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Larsh TR, Wu SW, Huddleston DA, Lipps TD, Gilbert DL. Differences in Tic Severity Among Adolescent Girls and Boys with Tourette Syndrome During the Pandemic. Neuropediatrics 2024; 55:67-70. [PMID: 36809795 DOI: 10.1055/a-2039-4425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Limited data are available regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on adolescents with Tourette syndrome (TS). We sought to compare sex differences in tic severity experienced by adolescents before and during the COVID-19 pandemic. We extracted from the electronic health record and retrospectively reviewed Yale Global Tic Severity Scores (YGTSS) from adolescents (ages 13 through 17) with TS presenting to our clinic before (36 months) and during (24 months) the pandemic. A total of 373 unique adolescent patient encounters (prepandemic: 199; pandemic: 173) were identified. Compared with prepandemic, girls accounted for a significantly greater proportion of visits during the pandemic (p < 0.001). Prepandemic, tic severity did not differ between girls and boys. During the pandemic, compared with girls, boys had less clinically severe tics (p = 0.003). During the pandemic, older girls, but not boys, had less clinically severe tics (ρ =- 0.32, p = 0.003). These findings provide evidence that, regarding tic severity assessed with YGTSS, the experiences of adolescent girls and boys with TS have differed during the pandemic.
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Affiliation(s)
- Travis R Larsh
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Steve W Wu
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - David A Huddleston
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Tara D Lipps
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Donald L Gilbert
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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Larsh TR, Wu SW, Huddleston DA, White S, Lipps TD, Gilbert DL. Adolescent Gender Differences in Tic- and Non-Tic-Related Impairments in Tourette Syndrome. J Child Neurol 2023:8830738231171959. [PMID: 37157809 DOI: 10.1177/08830738231171959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We aimed to compare tic- and non-tic-related impairment experienced by adolescent girls and boys (ages 13 through 17) with Tourette syndrome and associations with age. We extracted from the electronic health record child and parental responses to the mini-Child Tourette Syndrome Impairment Scale (mini-CTIM) and other questionnaire data reflective of tic- and non-tic-related impairment of adolescents with Tourette syndrome presenting to our clinic over a 12-month period. We identified a total of 132 (49 female, 83 male) unique adolescent encounters. Mini-CTIM scores did not differ significantly between genders. Tic- and non-tic-related impairment were lower in older boys, but not older girls. Obsessive-compulsive symptoms correlated with parent-reported non-tic-related impairment experienced by adolescent girls but not boys. During adolescence, tic- and non-tic-related impairments may be less likely to improve with age in girls. Future longitudinal studies are needed to confirm this finding.
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Affiliation(s)
- Travis R Larsh
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Steve W Wu
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David A Huddleston
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sean White
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tara D Lipps
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Donald L Gilbert
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Larsh TR, Huddleston DA, Horn PS, Wu SW, Cecil KM, Jackson HS, Edden RAE, Mostofsky SH, Gilbert DL. From urges to tics in children with Tourette syndrome: associations with supplementary motor area GABA and right motor cortex physiology. Cereb Cortex 2023; 33:3922-3933. [PMID: 35972405 PMCID: PMC10068284 DOI: 10.1093/cercor/bhac316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/12/2022] Open
Abstract
Tourette syndrome (TS) is a childhood-onset disorder in which tics are often preceded by premonitory sensory urges. More severe urges correlate with worse tics and can render behavioral therapies less effective. The supplementary motor area (SMA) is a prefrontal region believed to influence tic performance. To determine whether cortical physiological properties correlate with urges and tics, we evaluated, in 8-12-year-old right-handed TS children (n = 17), correlations of urge and tic severity scores and compared both to cortical excitability (CE) and short- and long-interval cortical inhibition (SICI and LICI) in both left and right M1. We also modeled these M1 transcranial magnetic stimulation measures with SMA gamma-amino butyric acid (GABA) levels in TS and typically developing control children (n = 16). Urge intensity correlated strongly with tic scores. More severe urges correlated with lower CE and less LICI in both right and left M1. Unexpectedly, in right M1, lower CE and less LICI correlated with less severe tics. We found that SMA GABA modulation of right, but not left, M1 CE and LICI differed in TS. We conclude that in young children with TS, lower right M1 CE and LICI, modulated by SMA GABA, may reflect compensatory mechanisms to diminish tics in response to premonitory urges.
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Affiliation(s)
- Travis R Larsh
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45267, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States
| | - David A Huddleston
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45267, United States
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45267, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States
| | - Steve W Wu
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45267, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States
| | - Kim M Cecil
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, United States
| | - Hannah S Jackson
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45267, United States
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, 707 N Broadway, Baltimore, MD 21205, United States
| | - Stewart H Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 707 N Broadway, Baltimore, MD 21205, United States
- Department of Neurology, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
| | - Donald L Gilbert
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45267, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, United States
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Zea Vera A, Bruce A, Larsh TR, Jordan Z, Brüggemann N, Westenberger A, Espay AJ, Gilbert DL, Wu SW. Spectrum of Pediatric to Early Adulthood POLR3A-Associated Movement Disorders. Mov Disord Clin Pract 2023; 10:316-322. [PMID: 36825045 PMCID: PMC9941928 DOI: 10.1002/mdc3.13635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/14/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Background POLR3A pathogenic variants are associated with hypomyelination, hypodontia, hypogonadism, and movement disorders. Cases We describe the range of movement disorders seen in six patients (four female, two male) with POLR3A variants [three novel (c.2214del, c.3775G>A, c.3905G>T) and six previously reported (c.760C>T, c.1771-7C>G, c.1909+22G>A, c.2005C>T, c.2422C>T, c.3337-11T>C)]. Patient 1 presented with a neonatal progeroid syndrome and developed parkinsonism, dystonia, ataxia, and spasticity. Patient 2 presented with infant-onset rapidly progressive chorea, and dystonia. Three patients (patients 3, 5, 6) presented predominantly with ataxia in combination with spasticity and dystonia. Patient 4 developed segmental dystonia during adolescence and ataxia in early adulthood. Four patients had vertical gaze impairment. The most common brain MRI abnormality was T2-weighted/FLAIR hyperintensity of the superior cerebellar peduncles and midbrain. Conclusion POLR3A-related disorders exhibit significant phenotypic pleomorphism. Vertical gaze dysfunction and T2-weighted/FLAIR hyperintensity of the superior cerebellar peduncles and midbrain may be useful signs suggestive of this condition.
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Affiliation(s)
- Alonso Zea Vera
- Department of NeurologyChildren's National HospitalWashingtonDCUSA
- Department of NeurologyGeorge Washington University School of Medicine & Health SciencesWashingtonDCUSA
| | - Adrienne Bruce
- Department of PediatricsPrisma HealthGreenvilleSouth CarolinaUSA
- University of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
| | - Travis R. Larsh
- Division of NeurologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Zachary Jordan
- Department of NeurologyUniversity of Cincinnati Gardner Neuroscience InstituteCincinnatiOhioUSA
| | - Norbert Brüggemann
- Institute of NeurogeneticsUniversity of LübeckLübeckGermany
- Department of NeurologyUniversity of LübeckLübeckGermany
| | | | - Alberto J. Espay
- Department of NeurologyUniversity of Cincinnati Gardner Neuroscience InstituteCincinnatiOhioUSA
| | - Donald L. Gilbert
- Division of NeurologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Steve W. Wu
- Division of NeurologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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Larsh TR, Wu SW, Gilbert DL. Comparison of Impairment in Functional Tic Disorders Versus Tourette Syndrome. Pediatr Neurol 2022; 134:83-84. [PMID: 35843129 DOI: 10.1016/j.pediatrneurol.2022.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Travis R Larsh
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, 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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Zea Vera A, Pedapati EV, Larsh TR, Kohmescher K, Miyakoshi M, Huddleston DA, Jackson HS, Gilbert DL, Horn PS, Wu SW. EEG Correlates of Active Stopping and Preparation for Stopping in Chronic Tic Disorder. Brain Sci 2022; 12:brainsci12020151. [PMID: 35203916 PMCID: PMC8870153 DOI: 10.3390/brainsci12020151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/16/2022] [Accepted: 01/20/2022] [Indexed: 01/11/2023] Open
Abstract
Motor inhibition is an important cognitive process involved in tic suppression. As the right frontal lobe contains important inhibitory network nodes, we characterized right superior, middle, and inferior frontal gyral (RSFG, RMFG, RIFG) event-related oscillations during motor inhibition in youth with chronic tic disorders (CTD) versus controls. Fourteen children with CTD and 13 controls (10–17 years old) completed an anticipated-response stop signal task while dense-array electroencephalography was recorded. Between-group differences in spectral power changes (3–50 Hz) were explored after source localization and multiple comparisons correction. Two epochs within the stop signal task were studied: (1) preparatory phase early in the trial before motor execution/inhibition and (2) active inhibition phase after stop signal presentation. Correlation analyses between electrophysiologic data and clinical rating scales for tic, obsessive-compulsive symptoms, and inattention/hyperactivity were performed. There were no behavioral or electrophysiological differences during active stopping. During stop preparation, CTD participants showed greater event-related desynchronization (ERD) in the RSFG (γ-band), RMFG (β, γ-bands), and RIFG (θ, α, β, γ-bands). Higher RSFG γ-ERD correlated with lower tic severity (r = 0.66, p = 0.04). Our findings suggest RSFG γ-ERD may represent a mechanism that allows CTD patients to keep tics under control and achieve behavioral performance similar to peers.
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Affiliation(s)
- Alonso Zea Vera
- Department of Neurology, Children’s National Hospital, Washington, DC 20010, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC 20052, USA
- Correspondence: ; Tel.: +1-(202)-476-5000
| | - Ernest V. Pedapati
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Travis R. Larsh
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (T.R.L.); (D.A.H.); (H.S.J.); (D.L.G.); (P.S.H.); (S.W.W.)
| | - Kevin Kohmescher
- College of Engineering and Applied Science, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - Makoto Miyakoshi
- Swartz Center for Computational Neuroscience, Institute for Neural Computation, University of California San Diego, La Jolla, CA 92093, USA;
| | - David A. Huddleston
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (T.R.L.); (D.A.H.); (H.S.J.); (D.L.G.); (P.S.H.); (S.W.W.)
| | - Hannah S. Jackson
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (T.R.L.); (D.A.H.); (H.S.J.); (D.L.G.); (P.S.H.); (S.W.W.)
| | - Donald L. Gilbert
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (T.R.L.); (D.A.H.); (H.S.J.); (D.L.G.); (P.S.H.); (S.W.W.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Paul S. Horn
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (T.R.L.); (D.A.H.); (H.S.J.); (D.L.G.); (P.S.H.); (S.W.W.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Steve W. Wu
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (T.R.L.); (D.A.H.); (H.S.J.); (D.L.G.); (P.S.H.); (S.W.W.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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Revilla FJ, Larsh TR, Mani A, Duker AP, Cox C, Succop P, Gartner M, Jarrin Tejada C, Bhattacharya A. Effect of dopaminergic medication on postural sway in advanced Parkinson's disease. Front Neurol 2013; 4:202. [PMID: 24379799 PMCID: PMC3861789 DOI: 10.3389/fneur.2013.00202] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 12/01/2013] [Indexed: 11/16/2022] Open
Abstract
Background: The effect of dopaminergic therapy on balance in Parkinson’s disease (PD) remains unclear, including previous studies that excluded the effect of dyskinesias or other involuntary movements on postural sway. Additionally, medication’s effects may differ between fallers and non-fallers. In this study, the authors quantify the effect of dopaminergic medication on postural balance (sway) in advanced PD, with and without dyskinesias, and consider the patient’s history of falls. Methods: In 24 patients with advanced idiopathic PD, postural balance was measured using a strain-gage force platform. Before and after taking dopaminergic medication, the patient’s postural sway was measured at 30-s intervals to determine sway length (SL) and sway area (SA). Data analysis included the presence of dyskinesias during “ON” medication condition and history of previous falls. Results: No significant changes occurred in SL or SA with dopaminergic treatment for fallers without dyskinesias or non-fallers with dyskinesias. However, after dopaminergic treatment, SL and SA were 37.8 and 45% lower, respectively, in non-fallers without dyskinesias (indicating better balance) and were 87.4 and 162.8% higher, respectively, in fallers with dyskinesias (indicating poorer balance). In the ON-medication condition, SL and SA were larger in patients with dyskinesias when compared with patients without dyskinesias; SL was larger in fallers than non-fallers in both groups with or without dyskinesias. Conclusion: Dopaminergic medication effects on postural sway could be a predictive factor for fall risk in PD patients with and without dyskinesias: specifically, decreased sway could indicate minimal fall risk whereas no change or increased postural sway could indicate a high risk.
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Affiliation(s)
- Fredy J Revilla
- Department of Neurology, University of Cincinnati College of Medicine , Cincinnati, OH , USA ; Gardner Center for Parkinson's and Movement Disorders, University of Cincinnati Neuroscience Institute , Cincinnati, OH , USA ; Veterans Affairs Medical Center , Cincinnati, OH , USA
| | - Travis R Larsh
- Department of Neurology, University of Cincinnati College of Medicine , Cincinnati, OH , USA
| | - Ashutosh Mani
- Biomechanics-Ergonomics Research Laboratory, Department of Environmental Health, University of Cincinnati College of Medicine , Cincinnati, OH , USA
| | - Andrew P Duker
- Department of Neurology, University of Cincinnati College of Medicine , Cincinnati, OH , USA ; Gardner Center for Parkinson's and Movement Disorders, University of Cincinnati Neuroscience Institute , Cincinnati, OH , USA
| | - Cyndy Cox
- Biomechanics-Ergonomics Research Laboratory, Department of Environmental Health, University of Cincinnati College of Medicine , Cincinnati, OH , USA
| | - Paul Succop
- Department of Environmental Health, Division of Epidemiology and Biostatistics, University of Cincinnati College of Medicine , Cincinnati, OH , USA
| | - Maureen Gartner
- Department of Neurology, University of Cincinnati College of Medicine , Cincinnati, OH , USA
| | - Claudia Jarrin Tejada
- Department of Internal Medicine, Virginia Commonwealth University Medical Center , Richmond, VA , USA
| | - Amit Bhattacharya
- Biomechanics-Ergonomics Research Laboratory, Department of Environmental Health, University of Cincinnati College of Medicine , Cincinnati, OH , USA
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