polyspike waves associated with eyelid jerks. This girl suffers from generalized epilepsy with photosensitivity. Photosensitivity is a common feature of many epilepsy syndromes, mainly occurring in children and adolescents. To control the seizures, it is essential to avoid the triggering stimulus, by wearing specific glasses. Additional antiseizures treatment is often necessary, at first with valproate and levetiracetam, and ethosuximide, lamotrigine, and benzodiazepines as the second choice. Overlapping phenomenology of seizures and movement disorders is well known in paediatric clinical practice. Moreover, epilepsy and movement disorder may coexist, mainly in children. Seizures with semeiology limited to eye motor manifestations may mimic functional blinking, tics, and other motor events frequently observed in childhood. Differentiating seizures from other non-epileptic paroxysmal movements may be challenging and specialist evaluation is needed for proper treatment and prognostic counselling.
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Affiliation(s)
- Francesca Burlo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Egidio Barbi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.,Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Marco Carrozzi
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Caterina Zanus
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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11
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European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part I: assessment. Eur Child Adolesc Psychiatry 2022; 31:383-402. [PMID: 34661764 PMCID: PMC8521086 DOI: 10.1007/s00787-021-01842-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/30/2021] [Indexed: 11/03/2022]
Abstract
In 2011 a working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines for Tourette syndrome (TS). Now, we present an updated version 2.0 of these European clinical guidelines for Tourette syndrome and other tic disorders, part I: assessment. Therefore, the available literature has been thoroughly screened, supplemented with national guidelines across countries and discussions among ESSTS experts. Diagnostic changes between DSM-IV and DSM-5 classifications were taken into account and new information has been added regarding differential diagnoses, with an emphasis on functional movement disorders in both children and adults. Further, recommendations regarding rating scales to evaluate tics, comorbidities, and neuropsychological status are provided. Finally, results from a recently performed survey among ESSTS members on assessment in TS are described. We acknowledge that the Yale Global Tic Severity Scale (YGTSS) is still the gold standard for assessing tics. Recommendations are provided for scales for the assessment of tics and psychiatric comorbidities in patients with TS not only in routine clinical practice, but also in the context of clinical research. Furthermore, assessments supporting the differential diagnosis process are given as well as tests to analyse cognitive abilities, emotional functions and motor skills.
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12
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Rawish T, Sallandt G, Münchau A. Tics bei Erwachsenen. NEUROTRANSMITTER 2022. [PMCID: PMC9735045 DOI: 10.1007/s15016-022-2974-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Tina Rawish
- Universität zu Lübeck, Institut für Systemische MotorikforschungCenter of Brain, Behavior and Metabolism (CBBM), Lübeck, Germany
| | - Gesine Sallandt
- Universität zu Lübeck, Institut für Systemische Motorikforschung, CBBM, Lübeck, Germany
| | - Alexander Münchau
- Universität zu Lübeck und UKSH, Arbeitsgruppe Bewegungsstörungen & Neuropsychiatrie, Marie-Curie-Straße, 23562 Lübeck, Germany
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13
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Martindale JM, Mink JW. The Rise of Functional Tic-Like Behaviors: What Do the COVID-19 Pandemic and Social Media Have to Do With It? A Narrative Review. Front Pediatr 2022; 10:863919. [PMID: 35899132 PMCID: PMC9309505 DOI: 10.3389/fped.2022.863919] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/24/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There has been a rise in explosive onset of tic-like behaviors during the COVID-19 pandemic. Historically, this is an uncommon phenomenology of functional movement disorders across all ages. Both the psychological burden of the pandemic and social media usage have been implicated in the rise of these tic-like behaviors. METHODS This paper provides a narrative review of the literature on chronic tic disorders, functional tics, and mass functional illness with particular focus on the key distinguishing features, role of social media, and the role of COVID-19. RESULTS The COVID-19 pandemic has profoundly affected the mental health of many individuals, including children, adolescents, and their caregivers. Implementation of lockdowns, lifestyle disruptions, school closures, and social distancing have driven a surge in social media and digital technology use. The combination of predisposing factors, the psychological burden of the COVID-19 pandemic, and social media are implicated in the rise and spread of tic-like behaviors; which may represent a modern-day form of mass functional illness. While many of the features overlap with functional tics, there are emerging distinctive features that are important to recognize. A more encompassing term, Functional Tic-Like Behaviors, is used to better reflect multiple contributing factors. CONCLUSION Knowledge of these differences is essential to mitigate downstream health effects and poor outcomes.
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Affiliation(s)
- Jaclyn M Martindale
- Department of Neurology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC, United States
| | - Jonathan W Mink
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
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14
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Abstract
Tic disorders and Tourette syndrome are the most common movement disorders in children and are characterized by movements or vocalizations. Clinically, Tourette syndrome is frequently associated with comorbid psychiatric symptoms. Although dysfunction of cortical–striatal–thalamic–cortical circuits with aberrant neurotransmitter function has been considered the proximate cause of tics, the mechanism underlying this association is unclear. Recently, many studies have been conducted to elucidate the epidemiology, clinical course, comorbid symptoms, and pathophysiology of tic disorders by using laboratory studies, neuroimaging, electrophysiological testing, environmental exposure, and genetic testing. In addition, many researchers have focused on treatment for tics, including behavioral therapy, pharmacological treatment, and surgical treatment. Here, we provide an overview of recent progress on Tourette syndrome.
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Affiliation(s)
- Keisuke Ueda
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kevin J Black
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
- Department of Neuroscience, Washington University School of Medicine, St Louis, MO, USA
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15
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Paulus T, Bäumer T, Verrel J, Weissbach A, Roessner V, Beste C, Münchau A. Pandemic Tic-like Behaviors Following Social Media Consumption. Mov Disord 2021; 36:2932-2935. [PMID: 34558735 DOI: 10.1002/mds.28800] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/23/2021] [Accepted: 09/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Currently, there is a marked increase of young people with sudden onset of tic-like behaviors (TLBs) resembling movements and vocalizations presented on social media videos as "Tourette's syndrome." OBJECTIVE To delineate clinical phenomenology of TLBs after social media exposure in comparison with clinical features of Tourette's syndrome. METHODS We compared demographic and clinical variables between 13 patients with TLBs and 13 age- and sex-related patients with Tourette's syndrome. RESULTS Patients with TLBs had several characteristics allowing to distinguish them from patients with Tourette's syndrome, some of which discriminated perfectly (ie, abrupt symptom onset, lack of spontaneous symptom fluctuations, symptom deterioration in the presence of others) and some nearly perfectly (ie, predominantly complex movements involving trunk/extremities). Also, symptom onset was significantly later. CONCLUSIONS TLBs after social media consumption differ from tics in Tourette's syndrome, strongly suggesting that these phenomena are categorically different conditions. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Theresa Paulus
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.,Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Julius Verrel
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany.,TU Dresden, University Neuropsychology Centre, Faculty of Medicine, Dresden, Germany.,Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
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16
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Vilela-Filho O, Santos UM, Castro JC, Reis DM, Domingues-Hajj PMS, Morais BA, Souza JT, Silva DJ, Grandi-Miranda FT, Dalle CR, Milhomem CBSS. Induction of Ticlike Involuntary Movements in Rats by Striatotomy and Subsequent Neurochemical Sensitization. World Neurosurg 2021; 155:e674-e686. [PMID: 34478885 DOI: 10.1016/j.wneu.2021.08.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE It has been proposed that Tourette syndrome is associated with dysfunction in widespread cortical areas and globus pallidus externus hyperactivity secondary to dopaminergic hyperactivity and serotonergic/dynorphinergic hypoactivity. The main objective of this study was to test this hypothesis by developing an animal model of Tourette syndrome via striatotomy, followed by administration of drugs that mimic the neurotransmitter environment, so as to induce globus pallidus externus hyperactivity. METHODS Rats were assigned to 3 groups: stereotactic striatotomy (STT) and striatal sham -lesion (SHAM) groups, treated with anterior and posterior striatum procedures in both hemispheres, and a group of nonoperated animals (NAIVE). Postoperatively, all rodents were blindly administered 3 drug protocols: levodopa/benserazide; levodopa/benserazide/ergotamine/naloxone (MIX); and saline. The animals were filmed at the peak action of these drugs. The videos were evaluated by a single blinded researcher. RESULTS Six types of involuntary movements (IMs) were observed: cephalic, trunk jerks, oromandibular, forepaw jerks, dystonic, and locomotive. The number of animals with IM and the mean number of IM after both levodopa/benserazide and MIX was significantly higher in the STT compared with the SHAM and NAIVE groups. In the SHAM and NAIVE, MIX was superior to levodopa/benserazide in the induction of IM. In the STT, MIX was superior to levodopa/benserazide in the induction of trunk jerks. Appendicular IM were more common after posterior than after anterior striatotomy. CONCLUSIONS These results show that striatotomy, followed by administration of levodopa/benserazide alone or associated with ergotamine and naloxone, is efficacious in inducing IM, supporting the hypothesis that led to this study.
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Affiliation(s)
- Osvaldo Vilela-Filho
- Division of Neurosurgery, Department of Surgery, Medical School, Clinics Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil; Department of Neurosciences, Medical School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil.
| | - Uliana M Santos
- Department of Neurosciences, Medical School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Jacqueline C Castro
- Department of Neurosciences, Medical School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Diego M Reis
- Department of Neurosciences, Medical School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Pryscilla M S Domingues-Hajj
- Division of Neurosurgery, Department of Surgery, Medical School, Clinics Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Bárbara A Morais
- Department of Neurosciences, Medical School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Joaquim T Souza
- Division of Neurosurgery, Department of Surgery, Medical School, Clinics Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Délson J Silva
- Neurology Unit, Clinics Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Flávia T Grandi-Miranda
- Division of Neurosurgery, Department of Surgery, Medical School, Clinics Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Camila R Dalle
- Division of Neurosurgery, Department of Surgery, Medical School, Clinics Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Caroline B S S Milhomem
- Department of Neurosciences, Medical School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
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17
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Cognitive Tic-Like Phenomena in Gilles de la Tourette Syndrome. J Clin Med 2021; 10:jcm10132749. [PMID: 34206614 PMCID: PMC8268074 DOI: 10.3390/jcm10132749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/19/2021] [Accepted: 06/20/2021] [Indexed: 12/04/2022] Open
Abstract
Coprolalia and echophenomena repeated in the patients’ mind (CTPh—cognitive tic-like phenomena) have been rarely recognized as part of Gilles de la Tourette syndrome (GTS) symptomatology and their assignment to tics, OCD or other psychopathologies has not been settled. The aim of the paper was to assess the incidence and clinical associations of CTPh in GTS, and to establish if CTPh belong to the tic spectrum. We performed a prospective, one-registration study on a cohort of 227 consecutive patients with GTS. CTPh were diagnosed during the interview and defined as brief, sudden, involuntary thoughts that had corresponding complex vocal tics. CTPh occurred at some point in the lives of 34 (15.0%) patients. The median age at onset of CTPh was 14.5 years (IQR: 10.5–17.5). CTPh were found more frequently in adults, with the most frequent onset in adolescence (44.1%). Four mental phenomena resembling tics were recognized: echolalia (n = 17), coprolalia (n = 16), palilalia (n = 13) and repeating of words in the mind (n = 7). The older the age of patients, the more severe tics, and anxiety disorder significantly correlated with CTPh. CTPh may be considered as a part of tic spectrum with a substantial impact of anxiety disorder. CTPh are a late and age-related symptom of GTS.
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18
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Adult-onset sporadic chorea: real-world data from a single-centre retrospective study. Neurol Sci 2021; 43:387-392. [PMID: 34041635 PMCID: PMC8724109 DOI: 10.1007/s10072-021-05332-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/17/2021] [Indexed: 01/02/2023]
Abstract
Background Adult-onset sporadic chorea includes a wide and heterogeneous group of conditions whose differential diagnosis and treatments are often challenging and extensive. Objectives To analyse retrospectively cases of adult-onset sporadic chorea from a single Italian centre to provide insights for a practical approach in the management of these patients. Methods A total of 11,071 medical charts from a 9-year period (2012–2020) were reviewed, identifying 28 patients with adult-onset sporadic chorea (genetic forms excluded). All available data regarding phenomenology, diagnostic workup, aetiology, treatments, and long-term outcome from this cohort were collected and analysed. Results Adult-onset sporadic chorea occurred more frequently in females and presented with an acute-subacute onset. Cerebrovascular diseases accounted for 68% of aetiology; further causes were structural brain lesions, internal diseases, and other movement disorder syndromes. Clinical course was mild, with spontaneous resolution or minimal disturbances in 82% of cases. Neuroimaging was fundamental to diagnose 76% of adult-onset sporadic chorea, an appropriate clinical examination contributed to the 14% of diagnoses, whereas basic laboratory tests to the 10%. Conclusions Revision of real-world data of adult-onset sporadic chorea patients from a single Italian cohort suggests that an accurate clinical examination, neuroimaging, and routine laboratory tests are useful to identify those cases underlying potentially severe but treatable conditions. Although in the majority of cases adult-onset sporadic chorea has mild clinical course and good response to symptomatic treatments, it is essential to run a fast diagnostic workup.
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19
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Benítez-Burraco A, Progovac L. Language evolution: examining the link between cross-modality and aggression through the lens of disorders. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200188. [PMID: 33745319 PMCID: PMC8059641 DOI: 10.1098/rstb.2020.0188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
We demonstrate how two linguistic phenomena, figurative language (implicating cross-modality) and derogatory language (implicating aggression), both demand a precise degree of (dis)inhibition in the same cortico-subcortical brain circuits, in particular cortico-striatal networks, whose connectivity has been significantly enhanced in recent evolution. We examine four cognitive disorders/conditions that exhibit abnormal patterns of (dis)inhibition in these networks: schizophrenia (SZ), autism spectrum disorder (ASD), synaesthesia and Tourette's syndrome (TS), with the goal of understanding why the two phenomena altered reactive aggression and altered cross-modality cluster together in these disorders. Our proposal is that enhanced cross-modality (necessary to support language, in particular metaphoricity) was a result, partly a side-effect, of self-domestication (SD). SD targeted the taming of reactive aggression, but reactive impulses are controlled by the same cortico-subcortical networks that are implicated in cross-modality. We further add that this biological process of SD did not act alone, but was engaged in an intense feedback loop with the cultural emergence of early forms of language/grammar, whose high degree of raw metaphoricity and verbal aggression also contributed to increased brain connectivity and cortical control. Consequently, in conjunction with linguistic expressions serving as approximations/'fossils' of the earliest stages of language, these cognitive disorders/conditions serve as confident proxies of brain changes in language evolution, helping us reconstruct certain crucial aspects of early prehistoric languages and cognition, as well as shed new light on the nature of the disorders. This article is part of the theme issue 'Reconstructing prehistoric languages'.
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Affiliation(s)
- Antonio Benítez-Burraco
- Department of Spanish, Linguistics and Theory of Literature (Linguistics), Faculty of Philology, University of Seville, Seville, Spain
| | - Ljiljana Progovac
- Linguistics Program, Department of English, Wayne State University, Detroit, MI, USA
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20
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Termine C, Grossi E, Anelli V, Derhemi L, Cavanna AE. Possible tics diagnosed as stereotypies in patients with severe autism spectrum disorder: a video-based evaluation. Neurol Sci 2021; 42:1559-1561. [PMID: 33340349 PMCID: PMC7955999 DOI: 10.1007/s10072-020-04995-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/12/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The association of stereotypies and tics is not rare in children with severe autism spectrum disorder (ASD). The differential diagnosis between stereotypies and tics in this patient population can be difficult; however, it could be clinically relevant because of treatment implications. METHODS A total of 108 video recordings of repetitive behaviors in young patients with stereotypies in the context of ASD were reviewed by a movement disorders expert and a trainee, in order to assess the prevalence of possible co-morbid tics. The Modified Rush Videotape Rating Scale (MRVS) was used to rate tic frequency and severity. RESULTS Out of 27 patients with stereotypies (24 males; mean age 14 years), 18 (67%) reported possible tics. The most frequently observed tics were eye blinking, shoulder shrugging, neck bending, staring, and throat clearing. The mean MRVS score was 5, indicating mild tic severity. The only significant difference between patients with tics and patients without tics was the total number of stereotypies, which was higher in the subgroup of patients without tics (p = 0.01). CONCLUSIONS Expert review of video-recordings of repetitive behaviors in young patients with ASD and stereotypies suggests the possibility of a relatively high rate of co-morbid tics. These findings need to be integrated with a comprehensive clinical assessment focusing on the diagnostic re-evaluation of heterogeneous motor manifestations.
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Affiliation(s)
- Cristiano Termine
- Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Enzo Grossi
- Department of Autism Research, "Villa Santa Maria" Child and Adolescent Neuropsychiatry Rehabilitation Unit, Tavernerio, CO, Italy
| | - Valentina Anelli
- Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Ledina Derhemi
- Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Andrea E Cavanna
- Michael Trimble Neuropsychiatry Research Group, University of Birmingham & BSMHFT, Birmingham, UK.
- School of Life & Health Sciences, Aston University, Birmingham, UK.
- Sobell Department of Motor Neuroscience & Movement Disorders, Institute of Neurology & University College London, London, UK.
- Department of Neuropsychiatry, National Centre for Mental Health, 25 Vincent Drive, Birmingham, B15 2FG, UK.
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21
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Swearing and coprophenomena - A multidimensional approach. Neurosci Biobehav Rev 2021; 126:12-22. [PMID: 33757814 DOI: 10.1016/j.neubiorev.2021.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
Swearing, cursing, expletives - all these terms are used to describe the utterance of taboo words. Studies show that swearing makes up around 0.5 % of the daily spoken content, however, the inter-individual variability is very high. One kind of pathologic swearing is coprolalia in Tourette syndrome (TS), which describes the involuntary outburst of taboo words. Coprolalia occurs in approximately 20-30 % of all patients with TS. This review compares swearing in healthy people and coprolalia in people with TS and is the first one to develop a multidimensional framework to account for both phenomena from a similar perspective. Different research findings are embedded in one theoretical framework consisting of reasons, targets, functions/effects and influencing factors for swearing and coprolalia. Furthermore, the very limited research investigating obscene gestures and copropraxia, compulsive obscene gestures, is summarized. New research questions and gaps are brought up for swearing, obscene gestures and coprophenomena.
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22
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Bhikram T, Elmaghraby R, Abi-Jaoude E, Sandor P. An International Survey of Health Care Services Available to Patients With Tourette Syndrome. Front Psychiatry 2021; 12:621874. [PMID: 33716822 PMCID: PMC7953144 DOI: 10.3389/fpsyt.2021.621874] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/05/2021] [Indexed: 12/13/2022] Open
Abstract
Objective: Tourette syndrome (TS) is a neuropsychiatric disorder that is highly associated with several comorbidities. Given the complex and multifaceted nature of TS, the condition is managed by a wide variety of practitioners in different disciplines. The goal of this study was to investigate health service delivery and care practices by clinicians who see TS patients across different geographic settings internationally. Methods: A comprehensive questionnaire was developed to assess clinical care resources for patients with TS and was sent to clinicians in Canada (CA), the United States (US), Europe (EU), and the United Kingdom (UK). Responses were compared quantitatively between geographic regions. Results: The majority of respondents, regardless of region, reported that fewer than 40% of their case-load are patients with tics. The accessibility of TS services varied among regions, as indicated by differences in wait times, telemedicine offerings, comorbidity management and the availability of behavioral therapies. First-line pharmacotherapy preferences varied among physicians in different geographical regions with CA respondents preferring alpha-2-adrenergic agonists and respondents from the UK and EU preferring dopamine receptor antagonists. Discussion: The results suggest that there is a scarcity of specialized TS clinics, potentially making access to services challenging, especially for patients newly diagnosed with TS. Differences in regional pharmacotherapeutic preferences are reflected in various published treatment guidelines in EU and North America. The lack of dedicated specialists and telemedicine availability, coupled with differences in comorbidity management, highlight the need for interprofessional care and holistic management to improve health care delivery to patients with TS.
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Affiliation(s)
- Tracy Bhikram
- Department of Psychiatry, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Rana Elmaghraby
- Department of Psychiatry, University Health Network and University of Toronto, Toronto, ON, Canada
- Youthdale Treatment Centre, Toronto, ON, Canada
| | - Elia Abi-Jaoude
- Department of Psychiatry, University Health Network and University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Paul Sandor
- Department of Psychiatry, University Health Network and University of Toronto, Toronto, ON, Canada
- Youthdale Treatment Centre, Toronto, ON, Canada
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23
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Park EG, Kim YH. Clinical features and neuropsychiatric comorbidities in pediatric patients with tic disorders: a retrospective chart review study from South Korea. BMC Psychiatry 2021; 21:14. [PMID: 33413251 PMCID: PMC7791808 DOI: 10.1186/s12888-020-03014-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/14/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tic disorders are childhood-onset neuropsychiatric disorders characterized by multiple motor or vocal tics with frequent comorbidities and a broad spectrum of phenotypic presentations. In this study, we aimed to investigate the clinical characteristics and comorbid neuropsychiatric conditions in pediatric patients with tic disorders. METHODS We retrospectively reviewed the medical records of 119 pediatric patients (89 males, 30 females) who were diagnosed with tic disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) at Uijeongbu St. Mary's Hospital, Republic of Korea, between January 2012 and July 2019. RESULTS The mean age of tic onset was 6.9 years (range, 1-14) and the mean age at diagnosis was 8 years (range, 1-17). The mean lag between tic onset and diagnosis was 13.3 months (range, 0.25-132). The most common, first-presenting tics were eye blinking (50.4%), followed by jaw or lip movement (29.4%) and throat clearing (29.4%). Thirty-seven (31.1%) patients had at least one co-occurring neuropsychiatric disorder at the time of tic diagnosis. Subtypes of tic disorders, types of initial tics, and presence of neuropsychiatric comorbidities were not associated with tic severity. Tic severity was associated with greater functional impairment and tic noticeability (p < 0.05). A relatively shorter time to diagnosis was associated with tic severity (Spearman's ρ = - 0.14, p = 0.11). CONCLUSIONS The evolving nature of tic expression and severity, high prevalence of neuropsychiatric comorbidities, and associated functional impairments emphasize the importance of comprehensive assessment during the disease course for determining and prioritizing goals of treatment.
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Affiliation(s)
- Eu Gene Park
- grid.411947.e0000 0004 0470 4224Department of Pediatrics, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 21431 Republic of Korea
| | - Young-Hoon Kim
- Department of Pediatrics, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, 11765, Republic of Korea.
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Prevalence and clinical correlates of self-injurious behavior in Tourette syndrome. Neurosci Biobehav Rev 2020; 113:299-307. [DOI: 10.1016/j.neubiorev.2020.03.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/11/2020] [Accepted: 03/19/2020] [Indexed: 02/08/2023]
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Mainka T, Di Costa S, Borngräber F, Barow E, Münchau A, Ganos C, Haggard P. Learning volition: A longitudinal study of developing intentional awareness in Tourette syndrome. Cortex 2020; 129:33-40. [PMID: 32422423 DOI: 10.1016/j.cortex.2020.03.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Abstract
Tourette syndrome (TS) is characterized by the presence of involuntary movements (tics) which are, at least partly, generated within 'voluntary' motor pathways. Here we reassess 16 TS patients (age 19 ± 2.3 years) who participated in a mental chronometry study of volition 5.5 years previously (Ganos C et al. Cortex. 2015 Mar.; 64:47-54), and 16 age-matched controls. Participants estimated the time of their own voluntary movements (Libet's M judgement), or of conscious intention to make voluntary movements (Libet's W judgement), in separate blocks. We considered M judgement as a control condition. Therefore, the experience of an intention to move occurring prior to actual movement onset, as measured by the W-M gap, was taken as the cardinal feature of volition. Time estimates of the TS group did not differ significantly from controls, for either M or W judgement. Further, M and W time estimates in the TS group had not changed significantly between the two assessments. However, exploratory analyses revealed a strong relation between disease duration and the development of M- and W-judgements: the longer was the disease duration, the less was the developmental increase in the W-M gap (linear regression, p = .003). In conclusion, our results suggest compromised development of experience of volition in developing TS patients. The developmental difficulty in processing internal premotor signals for voluntary actions could reflect the chronic persistence of tics from adolescence to adulthood.
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Affiliation(s)
- Tina Mainka
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Steven Di Costa
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Friederike Borngräber
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Ewgenia Barow
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, London, UK.
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Abstract
Tourette syndrome is a multifaceted disorder characterized by multiple motor and at least one vocal tics that start in childhood, persist for at least 1 year, and cannot be attributed to another medical condition or exposure to medications/drugs. Clinical diagnostic criteria are available, and identification of tics is typically straightforward based on characteristic appearance and features. Diagnostic uncertainty can rarely arise in cases of mild tics, atypical features, certain psychiatric comorbidities, and other non-tic movement disorders. Comorbid psychopathology, including attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive behaviors/obsessive-compulsive disorder, affects the majority of patients and is correlated with disease severity and the presence of additional psychiatric behaviors. The severity of tics often improves after adolescence, whereas psychiatric symptoms typically persist. The subset of patients in whom tics persist into adulthood experience higher rates of anxiety, and lower self-esteem, socioeconomic status, and quality of life; the relative contribution of motor tics and psychopathology is not fully understood. This article summarizes the clinical features of Tourette syndrome, including major diagnostic criteria, unique features of tics, and key aspects that differentiate tics from common mimics and chameleons. Comorbid psychiatric conditions and their impact on phenotype and quality of life are described. Finally, current understanding of the natural history is summarized, including limited research in adults with Tourette syndrome.
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Affiliation(s)
- Chandler E Gill
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, Chicago, IL, USA
| | - Katie Kompoliti
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, Chicago, IL, USA
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Progovac L, Benítez-Burraco A. From Physical Aggression to Verbal Behavior: Language Evolution and Self-Domestication Feedback Loop. Front Psychol 2019; 10:2807. [PMID: 31920850 PMCID: PMC6930236 DOI: 10.3389/fpsyg.2019.02807] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 11/28/2019] [Indexed: 12/13/2022] Open
Abstract
We propose that human self-domestication favored the emergence of a less aggressive phenotype in our species, more precisely phenotype prone to replace (reactive) physical aggression with verbal aggression. In turn, the (gradual) transition to verbal aggression and to more sophisticated forms of verbal behavior favored self-domestication, with the two processes engaged in a mutually reinforcing feedback loop, considering that verbal behavior entails not only less violence and better survival but also more opportunities to interact longer and socialize with more conspecifics, ultimately enabling the emergence of more complex forms of language. Whereas in the case of self-domestication, sexual selection has been proposed to work against physical aggression traits, in the case of verbal insult, the selection has been proposed to work in favor of verbal aggression. The tension between these two seemingly opposing forces gets resolved/alleviated by a tendency to replace physical aggression with verbal aggression and with verbal behavior more generally. This also helps solve the paradox of the Self-Domestication Hypothesis regarding aggression, more precisely why aggression in humans has been reduced only when it comes to reactive aggression, but not when it comes to proactive aggression, the latter exhibiting an increase in the advent of modern language. We postulate that this feedback loop was particularly important during the time period arguably between 200 and 50 kya, when humans were not fully modern, neither in terms of their skull/brain morphology and their behavior/culture nor in terms of their self-domestication. The novelty of our approach lies in (1) giving an active role to early forms of language in interacting with self-domestication processes; (2) providing specific linguistic details and functions of this early stage of grammar (including insult and humor); (3) supplying neurobiological, ontogenetic, and clinical evidence of a link between (reactive) aggression and (reactive) verbal behavior; (4) identifying proxies of the earlier stages in evolution among cognitive disorders; and (5) identifying specific points of contact and mutual reinforcement between these two processes (self-domestication and early language evolution), including reduction in physical aggression and stress/tension, as well as sexual selection.
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Affiliation(s)
- Ljiljana Progovac
- Linguistics Program, Department of English, Wayne State University, Detroit, MI, United States
| | - Antonio Benítez-Burraco
- Department of Spanish Language, Linguistics and Literary Theory (Linguistics), Faculty of Philology, University of Seville, Seville, Spain
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Cavanna A, Nani A. Gilles de la Tourette syndrome: An overview. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2019. [DOI: 10.4103/amhs.amhs_122_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The neuropsychiatry of Gilles de la Tourette syndrome: The état de l’art. Rev Neurol (Paris) 2018; 174:621-627. [DOI: 10.1016/j.neurol.2018.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/25/2018] [Indexed: 01/23/2023]
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Les mouvements anormaux : mise au point. Rev Med Interne 2018; 39:641-649. [DOI: 10.1016/j.revmed.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/25/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022]
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Ganos C, Martino D, Pringsheim T. Tics in the Pediatric Population: Pragmatic Management. Mov Disord Clin Pract 2017; 4:160-172. [PMID: 28451624 PMCID: PMC5396140 DOI: 10.1002/mdc3.12428] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/23/2016] [Accepted: 07/27/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Primary tic disorders, notably Tourette syndrome, are very common movement disorders in childhood. However, the management of such patients still poses great therapeutic challenges to medical professionals. METHODS Based on a synthesis of the available guidelines published in Europe, Canada, and the United States, coupled with more recent therapeutic developments, the authors provide a pragmatic guide to aid clinicians in deciding when and how to treat patients who have primary tic disorders. RESULTS After a systematic assessment of tics and common neuropsychiatric comorbidities (primarily attention-deficit hyperactivity disorder [ADHD] and obsessive-compulsive disorder [OCD]), the first step in treatment is a comprehensive psychoeducation of patients and families that addresses the protean phenomenology of tics and associated behaviors, coping mechanisms, prognosis, and treatment options. When more active intervention beyond watchful monitoring is indicated, hierarchical evaluation of treatment targets (i.e., tics vs. comorbid behavioral symptoms) is crucial. Behavioral treatments for tics are restricted to older children and are not readily available to all centers, mainly due to the paucity of well-trained therapists. Pharmacological treatments, such as antipsychotics for tics, stimulants and atomoxetine for ADHD, and α2A-agonists for children with tics plus ADHD, represent widely available and effective treatment options, but safety monitoring must be provided. Combined polypharmacological and behavioral/pharmacological approaches, as well as neuromodulation strategies, remain under-investigated in this population of patients. CONCLUSIONS The treatment of children with tics and Tourette syndrome is multifaceted. Multidisciplinary teams with expertise in neurology, psychiatry, psychology, and pediatrics may be helpful to address the complex needs of these children.
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Affiliation(s)
- Christos Ganos
- Department of NeurologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Sobell Department of Motor Neuroscience and Movement DisordersUniversity College London Institute of NeurologyUniversity College LondonLondonUnited Kingdom
| | - Davide Martino
- International Parkinson's Centre of ExcellenceKing's College and King's College HospitalDenmark Hill CampusLondonUnited Kingdom
- Queen Elizabeth Hospital, WoolwichLewisham and Greenwich National Health Service TrustLondonUnited Kingdom
| | - Tamara Pringsheim
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
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Su MT, McFarlane F, Cavanna AE, Termine C, Murray I, Heidemeyer L, Heyman I, Murphy T. The English Version of the Gilles de la Tourette Syndrome-Quality of Life Scale for Children and Adolescents (C&A-GTS-QOL). J Child Neurol 2017; 32:76-83. [PMID: 27686095 DOI: 10.1177/0883073816670083] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gilles de la Tourette syndrome is a chronic neuropsychiatric disorder that can have a detrimental impact on the health-related quality of life of children with the condition. To date no patient-reported health-related quality of life measures have been developed for children and adolescents in the English language. This study validated the first disease-specific scale for the quantitative assessment of health-related quality of life in 118 children and adolescents with Gilles de la Tourette syndrome (C&A-GTS-QOL) following language adaptation from Italian to English in the United Kingdom. Standard statistical methods were used to test the psychometric properties of the rating scale. Principal component factor analyses led to the identification of six health-related quality of life domains (cognitive, copro-phenomena, psychological, physical, obsessive-compulsive, and activities of daily living), explaining 66.7% of the overall variance. The C&A-GTS-QOL demonstrated satisfactory scaling assumptions and acceptability; validity was supported by interscale correlations (range 0.2-0.7), confirmatory factor analysis, and correlation patterns with other rating scales and clinical variables.
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Affiliation(s)
- Merina T Su
- 1 Developmental Neurosciences Programme, UCL Institute of Child Health, London, United Kingdom.,2 Psychological Medicine Team, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Fiona McFarlane
- 2 Psychological Medicine Team, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Andrea E Cavanna
- 3 Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, United Kingdom.,4 School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, United Kingdom.,5 Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London, United Kingdom
| | - Cristiano Termine
- 6 Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy
| | - Imogen Murray
- 2 Psychological Medicine Team, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Larissa Heidemeyer
- 2 Psychological Medicine Team, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Isobel Heyman
- 1 Developmental Neurosciences Programme, UCL Institute of Child Health, London, United Kingdom.,2 Psychological Medicine Team, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Tara Murphy
- 1 Developmental Neurosciences Programme, UCL Institute of Child Health, London, United Kingdom.,2 Psychological Medicine Team, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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