A clinical study of Gilles de la Tourette's syndrome in Korea

Clinical correlates of tourette's disorder across cultures: a comparative study between the United Arab Emirates and the United Kingdom

BACKGROUND AND OBJECTIVE

Tourette's disorder is a neuropsychiatric disorder characterized by motor and vocal (phonic) tics. While the disorder has been researched extensively in the Western populations, the clinical correlates and associated features are less well known in other populations and cultures. This study examines the presentation and clinical correlates of Tourette's disorder in 2 distinct populations, namely the United Kingdom and the United Arab Emirates.

METHOD

A consecutive series of 35 Tourette's disorder patients of Arab descent recruited from 2001 to 2005 from the Child Psychiatry clinics in Al Ain, United Arab Emirates (U.A.E.), were compared with 35 age- and gender-matched white Tourette's disorder patients attending the Tourette Clinic at the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom, from December 2004 to December 2005.

RESULTS

Rates of occurrence of obsessive-compulsive disorder and attention-deficit/hyperactivity disorder were similar in the 2 cohorts. Coprolalia was higher in the U.K. cohort and was noted to correlate with the severity of Tourette's disorder. Comorbid oppositional defiant disorder and conduct disorder were also higher in the U.K. cohort (54.3% [N = 19] and 20.0% [N = 7], respectively) as compared to the U.A.E. cohort (11.4% [N = 4] and 5.7% [N = 2], respectively) but were not linked to any other clinical feature or severity of Tourette's disorder.

CONCLUSION

The findings illustrate the similarity in the core clinical symptoms between the 2 populations, thus emphasizing the underlying biological and genetic basis of these symptoms. However, our finding of higher occurrence of behavioral symptoms in the Western sample has implications for our understanding of the phenotypic presentation of Tourette's disorder as well as the management.

The international prevalence, epidemiology, and clinical phenomenology of Tourette syndrome: a cross-cultural perspective

The overall international prevalence of Tourette syndrome (TS) is 1% in the majority of cultures of the world. Both TS and tics are certainly more obvious and may be more common in younger people. Moreover, TS is seen less frequently in some cultures. However, in all cultures where it has been reported, the phenomenology is similar, highlighting the biological underpinnings of the disorder. This article reviews the international prevalence, epidemiology, and clinical phenomenology of TS, from a cross-cultural perspective.

The prevalence and epidemiology of Gilles de la Tourette syndrome. Part 1: the epidemiological and prevalence studies

The prevalence and epidemiology of Gilles de la Tourette syndrome (GTS) are more complex than was once thought. Until fairly recently, GTS was thought to be a rare and, according to some, a psychogenically mediated disorder. Prevalence depends, at least in part, on the definition of GTS, the type of ascertainment, and epidemiological methods used. However, in dedicated specialist GTS clinics, the majority of patients were noted to have positive family histories of tics or GTS, and large, extended, multiply-affected GTS pedigrees indicated that many family members had undiagnosed tics or GTS: it was therefore realized that GTS was far from uncommon. Seven early epidemiological studies reported that GTS was uncommon or rare for a variety of reasons. More recently, however, two pilot studies and 12 large definitive studies in mainstream school and school-age youngsters in the community, using similar multistage methods, have documented remarkably consistent findings, demonstrating prevalence figures for GTS of between 0.4% and 3.8% for youngsters between the ages of 5 and 18 years. Of the 420,312 young people studied internationally, 3,989 (0.949%) were diagnosed as having GTS. It is therefore suggested that a figure of 1% would be appropriate for the overall international GTS prevalence figure. There were however, "outliers" to the figure. For instance, GTS does seem to be substantially rarer in African-American people and has been reported only very rarely in sub-Saharan black African people. GTS is found in all other cultures, although to possibly differing degrees. In all cultures where GTS has been reported, the phenomenology is similar, highlighting the biological underpinnings of the disorder.

Tourette's syndrome: psychopathology in adolescents

The aim of this study is to foster an understanding of the clinical characteristics, in terms of general psychopathology, of Tourette syndrome (TS), as it manifests in adolescent patients, and to compare these results with those of previous studies conducted in Western countries. In total, 38 male and 5 female adolescent patients who visited a pediatric neurological specialty clinic for TS between 1 January and 1 March 2003, and who met the World Health Organisation criteria for TS, were studied. These patients were clinically interviewed and assessed with the Symptom-Checklist-90-R, Family APGAR and Tic Symptoms questionnaire, a self-report questionnaire based on DSM-IV TS diagnostic criteria. Among this population, the mean age of onset of motor tics was 9.65 +/- 3.7 years, and motor tics of the head and eyes were usually the first symptoms to manifest; coprolalia occurred in 44.1% (n = 19) of our patients. Many of our findings were similar to those reported in trials conducted in other regions of the world. TS symptoms showed stronger correlation with emotional distress in older patients.

Tourette disorder: a cross-cultural review

Tourette's disorder (TD) is a complex disorder of motor and vocal tics starting in childhood or adolescence. Although the disorder has been researched extensively in North America and Europe, clinical features and associated conditions of TD are less well known in other cultures. The English-language literature relating to TD was searched for cross-cultural case reports, clinical investigations, and epidemiological studies, and the subsequent database was analyzed. The clinical characteristics of TD displayed a strong similarity across cultures. Demography, family history, clinical features, associated conditions, comorbidity, and treatment outcome were essentially the same in the various cultures investigated. The disorder appears world-wide, has similar clinical characteristics, and most likely has an underlying biological and genetic basis.

The clinical features of Tourette's disorder: an Australian study using a structured interview schedule

The clinical features of an Australian series of patients fulfilling DSM-III-R criteria for Tourette's Syndrome (TS) were examined. Fifty patients, recruited from a hospital-based outpatient clinic and a self-help group, were interviewed using a structured schedule. TS is a complex disorder with wide ranging manifestations. Forty male and ten female TS patients with a mean age of 20.8 years (SD 11.2) were assessed. The mean age of onset of tics was 8.3 years (SD 3.3). Simple motor tics occurring in the rostral body regions were more common (eye 86%, face and head 80%) when compared both to simple tics occurring caudally (leg 52%) and complex motor tics (58%). Simple vocal tics were more common (94%) than complex ones (44%). There was a rostrocaudal pattern in the age of onset and severity of simple motor tics. Rates of comorbidity were 32%, 18% and 30% for Attention-Deficit Hyperactivity Disorder, Major Depression and Generalised Anxiety Disorder respectively and this was reflected in the considerable proportion (32%) of the sample who first presented for reasons other than their tics. There were substantial delays between the age of first presentation and diagnosis of TS owing to the insidious onset of the disorder, misdiagnosis and delays in presentation for help. A comparison of the features of the present patients with those of other published studies revealed similarities with some differences. Better clinical recognition of the symptoms and modes of presentation of TS may improve existing delays in diagnosis and treatment.

Electroencephalographic abnormalities in monozygotic twins with Tourette's syndrome

The association of attentional, neuropsychological, and behavioural abnormalities with Tourette's syndrome (TS) suggests that the abnormal function of the disorder extends beyond the motor circuits of the basal ganglia. To explore this possibility we studied, with conventional 18-channel electroencephalography, monozygotic twins ranging from 8 to 26 years of age, where at least one member of the twin pair suffered from TS. In nine out of the 11 twin pairs that differed in clinical severity of the tic disorder, the twin with the more severe course of illness had a significantly more abnormal electroencephalogram (EEG) by qualitative visual analysis. Most of the differences were due to excessive frontocentral theta activity, suggesting dysfunction outside the basal ganglia. There was also a significant relationship between a lower global neuropsychological testing score and a worse overall EEG. In eight of nine twin sets with different global neuropsychological testing scores, the twin with the lower score had a worse EEG. A similar relationship was found between birth weight and overall EEG quality. In the nine sets that differed in birth weight, the twin with a lower birth weight had a worse EEG in seven of the sets. The EEG findings are unlikely to be unlikely to be a medication effect because the same result was seen in the six twin pairs who had been medication-free for at least six months before entry into the study. The origin of this slowing may relate to the interaction between environmental insults to the central nervous system and the genetic component of TS, an interaction producing damage to the cortex, thalamus, or both.

The Gilles de la Tourette syndrome: the current status

The Gilles de la Tourette Syndrome is a movement disorder characterised by both motor and vocal (phonic) tics. It was once thought to be rare, and the literature until the 1970s consisted predominantly of case reports, both highlighting the fascinating clinical manifestations and speculating as to their aetiology. Many areas of GTS are under investigation, including the neurology, psychopathology, neurophysiology, biochemistry, and genetics. This review briefly considers early descriptions of GTS as well as current research, highlighting the areas of agreement and controversy.