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DuBois M, Houlihan K, Raab B, Pryor A, Kellman M, Brinker M, Wellen B, Capriotti M, Conelea C. Quantifying tics: Best practices and design considerations for video-based tic coding in research. Behav Res Methods 2024:10.3758/s13428-024-02383-7. [PMID: 38472640 DOI: 10.3758/s13428-024-02383-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
Tic disorders (TD), including Tourette Syndrome, are characterized by involuntary, repetitive movements and/or vocalizations that can lead to persistent disability and impairment across the lifespan. Existing research demonstrates that video-based behavioral coding (VBBC) methods can be used to reliably quantify tics, enabling a more objective approach to tic measurement above and beyond standardly used TD questionnaires. VBBC is becoming more popular given the ease and ubiquity of obtaining patient videos. However, rigor and reproducibility of this work has been limited by undescribed and unstandardized approaches to using VBBC methods in TD research. The current paper describes "best practices" for VBBC in TD research, which have been tested and refined in our research over the past 15+ years, including considerations for data acquisition, coding implementation, interrater reliability demonstration, and methods reporting. We also address ethical considerations for researchers using this method.
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Affiliation(s)
- Megan DuBois
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Kerry Houlihan
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Brittany Raab
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Alison Pryor
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Mia Kellman
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Mayella Brinker
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Brianna Wellen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Matthew Capriotti
- Psychology Department, San Jose State University, San Jose, CA, 95192, USA
| | - Christine Conelea
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA.
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Dy-Hollins ME, Carr SJ, Essa A, Osiecki L, Lackland DT, Voeks JH, Mejia NI, Sharma N, Budman CL, Cath DC, Grados MA, King RA, Lyon GJ, Rouleau GA, Sandor P, Singer HS, Chibnik LB, Mathews CA, Scharf JM. The Challenge of Examining Social Determinants of Health in People Living With Tourette Syndrome. Pediatr Neurol 2024; 155:55-61. [PMID: 38608551 DOI: 10.1016/j.pediatrneurol.2024.02.008] [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] [Received: 10/12/2023] [Revised: 01/19/2024] [Accepted: 02/15/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND To examine the association between race, ethnicity, and parental educational attainment on tic-related outcomes among Tourette Syndrome (TS) participants in the Tourette Association of America International Consortium for Genetics (TAAICG) database. METHODS 723 participants in the TAAICG dataset aged ≤21 years were included. The relationships between tic-related outcomes and race and ethnicity were examined using linear and logistic regressions. Parametric and nonparametric tests were performed to examine the association between parental educational attainment and tic-related outcomes. RESULTS Race and ethnicity were collapsed as non-Hispanic white (N=566, 88.0%) versus Other (N=77, 12.0%). Tic symptom onset was earlier by 1.1 years (P < 0.0001) and TS diagnosis age was earlier by 0.9 years (P = 0.0045) in the Other group (versus non-Hispanic white). Sex and parental education as covariates did not contribute to the differences observed in TS diagnosis age. There were no significant group differences observed across the tic-related outcomes in parental education variable. CONCLUSIONS Our study was limited by the low number of nonwhite or Hispanic individuals in the cohort. Racial and ethnic minoritized groups experienced an earlier age of TS diagnosis than non-Hispanic white individuals. Tic severity did not differ between the two groups, and parental educational attainment did not affect tic-related outcomes. There remain significant disparities and gaps in knowledge regarding TS and associated comorbid conditions. Our study suggests the need for more proactive steps to engage individuals with tic disorders from all racial and ethnic minoritized groups to participate in research studies.
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Affiliation(s)
- Marisela E Dy-Hollins
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Samuel J Carr
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Angela Essa
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa Osiecki
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel T Lackland
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Jenifer H Voeks
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Nicte I Mejia
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Danielle C Cath
- Department of Psychiatry, University Medical Center Groningen, Rijks Universiteit Groningen, and Drenthe Mental Health Institute, Groningen, Netherlands
| | - Marco A Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A King
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Gholson J Lyon
- George A. Jervis Clinic and Institute for Basic Research in Developmental Disabilities, Staten Island, New York
| | - Guy A Rouleau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Center, Montreal, Canada
| | - Paul Sandor
- Department of Psychiatry, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Harvey S Singer
- Departments of Pediatrics and Neurology, Johns Hopkins Hospital, Kennedy Krieger Institute, Baltimore, Maryland
| | - Lori B Chibnik
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Carol A Mathews
- Department of Psychiatry, Center for OCD, Anxiety and Related Disorders, University of Florida, Gainsville, Florida
| | - Jeremiah M Scharf
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Yang Y, Yang H, Yu C, Ni F, Yu T, Luo R. Alterations in the topological organization of the default-mode network in Tourette syndrome. BMC Neurol 2023; 23:390. [PMID: 37899454 PMCID: PMC10614376 DOI: 10.1186/s12883-023-03421-1] [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: 07/04/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND The exact pathophysiology of TS is still elusive. Previous studies have identified default mode networks (DMN) abnormalities in patients with TS. However, these literatures investigated the neural activity during the tic suppression, not a true resting-state. Therefore, this study aimed to reveal the neural mechanism of Tourette's syndrome (TS) from the perspective of topological organization and functional connectivity within the DMN by electroencephalography (EEG) in resting-state. METHODS The study was conducted by analyzing the EEG data of TS patients with graph theory approaches. Thirty children with TS and thirty healthy controls (HCs) were recruited, and all subjects underwent resting-state EEG data acquisition. Functional connectivity within the DMN was calculated, and network properties were measured. RESULTS A significantly lower connectivity in the neural activity of the TS patients in the β band was found between the bilateral posterior cingulate cortex/retrosplenial cortex (t = -3.02, p < 0.05). Compared to HCs, the TS patients' local topological properties (degree centrality) in the left temporal lobe in the γ band were changed, while the global topological properties (global efficiency and local efficiency) in DMN exhibited no significant differences. It was also demonstrated that the degree centrality of the left temporal lobe in the γ band was positively related to the Yale Global Tic Severity Scale scores (r = 0.369, p = 0.045). CONCLUSIONS The functional connectivity and topological properties of the DMN of TS patients were disrupted, and abnormal DMN topological property alterations might affect the severity of tic in TS patients. The abnormal topological properties of the DMN in TS patients may be due to abnormal functional connectivity alterations. The findings provide novel insight into the neural mechanism of TS patients.
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Affiliation(s)
- Yue Yang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Hua Yang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Chunmei Yu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Fang Ni
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Tao Yu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Rong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, 610041, China.
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Shitova AD, Zharikova TS, Kovaleva ON, Luchina AM, Aktemirov AS, Olsufieva AV, Sinelnikov MY, Pontes-Silva A, Zharikov YO. Tourette syndrome and obsessive-compulsive disorder: A comprehensive review of structural alterations and neurological mechanisms. Behav Brain Res 2023; 453:114606. [PMID: 37524204 DOI: 10.1016/j.bbr.2023.114606] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/02/2023]
Abstract
Currently, it is possible to study the pathogenesis of Tourette's syndrome (TS) in more detail, due to more advanced methods of neuroimaging. However, medical and surgical treatment options are limited by a lack of understanding of the nature of the disorder and its relationship to some psychiatric disorders, the most common of which is obsessive-compulsive disorder (OCD). It is believed that the origin of chronic tic disorders is based on an imbalance of excitatory and inhibitory influences in the Cortico-Striato-Thalamo-Cortical circuits (CSTC). The main CSTCs involved in the pathological process have been identified by studying structural and neurotransmitter disturbances in the interaction between the cortex and the basal ganglia. A neurotransmitter deficiency in CSTC has been demonstrated by immunohistochemical and genetic methods, but it is still not known whether it arises as a consequence of genetically determined disturbances of neuronal migration during ontogenesis or as a consequence of altered production of proteins involved in neurotransmitter production. The aim of this review is to describe current ideas about the comorbidity of TS with OCD, the involvement of CSTC in the pathogenesis of both disorders and the background of structural and neurotransmitter changes in CSTC that may serve as targets for drug and neuromodulatory treatments.
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Affiliation(s)
| | - Tatyana S Zharikova
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Olga N Kovaleva
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Anastasia M Luchina
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Arthur S Aktemirov
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
| | - Anna V Olsufieva
- Moscow University for Industry and Finance "Synergy", Moscow 125315, Russia
| | - Mikhail Y Sinelnikov
- Department of Oncology and Radiotherapy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119048, Russia; Russian National Centre of Surgery, Avtsyn Research Institute of Human Morphology, Moscow 117418, Russia
| | - André Pontes-Silva
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
| | - Yury O Zharikov
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
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Lamanna J, Ferro M, Spadini S, Racchetti G, Malgaroli A. The Dysfunctional Mechanisms Throwing Tics: Structural and Functional Changes in Tourette Syndrome. Behav Sci (Basel) 2023; 13:668. [PMID: 37622808 PMCID: PMC10451670 DOI: 10.3390/bs13080668] [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] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
Tourette Syndrome (TS) is a high-incidence multifactorial neuropsychiatric disorder characterized by motor and vocal tics co-occurring with several diverse comorbidities, including obsessive-compulsive disorder and attention-deficit hyperactivity disorder. The origin of TS is multifactorial, with strong genetic, perinatal, and immunological influences. Although almost all neurotransmettitorial systems have been implicated in TS pathophysiology, a comprehensive neurophysiological model explaining the dynamics of expression and inhibition of tics is still lacking. The genesis and maintenance of motor and non-motor aspects of TS are thought to arise from functional and/or structural modifications of the basal ganglia and related circuitry. This complex wiring involves several cortical and subcortical structures whose concerted activity controls the selection of the most appropriate reflexive and habitual motor, cognitive and emotional actions. Importantly, striatal circuits exhibit bidirectional forms of synaptic plasticity that differ in many respects from hippocampal and neocortical plasticity, including sensitivity to metaplastic molecules such as dopamine. Here, we review the available evidence about structural and functional anomalies in neural circuits which have been found in TS patients. Finally, considering what is known in the field of striatal plasticity, we discuss the role of exuberant plasticity in TS, including the prospect of future pharmacological and neuromodulation avenues.
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Affiliation(s)
- Jacopo Lamanna
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Faculty of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Mattia Ferro
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Psychology, Sigmund Freud University, 20143 Milan, Italy
| | - Sara Spadini
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Division of Neuroscience, Scientific Institute Ospedale San Raffaele, 20132 Milan, Italy
| | - Gabriella Racchetti
- Division of Neuroscience, Scientific Institute Ospedale San Raffaele, 20132 Milan, Italy
| | - Antonio Malgaroli
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Faculty of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy
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Andersen K, Jensen I, Okkels KB, Skov L, Debes NM. Clarifying the Differences between Patients with Organic Tics and Functional Tic-Like Behaviors. Healthcare (Basel) 2023; 11:healthcare11101481. [PMID: 37239767 DOI: 10.3390/healthcare11101481] [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] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Due to the global increase in the number of patients with Functional Tic-Like Behaviors (FTLB), it has become increasingly important to find reliable differences between this patient group and patients with organic tics (OTs), which can be used in differential diagnosis. The purpose of this retrospective study was to critically examine both established and suggested differences between the patient groups. A total of 53 FTLB patients and 200 OT patients were included. Several findings from the current literature were replicated in this study: Compared to patients with OTs, patients with FTLB had significantly more complex tics, were older at symptom onset, were more likely to be female, and were less likely to have family members with tics. Furthermore, the study also revealed new differences between the groups: Patients with FTLB had significantly more family members with a psychiatric disorder, were more likely to have experienced an adverse psychosocial event immediately before symptom onset, and had significantly fewer simple tics. Finally, this study was unable to replicate the previously found differences in comorbidities between patients with OTs and FTLB. These findings could contribute significantly to the understanding of FTLB's etiology and to improve diagnosis, as including the presence of simple tics and comorbidities in the diagnostic criteria might be discussed in future studies.
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Affiliation(s)
- Kaja Andersen
- National Tourette Syndrome Clinic, Department of Pediatrics, Copenhagen University Hospital-Herlev and Gentofte, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Ida Jensen
- National Tourette Syndrome Clinic, Department of Pediatrics, Copenhagen University Hospital-Herlev and Gentofte, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kirstine Birkebæk Okkels
- National Tourette Syndrome Clinic, Department of Pediatrics, Copenhagen University Hospital-Herlev and Gentofte, 2730 Herlev, Denmark
| | - Liselotte Skov
- National Tourette Syndrome Clinic, Department of Pediatrics, Copenhagen University Hospital-Herlev and Gentofte, 2730 Herlev, Denmark
| | - Nanette Mol Debes
- National Tourette Syndrome Clinic, Department of Pediatrics, Copenhagen University Hospital-Herlev and Gentofte, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Prato A, Salerno AM, Saia F, Maugeri N, Zanini A, Scerbo M, Barone R, Rizzo R. Symptoms compatible with long COVID in an Italian pediatric cohort of Tourette patients with and without SARS‑CoV‑2 infection: a short-term follow-up assessment. BMC Pediatr 2023; 23:222. [PMID: 37147589 PMCID: PMC10161986 DOI: 10.1186/s12887-023-04035-9] [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] [Received: 01/25/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Tourette Syndrome (TS) is a childhood-onset neurodevelopmental disorder with a worldwide prevalence of about 0.3-1% of the population. During the pandemic caused by SARS-CoV-2 infection, the impact on the mental health of children and adolescents was very important. The persistence of symptoms in the post-acute phase of the disease has been termed Long COVID. The neuropsychiatric symptoms seem to be the most common impairment in children and adolescents with long COVID. OBJECTIVES Considering the impact of pandemic on mental health, in this study we analyzed the long-term effects of SARS-CoV-2 infection in children and adolescents affected by TS. METHODS We conducted an online questionnaire covering socio-demographic and clinical data among 158 patients affected by TS or chronic tic disorders (CTD), of which 78 participants reported a positive SARS-CoV-2 infection. Data were collected to investigate tic severity and both the comorbidities, as well as lockdown-related changes to daily life activities and, in case of infection of SARS-CoV-2, possible symptoms of acute infection and long COVID. Markers of systemic inflammation including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ferritin, iron, electrolytes, white blood cell counts, platelet cell counts levels, markers of liver, kidney and thyroid function were analyzed. First, all patients were screened with the Schedule for affective disorders and Schizophrenia for School age children-present and lifetime (Kiddie-SADS-PL) to rule out primary psychiatric disorders considered as criteria of exclusion. Then, all patients were clinically assessed at baseline (T0), and after three months (T1) through the administration of Yale Global Tic Severity Rating Scale (YGTSS), Multidimensional Anxiety Scale for Children (MASC), Child Depression Inventory (CDI) and Child Behavior Checklist (CBCL). RESULTS Among the cohort of TS patients that contracted SARS-CoV-2 infection, 84.6% (n = 66) experienced any acute symptoms, and long COVID symptoms occurred in 38.5% (n = 30). A worsening of clinical symptoms of tics and eventually associated comorbidities occurred in 34.6% (n = 27) of TS patients that contracted SARS-CoV-2 infection. TS patients with or without SARS-CoV-2 infection showed an increase in the severity of tics and also behavioral, depressive and anxious symptoms. Instead, this increase was more evident in patients who contracted the infection than in patients who did not contract it. CONCLUSIONS SARS-CoV-2 infection may have a role in the increase of tics and associated comorbidities in TS patients. Despite of these preliminary results, further investigations are necessary to improve knowledge about the acute and long-term impact of SARS-CoV-2 in TS patients.
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Affiliation(s)
- Adriana Prato
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, 95124, Italy.
| | - Angela Maria Salerno
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, 95124, Italy
| | - Federica Saia
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, 95124, Italy
| | - Nicoletta Maugeri
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, 95124, Italy
| | - Alice Zanini
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, 95124, Italy
| | - Miriam Scerbo
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, 95124, Italy
| | - Rita Barone
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, 95124, Italy
| | - Renata Rizzo
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, 95124, Italy
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Isaacs DA, Narapareddy A, Eckland MR, Riordan HR. Dimensional Assessment of Depression and Anxiety in a Clinical Sample of Adults With Chronic Tic Disorder. J Neuropsychiatry Clin Neurosci 2023; 35:352-360. [PMID: 37089074 PMCID: PMC10726996 DOI: 10.1176/appi.neuropsych.20220197] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Among adults with Tourette syndrome, depression and anxiety symptoms are widely prevalent and consistently associated with poor quality of life. Important knowledge gaps remain regarding mood and anxiety dimensions of the adult Tourette syndrome phenotype. Taking a dimensional approach, this study sought to determine the prevalence, severity, and clinical correlates of depression and anxiety symptoms in a clinical sample of adults with Tourette syndrome and other chronic tic disorders. METHODS A retrospective chart review was conducted of all adults with a chronic tic disorder presenting to a tertiary care Tourette syndrome clinic between December 2020 and July 2022. Information extracted during chart review included data from scales administered as part of routine care: Quality of Life in Neurological Disorders (Neuro-QoL) Depression Short Form, Neuro-QoL Anxiety Short Form, Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale, Dimensional Obsessive-Compulsive Scale, and Yale Global Tic Severity Scale. Relationships between variables were examined by conducting between-group, correlation, and multivariable regression analyses. RESULTS Data from 120 adult patients with a chronic tic disorder (77 men and 43 women) were analyzed. Neuro-QoL Anxiety scores were elevated in 66% of the cohort; Neuro-QoL Depression scores were elevated in 26%. Neuro-QoL Anxiety scores were significantly higher than general population norms, whereas Neuro-QoL Depression scores were not. After adjustment for covariates, depressive and anxiety symptom severity scores were significantly associated with each other and with obsessive-compulsive disorder symptom severity but not with tic severity. Sex-based differences emerged in the analyses. CONCLUSIONS Among adults with chronic tic disorder, anxiety symptoms were more prevalent and severe than depressive symptoms, co-occurring psychiatric symptoms were more tightly linked with each other than with tic severity, and sex-based differences were evident.
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Affiliation(s)
- David A. Isaacs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, United States
| | | | - Michelle R. Eckland
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Heather R. Riordan
- Phelps Center for Cerebral Palsy and Developmental Medicine at Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Pediatric Neurology, Johns Hopkins Children’s Center, Baltimore, MD, United States
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Arbuckle AL, Bihun EC, Schlaggar BL, Black KJ. Functional tic-like presentations differ strikingly from Provisional Tic Disorder. F1000Res 2023; 11:1566. [PMID: 37224324 PMCID: PMC10186060 DOI: 10.12688/f1000research.129252.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/26/2023] Open
Abstract
Background: Recent years have seen a dramatic increase in new "tic" cases in teens and young adults. These individuals often present with fulminant onset of symptoms not commonly seen in Tourette syndrome (TS) and are often diagnosed with Functional Neurological Symptom Disorder (FND-tic). However, some authors have questioned whether this illness truly differs from typical Provisional Tic Disorder (PTD) and TS. Previous studies have compared FND-tic, usually a few months after symptom onset, to patients with TS, usually years after symptom onset. We sought to test whether the presenting symptoms of FND-tic differ substantially from those in patients at a similar duration of symptoms who are later diagnosed with TS. Methods: This comparative study examines clinical features summarized from published reports of FND-tic with novel data from a longitudinal study of PTD. This study came from a referral center for TS and tic disorders and included 89 children with tics whose first tic occurred a median of 3.6 months earlier, nearly all of whom were diagnosed with a chronic tic disorder at follow-up. Specifically, we examine clinical features identified in a recent literature review as supporting a diagnosis of FND-tic, including symptom characteristics, course, severity and comorbidity. Results: Several clinical features dramatically distinguish the patients diagnosed with FND-tic from those diagnosed with typical PTD. For example, coprophenomena are reported at or shortly after symptom onset in over half of FND-tic patients, whereas even several months after onset, coprophenomena had occurred in only 1 of 89 children with PTD. Six clinical features each have a positive predictive value over 90% for FND-tic diagnosis if prior probability is 50%. Conclusions: These new data provide strong evidence supporting the diagnostic validity of FND-tic as distinct from TS.
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Affiliation(s)
- Amanda L. Arbuckle
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USA
| | - Emily C. Bihun
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USA
| | - Bradley L. Schlaggar
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, MD, 21287, USA
- Department of Neurology, Johns Hopkins Medicine, Baltimore, Maryland, 21287, USA
- Kennedy Krieger Institute, Baltimore, Maryland, 21205, USA
| | - Kevin J. Black
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USA
- Department of Neurology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USA
- Department of Neuroscience, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USA
- Department of Radiology, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, 63110, USA
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Saia F, Prato A, Saccuzzo L, Madia F, Barone R, Fichera M, Rizzo R. Copy Number Variations in Children with Tourette Syndrome: Systematic Investigation in a Clinical Setting. Genes (Basel) 2023; 14:500. [PMID: 36833427 PMCID: PMC9956985 DOI: 10.3390/genes14020500] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Tourette syndrome (TS) is a neurodevelopmental disturbance with heterogeneous and not completely known etiology. Clinical and molecular appraisal of affected patients is mandatory for outcome amelioration. The current study aimed to understand the molecular bases underpinning TS in a vast cohort of pediatric patients with TS. Molecular analyses included array-CGH analyses. The primary goal was to define the neurobehavioral phenotype of patients with or without pathogenic copy number variations (CNVs). Moreover, we compared the CNVs with CNVs described in the literature in neuropsychiatric disorders, including TS, to describe an effective clinical and molecular characterization of patients for prognostic purposes and for correctly taking charge. Moreover, this study showed that rare deletions and duplications focusing attention on significant genes for neurodevelopment had a statistically higher occurrence in children with tics and additional comorbidities. In our cohort, we determined an incidence of potentially causative CNVs of about 12%, in line with other literature studies. Clearly, further studies are needed to delineate the genetic background of patients with tic disorders in a superior way to elucidate the complex genetic architecture of these disorders, to describe the outcome, and to identify new possible therapeutic targets.
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Affiliation(s)
- Federica Saia
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, 95124 Catania, Italy
| | - Adriana Prato
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, 95124 Catania, Italy
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, 98121 Messina, Italy
| | - Lucia Saccuzzo
- Department of Biomedical and Biotechnological Sciences, Medical Genetics, University of Catania, 95124 Catania, Italy
| | - Francesca Madia
- Laboratory of Neurogenetics and Neuroscience, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Rita Barone
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, 95124 Catania, Italy
| | - Marco Fichera
- Department of Biomedical and Biotechnological Sciences, Medical Genetics, University of Catania, 95124 Catania, Italy
- Research Unit of Rare Diseases and Neurodevelopmental Disorders, Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | - Renata Rizzo
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, 95124 Catania, Italy
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11
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Tygesen MLB, Maigaard K, Hagstrøm J, Skov L, Plessen KJ, Debes NMM. Fine Motor Skills in Children with Tourette Syndrome and their Unaffected First-degree Siblings. Scand J Child Adolesc Psychiatr Psychol 2023; 11:60-68. [PMID: 37359272 PMCID: PMC10286835 DOI: 10.2478/sjcapp-2023-0006] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background The exact etiology of Tourette Syndrome (TS) remains unclear, making the search for impaired neuropsychological functions possibly connected to the underlying cause of TS as important as it is challenging. One neuropsychological domain of interest is fine motor skills. Method This study compared fine motor skill performance on the Purdue Pegboard Task (PPT) in 18 children with TS, 24 unaffected first-degree siblings and 20 controls. A set of screening questionnaires was administered to determine comorbid psychiatric illness. Results Children with TS, their siblings and controls did not differ significantly in fine motor skills as measured with the PPT. Performance on the PPT was not correlated with tic severity; however, we found an inverse correlation with severity of attention-deficit/hyperactivity disorder (ADHD) symptoms, as assessed by parent reported ADHD symptoms. Children with TS were found to have significantly higher parent reported ADHD symptoms compared to controls, yet only two out of the 18 participants had been diagnosed with ADHD. Conclusion This study suggests that fine motor skill impairment in children with TS may be more strongly correlated with comorbid ADHD than to TS and tics.
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Affiliation(s)
- Marie Louise Boeg Tygesen
- Child and Adolescent Mental Health Center, Mental Health Services, Gentofte, Capital Region of Denmark
| | - Katrine Maigaard
- Child and Adolescent Mental Health Center, Mental Health Services, Gentofte, Capital Region of Denmark
| | - Julie Hagstrøm
- Child and Adolescent Mental Health Center, Mental Health Services, Gentofte, Capital Region of Denmark
| | - Liselotte Skov
- Department of Pediatrics, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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12
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McCann B, Lam M, Shiohama T, Ijner P, Takahashi E, Levman J. Magnetic Resonance Imaging Demonstrates Gyral Abnormalities in Tourette Syndrome. Int J Dev Neurosci 2022; 82:539-547. [PMID: 35775746 DOI: 10.1002/jdn.10209] [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] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/07/2022] Open
Abstract
Tourette syndrome (TS) is a neurological disorder characterized by involuntary and repetitive movements known as tics. A retrospective analysis of magnetic resonance imaging (MRI) scans from 39 children and adolescents with TS was performed and subsequently compared to MRI scans from 834 neurotypical controls. The purpose of this study was to identify any differences in the regions of motor circuitry in TS to further our understanding of their disturbances in motor control (i.e., motor tics). Measures of volume, cortical thickness, surface area, and surface curvature for specific motor regions were derived from each MRI scan. The results revealed increased surface curvature in the opercular part of the inferior frontal gyrus and the triangular part of the inferior frontal gyrus in the TS group compared to the neurotypical control group. These novel findings offer some of the first evidence for surface curvature differences in motor circuitry regions in TS, which may be associated with known motor and vocal tics.
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Affiliation(s)
- Bernadette McCann
- Department of Human Kinetics, St. Francis Xavier University, Antigonish, NS, Canada
| | - Melanie Lam
- Department of Human Kinetics, St. Francis Xavier University, Antigonish, NS, Canada
| | - Tadashi Shiohama
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Japan
| | - Prahar Ijner
- Department of Computer Science, St. Francis Xavier University, Antigonish, NS, Canada
| | - Emi Takahashi
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Department of Pediatrics, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Massachusetts Institute of Technology, Charlestown, MA, USA
| | - Jacob Levman
- Department of Computer Science, St. Francis Xavier University, Antigonish, NS, Canada.,Nova Scotia Health Authority - Research, Innovation and Discovery, Center for Clinical Research, Halifax, NS, Canada
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13
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Eapen V, Črnčec R, Pick AX, Tsao O, Lai R, Lee J, Sowman PF. Comprehensive behavioural intervention for tics: a neurophysiological intervention. J Integr Neurosci 2022; 21:89. [PMID: 35633170 DOI: 10.31083/j.jin2103089] [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] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/06/2021] [Accepted: 12/27/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Gilles de la Tourette Syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterised by motor and vocal tics. While Comprehensive Behavioural Intervention for Tics (CBIT) is an effective, non-pharmacological treatment for patients with GTS, the underlying neurophysiological basis of this intervention has not been investigated. METHODS To investigate the clinical effectiveness of CBIT in reducing tic severity in young people with GTS and explore neurophysiological mechanisms associated with clinical change. RESULTS There was a significant overall improvement in tic severity of large effect size. The Cortical Silent Period (CSP) to motor evoked potential (MEP) ratio (CSP/MEP ratio) increased after the intervention with a small effect size. Other neurophysiological measures of inhibition were not significantly related to the change in tic severity. CONCLUSIONS Alongside significant clinical improvements, these results suggest a role for motor cortical Gamma-aminobutyric acid (GABA)-ergic inhibitory circuitry in the neurophysiological changes underlying CBIT treatment. These findings need to be replicated in larger studies using control samples.
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Affiliation(s)
- Valsamma Eapen
- School of Psychiatry, University of New South Wales, 2052 Sydney, Australia.,Academic Unit of Child Psychiatry, South Western Sydney Local Health District and Ingham Institute, 2170 Sydney, Australia
| | - Rudi Črnčec
- Pnerith Therapy Centre, Penrith, 2750 Sydney, Australia
| | - Anna Xenia Pick
- Faculty of Medicine, University of New South Wales, 2052 Sydney, Australia
| | - Owen Tsao
- Faculty of Medicine, University of New South Wales, 2052 Sydney, Australia
| | - Richard Lai
- Faculty of Medicine, University of New South Wales, 2052 Sydney, Australia
| | - Janette Lee
- Faculty of Medicine, University of New South Wales, 2052 Sydney, Australia.,Sydney Children's Hospital, Randwick, 2031 Sydney, Australia
| | - Paul F Sowman
- School of Psychological Sciences, Macquarie University Australia, 2113 Sydney, Australia
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14
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Zimmerman-Brenner S, Pilowsky-Peleg T, Rachamim L, Ben-Zvi A, Gur N, Murphy T, Fattal-Valevski A, Rotstein M. Group behavioral interventions for tics and comorbid symptoms in children with chronic tic disorders. Eur Child Adolesc Psychiatry 2022; 31:637-648. [PMID: 33415472 DOI: 10.1007/s00787-020-01702-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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] [Received: 06/25/2020] [Accepted: 12/05/2020] [Indexed: 11/28/2022]
Abstract
Exposure and Response Prevention (ERP), Habit Reversal Training (HRT) and Comprehensive Behavioral Intervention for Tics (CBIT) are effective in reducing tic severity. ERP and HRT have recently gained primary support in a group setting, while CBIT has not been examined similarly. We compared the efficacy of group-CBIT to group-Educational Intervention for Tics (group-EIT) for tics and comorbid symptoms. Children with Tourette Syndrome (TS) or Chronic Tic Disorder (CTD) were randomized to group-CBIT or group-EIT. Tics and comorbid symptoms were assessed in forty-six children pre- and postintervention, and 3-month later. Yale Global Tic Severity Scale (YGTSS) Motor tic severity decreased following both interventions, and was maintained at follow-up for group-CBIT only. The Parent Tic Questionnaire (PTQ) showed significant decrease in total and motor tic severity following group-CBIT only, a gain maintained three months later. YGTSS impairment score decreased following both interventions and was maintained at follow-up. YGTSS vocal tic severity score increased following both interventions, and then decreased significantly at follow up. Co-morbid symptoms including anxiety, behavioral problems, and aggressive behavior decreased following both interventions. Children with behavioral problems benefitted less while children with higher intellectual ability benefit more from intervention. Both group interventions showed efficacy in reducing tic impairment and comorbid symptoms. Group-CBIT was superior to group-EIT in reducing motor tic severity at 3-month follow-up, showing an advantage for tic-focused treatment. Based on the PTQ, group-CBIT was superior to group-EIT in reducing motor, vocal, and total tic scores, a gain maintained three months later. Clinical trial registry information-Group Intervention for Children with Chronic Tics Syndrome: CBIT vs Psychoeducational Intervention URL: http://clinicaltrials.gov , Identifier: NCT02407951, http://www.controlled-trials.com ).
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Affiliation(s)
- Sharon Zimmerman-Brenner
- Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel.,Tourette Syndrome Association in Israel (TSAI), Tel Aviv-Yaffo, Israel
| | - Tammy Pilowsky-Peleg
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.,Neuropsychology Unit, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Lilach Rachamim
- Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel.,Cohen & Harris Resilience Center, Association for Children at Risk, Tel Aviv-Yaffo, Israel
| | - Amit Ben-Zvi
- Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | - Noa Gur
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.,Neuropsychology Unit, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Tara Murphy
- Tourette Syndrome Clinic, Great Ormond Street Hospital for Children, NHS Foundation Trust London, London, UK
| | - Aviva Fattal-Valevski
- Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel
| | - Michael Rotstein
- Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel. .,Pediatric Movement Disorders Clinic, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel. .,Pediatric Movement Disorders Service, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv-Yaffo, Israel.
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15
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Anderson SM; Tics and Tourette Around the Globe (TTAG) representing Tic and Tourette Syndrome (TS) patient associations around the world. European clinical guidelines for Tourette Syndrome and other tic disorders: patients' perspectives on research and treatment. Eur Child Adolesc Psychiatry 2022; 31:463-9. [PMID: 34370120 DOI: 10.1007/s00787-021-01854-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
The formation of a new umbrella organisation called Tics and Tourette Across the Globe (TTAG) representing Tic and Tourette Syndrome (TS) patient associations around the world has led to a clearer voice for patients with Tourette Syndrome (TS). An opportunity has been created for this group to bridge research, clinical work and shared decision-making between researchers, clinicians and patients across Europe, with the result of improving the treatment and management of TS. A survey was sent out to capture the patients' perspective on research and treatment, and 2269 participants responded. 71% of participants reported they would prefer research into how to treat TS and/or make symptoms better. The inclusion of patients' perspectives on research and treatment in the updated European clinical guidelines for TS and other tic disorders highlights the new opportunities that have been created for the participation of patients in the discussion of TS research.
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16
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Ritter M, Vangkilde SA, Maigaard K, Pagsberg AK, Plessen KJ, Hagstrøm J. Inhibitory Control in Children with Tourette Syndrome Is Impaired in Everyday Life but Intact during a Stop Signal Task. J Clin Med 2022; 11:jcm11020309. [PMID: 35054004 PMCID: PMC8781955 DOI: 10.3390/jcm11020309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
Tourette Syndrome (TS) has previously been associated with deficits in inhibitory control (IC). However, studies on IC in individuals with TS have produced conflicting results. In the present study, we investigated IC, comparing the Stop Signal Reaction Time (SSRT) measure with parent and teacher ratings of daily life IC in 169 children aged 8–12 (60 with TS, 60 typically developing controls, 27 with attention-deficit/hyperactivity disorder (ADHD), and 22 with TS + ADHD). We further investigated associations of IC with TS and ADHD symptom severity. Children with TS showed intact SSRT performance, but impairments in daily life IC, as reported by parents and teachers. For the latter, we observed a staircase distribution of groups, with the healthy controls presenting with the best IC, followed by TS, TS + ADHD, and finally ADHD. Dimensional analyses indicated a strong association between ADHD severity and both measures of IC. Our results indicate that children with TS are not impaired in a laboratory-based measure of IC, although some difficulties were evident from measures of everyday behaviour, which may in part be due to parents and teachers interpreting tics as disinhibited behaviour. Comorbid ADHD or the severity of subthreshold ADHD symptomatology appeared to account for IC deficits.
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Affiliation(s)
- Melanie Ritter
- Child and Adolescent Mental Health Center, Copenhagen University Hospital—Mental Health Services CPH, 2400 Copenhagen, Denmark; (M.R.); (K.M.); (A.K.P.); (K.J.P.)
| | - Signe Allerup Vangkilde
- Center for Visual Cognition, Department of Psychology, University of Copenhagen, 1353 Copenhagen, Denmark;
| | - Katrine Maigaard
- Child and Adolescent Mental Health Center, Copenhagen University Hospital—Mental Health Services CPH, 2400 Copenhagen, Denmark; (M.R.); (K.M.); (A.K.P.); (K.J.P.)
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital—Mental Health Services CPH, 2400 Copenhagen, Denmark; (M.R.); (K.M.); (A.K.P.); (K.J.P.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital—Mental Health Services CPH, 2400 Copenhagen, Denmark; (M.R.); (K.M.); (A.K.P.); (K.J.P.)
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Julie Hagstrøm
- Child and Adolescent Mental Health Center, Copenhagen University Hospital—Mental Health Services CPH, 2400 Copenhagen, Denmark; (M.R.); (K.M.); (A.K.P.); (K.J.P.)
- Correspondence:
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17
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Prato A, Maugeri N, Chiarotti F, Morcaldi L, Vicario CM, Barone R, Rizzo R. A Randomized Controlled Trial Comparing Videoconference vs. Face-to-Face Delivery of Behavior Therapy for Youths With Tourette Syndrome in the Time of COVID-19. Front Psychiatry 2022; 13:862422. [PMID: 35686189 PMCID: PMC9170982 DOI: 10.3389/fpsyt.2022.862422] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the clinical effectiveness of online remote behavior therapy, compared with face-to-face therapy in reducing tics and co-occurring disorders associated with the tics in a sample of youths with Tourette Syndrome. DESIGN A randomized controlled trial. TS patients were randomized to receive face-to-face or online remote behavior therapy. PARTICIPANTS 40 children aged between 9 and 16 years affected by Tourette Syndrome. RESULTS Online remote and face-to-face behavior therapy are equally effective in the treatment of tics and co-occurring disorders in children and adolescents affected by Tourette Syndrome. Both groups showed an improvement in the severity of tics, obsessive-compulsive symptoms, and anxiety symptoms, as assessed by neuropsychological findings. Online remote behavior therapy was more effective for reducing depressive symptoms than face-to-face behavior therapy. CONCLUSIONS Online remote behavior therapy is a promising tool for behavioral therapies for patients with Tourette Syndrome and may represents an alternative treatment option.
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Affiliation(s)
- Adriana Prato
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy.,Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
| | - Nicoletta Maugeri
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Flavia Chiarotti
- Center for Behavioral Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Morcaldi
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Carmelo M Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Italy
| | - Rita Barone
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
| | - Renata Rizzo
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicine, Catania University, Catania, Italy
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18
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Ramsey KA, De Nadai AS, Espil FM, Ricketts E, Stiede JT, Schild J, Specht MW, Woods DW, Bennet S, Walkup JT, Chang S, Piacentini J, McGuire JF. Urge intolerance predicts tic severity and impairment among adults with Tourette syndrome and chronic tic disorders. Front Psychiatry 2022; 13:929413. [PMID: 36032236 PMCID: PMC9399515 DOI: 10.3389/fpsyt.2022.929413] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Individuals with Tourette Syndrome and Persistent Tic Disorders (collectively TS) often experience premonitory urges-aversive physical sensations that precede tics and are temporarily relieved by tic expression. The relationship between tics and premonitory urges plays a key role in the neurobehavioral treatment model of TS, which underlies first-line treatments such as the Comprehensive Behavioral Intervention for Tics (CBIT). Despite the efficacy of CBIT and related behavioral therapies, less than 40% of adults with TS respond to these treatments. Further examination of the relationship between premonitory urges, tic severity, and tic impairment can provide new insights into therapeutic targets to optimize behavioral treatment outcomes. This study examined whether urge intolerance-difficulty tolerating premonitory urges-predicted tic severity and tic-related impairment among adults with TS. METHODS Participants were 80 adults with TS. Assessments characterized premonitory urge, distress tolerance, tic severity, and tic impairment. We used structural equation modeling (SEM) to examine the construct of urge intolerance-comprised of premonitory urge ratings and distress tolerance ratings. We first evaluated a measurement model of urge intolerance through bifactor modeling, including tests of the incremental value of subfactors that reflect premonitory urge severity and distress tolerance within the model. We then evaluated a structural model where we predicted clinician-rated tic severity and tic impairment by the latent variable of urge intolerance established in our measurement model. RESULTS Analyses supported a bifactor measurement model of urge intolerance among adults with TS. Consistent with theoretical models, higher levels of urge intolerance predicted greater levels of clinician-rated tic severity and tic impairment. CONCLUSION This investigation supports the construct of urge intolerance among adults with TS and distinguishes it from subcomponents of urge severity and distress tolerance. Given its predictive relationship with tic severity and tic impairment, urge intolerance represents a promising treatment target to improve therapeutic outcomes in adults with TS.
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Affiliation(s)
- Kesley A Ramsey
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children (COACH), Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Emily Ricketts
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - Jordan T Stiede
- Department of Psychology, Behavior Therapy and Research Lab, Marquette University, Milwaukee, WI, United States
| | - Jennifer Schild
- Department of Psychology, Choices Youth Psychopathology Lab, Suffolk University, Boston, MA, United States
| | - Matthew W Specht
- Department of Psychiatry, Weill-Cornell Medicine, New York, NY, United States
| | - Douglas W Woods
- Department of Psychology, Behavior Therapy and Research Lab, Marquette University, Milwaukee, WI, United States
| | - Shannon Bennet
- Department of Psychiatry, Weill-Cornell Medicine, New York, NY, United States
| | - John T Walkup
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Susanna Chang
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children (COACH), Johns Hopkins University School of Medicine, Baltimore, MD, United States
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19
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Wang Y, Zhao L, Li AY. Gastrodin - A potential drug used for the treatment of Tourette Syndrome. J Pharmacol Sci 2021; 145:289-295. [PMID: 33602510 DOI: 10.1016/j.jphs.2021.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 09/29/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022] Open
Abstract
Gastrodin (Gas) represents the major active component of Gastrodia elata, a Chinese herb. Clinically, Gas is widely used for its sedative, anticonvulsive and neuroprotective properties. This work aimed to assess Gas for its efficacy in Tourette Syndrome (TS) treatment. Twenty-four rats were randomized to the blank control (n = 6) and experimental (n = 18) groups. The experimental group was administered continuous injection of 3, 3'-iminodipropionitrile (IDPN) intraperitoneally for 7 days, and subdivided into the IDPN + NS, IDPN + Hal, and IDPN + Gas groups (n = 6). The control and IDPN + NS groups received saline intragastrically, while the IDPN + Hal and IDPN + Gas groups were administered Gas and Haloperidol, respectively, for 8 weeks. Then, micro-positron emission tomography (PET) was performed for measuring the density and brain distribution of dopamine D2 receptors (D2Rs), dopamine transporters (DATs), 5-HT2A receptors (5-HT2ARs) and 5-HT transporters (SERTs). According to stereotypical behavior experiments, IDPN significantly induced abnormal stereotypical behaviors in rats in comparison with control animals. In addition, micro-PET revealed that by reducing the amounts of D2Rs and increasing those of DATs, Gas could significantly reduce stereotypical TS-like behaviors in this rat model system. Furthermore, Gas treatment reduced the density of SERTs, which could indirectly decrease DA release. The current study demonstrated that Gas could be effective in treating TS.
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Affiliation(s)
- Yuan Wang
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Lin Zhao
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.
| | - An-Yuan Li
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
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20
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Goto R, Matsuda N, Nonaka M, Hamamoto Y, Eriguchi Y, Fujiwara M, Suzuki A, Yokoyama Y, Kano Y. The Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL): A Validation in Japanese Patients. Front Psychiatry 2021; 12:797037. [PMID: 35046856 PMCID: PMC8761978 DOI: 10.3389/fpsyt.2021.797037] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Though Gilles de la Tourette's syndrome (GTS) has significant impact on the quality of life of its patients, measures of health-related quality of life (HR-QOL) specific to adolescents and adults with GTS were not developed until recently. The present study provides evidence on the validity of the Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL), the first disease-specific HR-QOL instrument for GTS patients, for the first time in an East Asian sample. Methods: One hundred and two Japanese individuals aged 13 and above with GTS were included in our study. Internal consistency was evaluated using Cronbach's alpha. The 4-factor structure of the GTS-QOL was assessed using confirmatory factor analysis, using goodness of fit indices, factor loadings of each questionnaire item, and covariances between factors. Validity was assessed using interscale correlations. Convergent and discriminate construct validity was evaluated using correlations with other scales such as the 28-item General Health Questionnaire, the Yale Global Tic Severity Scale, and the short version of the Padua Inventory. Results: Scaling assumptions were met. Internal consistency reliability was high, with a Cronbach's alpha of 0.96. Confirmatory factor analysis revealed sufficient factor loadings and goodness of fit. All measures of goodness of fit corroborated the fit of the 4-factor model. Standardized covariances between factors in the confirmatory factor analysis were >0.8. There were significant correlations with other well-validated scales, and thus convergent and discriminate construct validity was sufficient. Conclusion: The GTS-QOL is a valid and reliable instrument to measure disease-specific HR-QOL of GTS patients in Japan.
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Affiliation(s)
- Ryunosuke Goto
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Natsumi Matsuda
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Department of Developmental Psychology, Faculty of Human Studies, Shirayuri University, Tokyo, Japan
| | - Maiko Nonaka
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Yu Hamamoto
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yosuke Eriguchi
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mayu Fujiwara
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan
| | - Akane Suzuki
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukari Yokoyama
- Department of Social Welfare, Faculty of Social Welfare, Nihon Fukushi University, Mihama, Japan
| | - Yukiko Kano
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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21
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Pagliaroli L, Vereczkei A, Padmanabhuni SS, Tarnok Z, Farkas L, Nagy P, Rizzo R, Wolanczyk T, Szymanska U, Kapisyzi M, Basha E, Koumoula A, Androutsos C, Tsironi V, Karagiannidis I, Paschou P, Barta C. Association of Genetic Variation in the 3'UTR of LHX6, IMMP2L, and AADAC With Tourette Syndrome. Front Neurol 2020; 11:803. [PMID: 32922348 PMCID: PMC7457023 DOI: 10.3389/fneur.2020.00803] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Tourette Syndrome (TS) is a neurodevelopmental disorder that presents with motor and vocal tics early in childhood. The aim of this study was to investigate genetic variants in the 3' untranslated region (3'UTR) of TS candidate genes with a putative link to microRNA (miRNA) mediated regulation or gene expression. Methods: We used an in silico approach to identify 32 variants in the 3'UTR of 18 candidate genes putatively changing the binding site for miRNAs. In a sample composed of TS cases and controls (n = 290), as well as TS family trios (n = 148), we performed transmission disequilibrium test (TDT) and meta-analysis. Results: We found positive association of rs3750486 in the LIM homeobox 6 (LHX6) gene (p = 0.021) and rs7795011 in the inner mitochondrial membrane peptidase subunit 2 (IMMP2L) gene (p = 0.029) with TS in our meta-analysis. The TDT showed an over-transmission of the A allele of rs1042201 in the arylacetamide deacetylase (AADAC) gene in TS patients (p = 0.029). Conclusion: This preliminary study provides further support for the involvement of LHX6, IMMP2L, and AADAC genes, as well as epigenetic mechanisms, such as altered miRNA mediated gene expression regulation in the etiology of TS.
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Affiliation(s)
- Luca Pagliaroli
- Institute of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Andrea Vereczkei
- Institute of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | | | - Zsanett Tarnok
- Vadaskert Clinic for Child and Adolescent Psychiatry, Budapest, Hungary
| | - Luca Farkas
- Vadaskert Clinic for Child and Adolescent Psychiatry, Budapest, Hungary
| | - Peter Nagy
- Vadaskert Clinic for Child and Adolescent Psychiatry, Budapest, Hungary
| | - Renata Rizzo
- Materno Infantile and Radiological Science Department, University of Catania, Catania, Italy
| | - Tomasz Wolanczyk
- Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Urszula Szymanska
- Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Mira Kapisyzi
- University Hospital Center "Mother Theresa," Tirana, Albania
| | - Entela Basha
- University Hospital Center "Mother Theresa," Tirana, Albania
| | - Anastasia Koumoula
- Department of Child and Adolescent Psychiatry, Sismanoglio General Hospital of Attica, Athens, Greece
| | - Christos Androutsos
- Department of Child and Adolescent Psychiatry, Sismanoglio General Hospital of Attica, Athens, Greece
| | - Vaia Tsironi
- Department of Child and Adolescent Psychiatry, Sismanoglio General Hospital of Attica, Athens, Greece
| | - Iordanis Karagiannidis
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupoli, Greece
| | - Peristera Paschou
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupoli, Greece
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary
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22
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Novara C, Pardini S, Cardona F, Pastore M. Comparing Models of the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) in an Italian Clinical Sample. Front Psychiatry 2020; 11:615. [PMID: 32848897 PMCID: PMC7424057 DOI: 10.3389/fpsyt.2020.00615] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obsessive-Compulsive Disorder (OCD) is a mental disorder that interferes with daily functioning and may arise during childhood. The current study is the first attempt by Italian researchers to validate the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). AIMS The study's primary aim was to investigate the best CY-BOCS model fit, adopting a Bayesian model comparison strategy, among four different factor models: a one-factor model; a two-factor model based on Obsessions and Compulsions; Storch et al.'s and Mc Kay et al.'s two-factor model based on Disturbance and Severity. The study also aimed to investigate the types of treatments found in a sample of Italian OCD children patients. METHODS The study sample was made up of 53 children with OCD and 14 children with Tourette Syndrome and TIC. RESULTS An analysis of our data demonstrated that the Obsessions and Compulsions model was the most plausible one, as it demonstrated the best fit indices, strong convergent validity, and good reliability. The study results additionally uncovered that 24.5% of the children in the OCD sample had not yet begun any treatment pathway a year after a diagnosis was formulated. CONCLUSIONS These findings suggest that the Obsessions and Compulsions scales of the CY-BOCS separately represent appropriate instruments to evaluate children with OCD.
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Affiliation(s)
- Caterina Novara
- Dipartimento di Psicologia Generale, Università di Padova, Padova, Italy
| | - Susanna Pardini
- Dipartimento di Psicologia Generale, Università di Padova, Padova, Italy
| | - Francesco Cardona
- Dipartimento di Neuroscienze Umane, Università di Roma “La Sapienza”, Roma, Italy
| | - Massimiliano Pastore
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, Università di Padova, Padova, Italy
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23
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Bennett SM, Capriotti M, Bauer C, Chang S, Keller AE, Walkup J, Woods D, Piacentini J. Development and Open Trial of a Psychosocial Intervention for Young Children With Chronic Tics: The CBIT-JR Study. Behav Ther 2020; 51:659-669. [PMID: 32586437 DOI: 10.1016/j.beth.2019.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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] [Received: 05/06/2019] [Revised: 10/09/2019] [Accepted: 10/13/2019] [Indexed: 11/29/2022]
Abstract
The Comprehensive Behavioral Intervention for Tic Disorders (CBIT) has demonstrated efficacy in large randomized controlled trials for children (≥9 yrs), adolescents and adults with Tourette Syndrome and Chronic Tic Disorders. Given the early age of onset for tic disorders, a large portion of affected individuals with chronic tic disorders are less than 9 years of age and appropriate developmental adaptations of behavioral treatment have not yet been tested. The goal of this study was to adapt and evaluate the acceptability and utility of a family-based adaptation of CBIT for children under 9 years of age. Children 5-8 years of age (N = 15) with chronic tics were recruited from three study sites. CBIT was adapted for use with young children and included habit reversal strategies introduced in a developmentally appropriate game format and function-based interventions to reduce family accommodation of and attention to tic symptoms. Children and parents described high level of treatment satisfaction and study retention rate was 100%. Treatment response rate was 54% (CGI-I = 1 or 2) with a significant decrease in the YGTSS total score (Cohen's d = 0.73) that was largely maintained at 3-month and 1-year follow-up assessments. Treatment was associated with reduction of some symptoms of tic-related comorbid syndromes and with changes in parental accommodation and attention to tics. Future research should determine if parental attention to tics and symptom accommodation are important mediators of treatment outcome, or if participating in this intervention at a younger age may prevent the chronic course of tic symptoms.
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Affiliation(s)
| | | | | | - Susanna Chang
- UCLA Semel Institute for Neuroscience and Human Behavior
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24
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Servello D, Galbiati TF, Balestrino R, Iess G, Zekaj E, Michele S, Porta M. Deep Brain Stimulation for Gilles de la Tourette Syndrome: Toward Limbic Targets. Brain Sci 2020; 10:E301. [PMID: 32429219 DOI: 10.3390/brainsci10050301] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 01/01/2023] Open
Abstract
Gilles de la Tourette syndrome (GTS) is a complex neurodevelopmental disorder characterized by tics and, frequently, psychiatric and behavioral comorbidities. Above all, obsessive compulsive disorder/behavior (OCD/OCB) influences the clinical picture and has a severe impact on quality of life, eventually more than the tics themselves. Deep brain stimulation (DBS) is an effective therapy in selected, refractory cases. Clinical response to DBS may vary according to the clinical picture, comorbidities, and to the anatomical target. This retrospective study compares the results obtained from DBS in the ventralis oralis/centromedian-parascicular nucleus of the thalamus (Voi-Cm/Pf) (41 patients) and antero-medial Globus Pallidus internus (am-GPi) (14 patients), evaluating clinical response over time by means of Yale Global Tic Severity Scale (YGTSS) and Yale–Brown Obsessive-Compulsive Scale (YBOCS) scores over a period of 48 months. A significant and stable improvement in the YGTSS and YBOCS has been obtained in both groups (p < 0.001). There was a significant difference in YBOCS improvement over time between the am-GPi group and the Voi-Cm/Pf group, indicating a better and faster control of OCD/OCB symptoms in the former group. The ratio of hardware removal was 23% and limited to 13 patients in the Voi-Cm/Pf group. These results confirm that DBS is an effective therapy in treating GTS and suggest that the am-GPi might be superior to Voi-Cm/Pf in alleviating comorbid OCD/OCB.
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25
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Abstract
Tics and Tourette's syndrome are common hyperkinetic movement disorders seen mostly in the pediatric age group. Tics are defined as sudden, rapid, recurrent, nonrhythmic motor movements or vocalization, generally preceded by urge. Tourette's syndrome is defined as the presence of both motor and phonic tics for more than 1 year in patients with onset less than 18 years old. Most of these hyperkinetic movement disorders improve in adulthood. This review emphasizes the clinical pearls in the diagnosis and distinguishing it from other movement disorders. The treatment ranges from behavioral therapies, medical management, and also surgical treatment such as deep brain stimulation that is limited to refractory patients.
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Affiliation(s)
- Shivam Om Mittal
- Parkinson's Disease & Movement Disorders Division, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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26
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Abstract
OBJECTIVES The aim of the study is to show relationship between severity of depressive symptoms and the severity of tics, declared feeling of stigmatization and feelings about the body. METHODS The study included 13 people with Tourette syndrome and 13 people in a comparative group - matching method, taking into account compatibility of gender, age, number of years of education, and size of the place of residence. The study used: Polish adaptation of the Yale Global Tic Severity Scale (YGTSS), Questionnaire for Measuring Depression (Kwestionariusz do Pomiaru Depresji -KPD), Perceived Stigmatization Questionnaire (PSQ), Questionnaire of feelings about the body. RESULTS Wilcoxon signed-rank test analysis showed that the declared general depression rate is significantly higher in the group of people with Tourette syndrome (Z = - 2.691; p < 0.01). The indicator differentiating the declared feeling of stigmatization among people with TS was the feeling of embarrassment due to other people's stare/the stare of bystanders (ZG) (Z = - 1.888; p < 0.05). The general assessment of one's body image is not different in the group of people with TS and comparative group, but two important factors have been distinguished: "My body is alien to me" (Z = - 1.897; p < 0.05), "It is difficult for me to understand changes in my body" (Z = 1.950; p < 0.05). CONCLUSIONS It is concluded that the severity of tics, the feeling of stigmatization and selected body image indexes are related to both the general severity of symptoms of depression and its individual indicators.
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Affiliation(s)
- Agnieszka Małek
- Akademia Wychowania Fizycznego i Sportu im. Jędrzeja Śniadeckiego w Gdańsku, Zakład Pedagogiki Kultury Fizycznej
| | - Paulina Golińska
- Zakład Psychologii Klinicznej i Neuropsychologii Uniwersytetu Gdańskiego
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27
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Yu D, Sul JH, Tsetsos F, Nawaz MS, Huang AY, Zelaya I, Illmann C, Osiecki L, Darrow SM, Hirschtritt ME, Greenberg E, Muller-Vahl KR, Stuhrmann M, Dion Y, Rouleau G, Aschauer H, Stamenkovic M, Schlögelhofer M, Sandor P, Barr CL, Grados M, Singer HS, Nöthen MM, Hebebrand J, Hinney A, King RA, Fernandez TV, Barta C, Tarnok Z, Nagy P, Depienne C, Worbe Y, Hartmann A, Budman CL, Rizzo R, Lyon GJ, McMahon WM, Batterson JR, Cath DC, Malaty IA, Okun MS, Berlin C, Woods DW, Lee PC, Jankovic J, Robertson MM, Gilbert DL, Brown LW, Coffey BJ, Dietrich A, Hoekstra PJ, Kuperman S, Zinner SH, Luðvigsson P, Sæmundsen E, Thorarensen Ó, Atzmon G, Barzilai N, Wagner M, Moessner R, Ophoff R, Pato CN, Pato MT, Knowles JA, Roffman JL, Smoller JW, Buckner RL, Willsey JA, Tischfield JA, Heiman GA, Stefansson H, Stefansson K, Posthuma D, Cox NJ, Pauls DL, Freimer NB, Neale BM, Davis LK, Paschou P, Coppola G, Mathews CA, Scharf JM. Interrogating the Genetic Determinants of Tourette's Syndrome and Other Tic Disorders Through Genome-Wide Association Studies. Am J Psychiatry 2019; 176:217-227. [PMID: 30818990 PMCID: PMC6677250 DOI: 10.1176/appi.ajp.2018.18070857] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Tourette's syndrome is polygenic and highly heritable. Genome-wide association study (GWAS) approaches are useful for interrogating the genetic architecture and determinants of Tourette's syndrome and other tic disorders. The authors conducted a GWAS meta-analysis and probed aggregated Tourette's syndrome polygenic risk to test whether Tourette's and related tic disorders have an underlying shared genetic etiology and whether Tourette's polygenic risk scores correlate with worst-ever tic severity and may represent a potential predictor of disease severity. METHODS GWAS meta-analysis, gene-based association, and genetic enrichment analyses were conducted in 4,819 Tourette's syndrome case subjects and 9,488 control subjects. Replication of top loci was conducted in an independent population-based sample (706 case subjects, 6,068 control subjects). Relationships between Tourette's polygenic risk scores (PRSs), other tic disorders, ascertainment, and tic severity were examined. RESULTS GWAS and gene-based analyses identified one genome-wide significant locus within FLT3 on chromosome 13, rs2504235, although this association was not replicated in the population-based sample. Genetic variants spanning evolutionarily conserved regions significantly explained 92.4% of Tourette's syndrome heritability. Tourette's-associated genes were significantly preferentially expressed in dorsolateral prefrontal cortex. Tourette's PRS significantly predicted both Tourette's syndrome and tic spectrum disorders status in the population-based sample. Tourette's PRS also significantly correlated with worst-ever tic severity and was higher in case subjects with a family history of tics than in simplex case subjects. CONCLUSIONS Modulation of gene expression through noncoding variants, particularly within cortico-striatal circuits, is implicated as a fundamental mechanism in Tourette's syndrome pathogenesis. At a genetic level, tic disorders represent a continuous spectrum of disease, supporting the unification of Tourette's syndrome and other tic disorders in future diagnostic schemata. Tourette's PRSs derived from sufficiently large samples may be useful in the future for predicting conversion of transient tics to chronic tic disorders, as well as tic persistence and lifetime tic severity.
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Affiliation(s)
- Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of
MIT and Harvard, Cambridge, Massachusetts, USA
| | - Jae Hoon Sul
- Semel Institute for Neuroscience and Human Behavior, David
Geffen School of Medicine, University of California Los Angeles, Los Angeles,
California, USA
- Department of Psychiatry and Biobehavioral Sciences,
University of California, Los Angeles, California, USA
| | - Fotis Tsetsos
- Department of Molecular Biology and Genetics, Democritus
University of Thrace, Xanthi, Greece
- Department of Biological Sciences, Purdue University, West
Lafayette, Indiana, USA
| | | | - Alden Y. Huang
- Semel Institute for Neuroscience and Human Behavior, David
Geffen School of Medicine, University of California Los Angeles, Los Angeles,
California, USA
- Department of Psychiatry and Biobehavioral Sciences,
University of California, Los Angeles, California, USA
- Bioinformatics Interdepartmental Program, University of
California, Los Angeles, Los Angeles, California, USA
| | - Ivette Zelaya
- Semel Institute for Neuroscience and Human Behavior, David
Geffen School of Medicine, University of California Los Angeles, Los Angeles,
California, USA
- Department of Psychiatry and Biobehavioral Sciences,
University of California, Los Angeles, California, USA
- Bioinformatics Interdepartmental Program, University of
California, Los Angeles, Los Angeles, California, USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
| | - Sabrina M. Darrow
- Department of Psychiatry, University of California, San
Francisco, San Francisco, California, USA
| | - Matthew E. Hirschtritt
- Department of Psychiatry, UCSF Weill Institute for
Neurosciences, University of California, San Francisco, San Francisco, California,
USA
| | - Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
| | - Kirsten R. Muller-Vahl
- Clinic of Psychiatry, Social Psychiatry and
Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Manfred Stuhrmann
- Institute of Human Genetics, Hannover Medical School,
Hannover, Germany
| | - Yves Dion
- McGill University Health Center (MUHC), University of
Montréal, Centre Universitaire de Santé de Montréal (CHUM),
Montreal, Quebec, Canada
| | - Guy Rouleau
- Montreal Neurological Institute, Department of Neurology
and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Harald Aschauer
- Department of Psychiatry and Psychotherapy, Medical
University Vienna, Vienna, Austria
- Biopsychosocial Corporation, Vienna, Austria
| | - Mara Stamenkovic
- Department of Psychiatry and Psychotherapy, Medical
University Vienna, Vienna, Austria
| | | | - Paul Sandor
- University Health Network and Youthdale Treatment Centres
University of Toronto, Toronto, Ontario, Canada
| | - Cathy L. Barr
- Krembil Research Institute, University Health Network,
Hospital for Sick Children, and The University of Toronto, Toronto, Ontario,
Canada
| | - Marco Grados
- Johns Hopkins University School of Medicine, Baltimore,
Maryland, USA
| | - Harvey S. Singer
- Johns Hopkins University School of Medicine, Baltimore,
Maryland, USA
| | - Markus M. Nöthen
- Institute of Human Genetics, University Hospital Bonn,
University of Bonn Medical School, Bonn, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry,
Psychosomatics and Psychotherapy, University Hospital Essen, University of
Duisburg-Essen, Essen, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry,
Psychosomatics and Psychotherapy, University Hospital Essen, University of
Duisburg-Essen, Essen, Germany
| | - Robert A. King
- Yale Child Study Center, Yale University School of
Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale University School of
Medicine, New Haven, Connecticut, USA
| | - Thomas V. Fernandez
- Yale Child Study Center, Yale University School of
Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale University School of
Medicine, New Haven, Connecticut, USA
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology and
Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Zsanett Tarnok
- Vadaskert Child and Adolescent Psychiatric Hospital,
Budapest, Hungary
| | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital,
Budapest, Hungary
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen,
University Duisburg-Essen, Essen, Germany
- Sorbonne Universités, UPMC Université Paris
06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
| | - Yulia Worbe
- Sorbonne Universités, UPMC Université Paris
06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette
Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris,
France
- Assistance Publique-Hôpitaux de Paris, Department
of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris,
France
| | - Andreas Hartmann
- Sorbonne Universités, UPMC Université Paris
06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
- French Reference Centre for Gilles de la Tourette
Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris,
France
- Assistance Publique-Hôpitaux de Paris, Department
of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris,
France
| | - Cathy L. Budman
- Zucker School of Medicine at Hofstra/Northwell,
Hempstead, New York, USA
| | - Renata Rizzo
- Neuropsichiatria Infantile. Dipartimento di Medicina
Clinica e Sperimentale, Università di Catania, Catania, Italy
| | - Gholson J. Lyon
- Stanley Institute for Cognitive Genomics, Cold Spring
Harbor Laboratory, Cold Spring Harbor, New York, USA
| | | | | | - Danielle C. Cath
- Department of Psychiatry, University Medical Center
Groningen & Rijksuniversity Groningen, Groningen, the Netherlands
- Drenthe Mental Health Center, Groningen, the
Netherlands
| | - Irene A. Malaty
- Department of Neurology, Fixel Center for Neurological
Diseases, McKnight Brain Institute, University of Florida, Gainesville, Florida,
USA
| | - Michael S. Okun
- Department of Neurology, Fixel Center for Neurological
Diseases, McKnight Brain Institute, University of Florida, Gainesville, Florida,
USA
| | - Cheston Berlin
- Pennsylvania State University College of Medicine,
Hershey, Pennsylvania, USA
| | - Douglas W. Woods
- Marquette University, Milwaukee, Wisconsin, USA
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin,
USA
| | - Paul C. Lee
- Tripler Army Medical Center, University of Hawai’i
John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Joseph Jankovic
- Parkinson’s Disease Center and Movement Disorders
Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas,
USA
| | - Mary M. Robertson
- Division of Psychiatry, Department of Neuropsychiatry,
University College London, London, UK
| | - Donald L. Gilbert
- Department of Pediatrics, Cincinnati Children’s
Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lawrence W. Brown
- Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania, USA
| | - Barbara J. Coffey
- Department of Psychiatry and Behavioral Sciences,
University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrea Dietrich
- University of Groningen, University Medical Center
Groningen, Department of Child and Adolescent Psychiatry, Groningen, The
Netherlands
| | - Pieter J. Hoekstra
- University of Groningen, University Medical Center
Groningen, Department of Child and Adolescent Psychiatry, Groningen, The
Netherlands
| | - Samuel Kuperman
- University of Iowa Carver College of Medicine, Iowa City,
Iowa, USA
| | - Samuel H Zinner
- Department of Pediatrics, University of Washington,
Seattle, Washington, USA
| | - Pétur Luðvigsson
- Department of Pediatrics, Landspitalinn University
Hospital, Reykjavik, Iceland
| | - Evald Sæmundsen
- Faculty of Medicine, University of Iceland,
Reykjavík, Iceland
- The State Diagnostic and Counselling Centre,
Kópavogur, Iceland
| | - Ólafur Thorarensen
- Department of Pediatrics, Landspitalinn University
Hospital, Reykjavik, Iceland
| | - Gil Atzmon
- Department of Genetics, Albert Einstein College of
Medicine, Bronx, New York, USA
- Department of Medicine, Albert Einstein College of
Medicine, Bronx, New York, USA
- Department of Human Biology, Haifa University, Haifa,
Israel
| | - Nir Barzilai
- Department of Genetics, Albert Einstein College of
Medicine, Bronx, New York, USA
- Department of Medicine, Albert Einstein College of
Medicine, Bronx, New York, USA
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of
Bonn, Bonn, Germany
| | - Rainald Moessner
- Department of Psychiatry and Psychotherapy, University of
Tuebingen, Tuebingen, Germany
| | - Roel Ophoff
- Semel Institute for Neuroscience and Human Behavior, David
Geffen School of Medicine, University of California Los Angeles, Los Angeles,
California, USA
| | | | | | | | - Joshua L. Roffman
- Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Research,
Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts,
USA
| | - Jordan W. Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of
Public Health, Boston, Massachusetts, USA
| | - Randy L. Buckner
- Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Research,
Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts,
USA
- Center for Brain Science, Harvard University, Cambridge,
Massachusetts, USA
- Department of Psychology, Harvard University, Cambridge,
Massachusetts, USA
| | - Jeremy A. Willsey
- Department of Psychiatry, UCSF Weill Institute for
Neurosciences, University of California, San Francisco, San Francisco, California,
USA
- Institute for Neurodegenerative Diseases, UCSF Weill
Institute for Neurosciences, University of California San Francisco, San Francisco,
California, USA
| | - Jay A. Tischfield
- Department of Genetics and the Human Genetics Institute
of New Jersey, Rutgers, the State University of New Jersey, Piscataway, New Jersey,
USA
| | - Gary A. Heiman
- Department of Genetics and the Human Genetics Institute
of New Jersey, Rutgers, the State University of New Jersey, Piscataway, New Jersey,
USA
| | | | - Kári Stefansson
- deCODE Genetics/Amgen, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland,
Reykjavík, Iceland
| | - Danielle Posthuma
- Department of Complex Trait Genetics Center for
Neurogenomics and Cognitive Research, VU University Amsterdam, Amsterdam, the
Netherlands
| | - Nancy J. Cox
- Division of Genetic Medicine, Vanderbilt Genetics
Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David L. Pauls
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
| | - Nelson B. Freimer
- Semel Institute for Neuroscience and Human Behavior, David
Geffen School of Medicine, University of California Los Angeles, Los Angeles,
California, USA
- Department of Psychiatry and Biobehavioral Sciences,
University of California, Los Angeles, California, USA
| | - Benjamin M. Neale
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of
MIT and Harvard, Cambridge, Massachusetts, USA
- Analytic and Translational Genetics Unit, Department of
Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lea K. Davis
- Division of Genetic Medicine, Vanderbilt Genetics
Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West
Lafayette, Indiana, USA
| | - Giovanni Coppola
- Semel Institute for Neuroscience and Human Behavior, David
Geffen School of Medicine, University of California Los Angeles, Los Angeles,
California, USA
- Department of Psychiatry and Biobehavioral Sciences,
University of California, Los Angeles, California, USA
| | - Carol A. Mathews
- Department of Psychiatry, Genetics Institute, University
of Florida, Gainesville, Florida, USA
| | - Jeremiah M. Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center
for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital,
Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of
MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Neurology, Brigham and Women’s
Hospital, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital,
Boston, Massachusetts, USA
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28
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Doja A, Bookwala A, Pohl D, Rossi-Ricci A, Barrowman N, Chan J, Longmuir PE. Relationship Between Physical Activity, Tic Severity and Quality of Life in Children with Tourette Syndrome. J Can Acad Child Adolesc Psychiatry 2018; 27:222-227. [PMID: 30487937 PMCID: PMC6254264] [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] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 07/08/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine the relationship between physical activity, tic severity and quality of life (QoL) in children and adolescents with persistent tic disorder and Tourette Syndrome. METHOD Baseline data was examined from a larger randomized controlled trial (Clinicaltrials.gov NCT02153463). Physical activity was assessed via pedometers with daily step count recorded. Tic severity (assessed via Yale Global Tic Severity Scale or YGTSS) and QoL (assessed via PEDs QL 4.0) were compared between those more physically active (≥12,000 steps/day) and less physically active (<12,000 steps/day). RESULTS Thirteen children participated; four had ≥12,000 steps/day and nine had <12,000 steps/day. The active group had a lower total tic severity (p = 0.02), and total YGTSS score (p=0.01). The vocal tic severity score was lower in the active group (p=0.02). Motor tic severity was not different amongst the two groups. For Peds QL scores, the active group performed better in physical functioning (p=0.01), social functioning (p=0.03), school functioning (p=0.02), psychosocial functioning (p=0.03) and total PEDs QL score (p=0.01). CONCLUSIONS Higher physical activity levels are associated with lower vocal tic severity and improved aspects of quality of life. Further research is needed to determine the utility of physical activity as therapy for tics.
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Affiliation(s)
- Asif Doja
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Ammar Bookwala
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Daniela Pohl
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Alessandra Rossi-Ricci
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Nicholas Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Jason Chan
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Patricia E Longmuir
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
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29
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Fan S, van den Heuvel OA, Cath DC, de Wit SJ, Vriend C, Veltman DJ, van der Werf YD. Altered Functional Connectivity in Resting State Networks in Tourette's Disorder. Front Hum Neurosci 2018; 12:363. [PMID: 30279651 PMCID: PMC6154258 DOI: 10.3389/fnhum.2018.00363] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 01/14/2018] [Accepted: 08/23/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Brain regions are anatomically and functionally interconnected in order to facilitate important functions like cognition and movement. It remains incompletely understood how brain connectivity contributes to the pathophysiology of Tourette's disorder (TD). By using resting-state functional MRI, we aimed to identify alterations in the default mode network (DMN), frontal-parietal network (FPN), sensori-motor network (SMN), and salience network (SN) in TD compared with healthy control (HC) subjects. Method: In 23 adult TD patients and 22 HC, 3T-MRI resting-state scans were obtained. Independent component analysis was performed comparing TD and HC to investigate connectivity patterns within and between resting-state networks. Results: TD patients showed higher involvement of the dorsal medial prefrontal cortex in the connectivity of the DMN and less involvement of the inferior parietal cortex in the connectivity of the FPN when compared to HC. Moreover, TD patients showed a stronger coupling between DMN and left FPN than HC. Finally, in TD patients, functional connectivity within DMN correlated negatively with tic severity. Conclusion: We tentatively interpret the increased functional connectivity within DMN in TD patients as compensatory to the lower functional connectivity within left FPN. The stronger coupling between DMN and left FPN, together with the finding that higher DMN intrinsic connectivity is associated with lower tic severity would indicate that DMN is recruited to exert motor inhibition.
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Affiliation(s)
- Siyan Fan
- Division of Social and Behavioural Science, Utrecht University, Utrecht, Netherlands.,Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Odile A van den Heuvel
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,The OCD Team, Haukeland University Hospital, Bergen, Norway
| | - Danielle C Cath
- Division of Social and Behavioural Science, Utrecht University, Utrecht, Netherlands.,Department of Psychiatry and Rob Giel Research Center (RGOC), University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stella J de Wit
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Chris Vriend
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ysbrand D van der Werf
- Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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30
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Abstract
OBJECTIVES It has been suggested that Tourette syndrome (TS) might be associated with alterations of the attention system, but the nature of these alterations and the underlying neuroanatomical network remains elusive. We aimed at investigating the functional neuroanatomical modulators of attention allocation towards predictable versus unpredictable stimuli in boys with TS. METHODS Using functional magnetic resonance imaging, we ran a harmonic expectancy violation paradigm in 17 boys with TS and 23 matched healthy controls (HCs). We presented chord sequence in which the first four chords induced a strong expectancy for a harmonic chord at the next position. In 70% this expectancy was fulfilled (harmonic), in 30% the expectancy was violated (disharmonic). RESULTS HCs responded faster to the disharmonic compared to harmonic chords, indicating a stronger attention allocation towards unpredictable stimuli, while this effect was not found in boys with TS. HCs showed stronger anterior cingulate cortex (ACC) activation during disharmonic compared to harmonic chords. Boys with TS showed stronger ACC activation during harmonic chords, which was associated with greater tic severity. CONCLUSIONS Our findings indicate that boys with TS showed altered reactions towards predictable versus unpredictable stimuli in brain regions playing an important role in attention control. This might indicate altered allocation of attention towards those stimuli.
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Affiliation(s)
- Judith Buse
- a Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden , Dresden , Germany
| | - Christian Beste
- a Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden , Dresden , Germany.,b Experimental Neurobiology , National Institute of Mental Health , Klecany , Czech Republic
| | - Veit Roessner
- a Department of Child and Adolescent Psychiatry, Faculty of Medicine of the TU Dresden , Dresden , Germany
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31
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Marwitz L, Pringsheim T. Clinical Utility of Screening for Anxiety and Depression in Children with Tourette Syndrome. J Can Acad Child Adolesc Psychiatry 2018; 27:15-21. [PMID: 29375629 PMCID: PMC5777687] [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] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/27/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Tourette syndrome (TS) is often co-morbid with attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD). Studies of TS, anxiety and depression have found variable results depending on study methodology and sample characteristics. Our aim was to examine the clinical utility of routine screening for anxiety and depression in children with TS. METHODS Using a clinic-based sample, we evaluated the proportion of children with TS meeting diagnostic criteria for ADHD, OCD, generalized anxiety disorder (GAD), separation anxiety disorder (SAD), and major depressive disorder (MDD); the frequency of above average anxiety and depressive symptoms using the Multidimensional Anxiety Scale for Children (MASC) and the Children's Depression Inventory (CDI); and the association between diagnoses and symptom severity. RESULTS One hundred twenty six children were included (mean age 10.7 years). The most common comorbid disorder was ADHD (37%), followed by GAD (21%), OCD (10%), MDD (2%) and SAD (2%). On the MASC, the separation anxiety/panic subscale score was higher than all other subscale scores (p<0.0001). Clinically significant anxiety symptoms were present in 20% of the sample based on the MASC Anxiety Disorders Index, while 6% were identified as potentially clinically depressed based on the CDI Total Score. Yale Global Tic Severity Scale scores were positively correlated with total scores on the MASC (r=0.22, p=0.03) and CDI (r=0.37, p=0.0002). CONCLUSIONS Routine screening children with TS for anxiety is warranted given the rate of comorbidity. Screening for depression in TS will have a higher yield in adolescents, adults, and children with more severe tics.
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Affiliation(s)
- Leonie Marwitz
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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32
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Eapen V, Baker R, Walter A, Raghupathy V, Wehrman JJ, Sowman PF. The Role of Transcranial Direct Current Stimulation (tDCS) in Tourette Syndrome: A Review and Preliminary Findings. Brain Sci 2017; 7:brainsci7120161. [PMID: 29292730 PMCID: PMC5742764 DOI: 10.3390/brainsci7120161] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 10/31/2017] [Revised: 11/27/2017] [Accepted: 12/05/2017] [Indexed: 12/24/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that is being investigated for a variety of neurological and psychiatric conditions. Preliminary evidence suggests that tDCS may be useful in the treatment of Tourette Syndrome (TS). This paper reviews the literature on the use of tDCS in commonly occurring comorbid conditions that are relevant to its proposed use in TS. We describe the protocol for a double-blind, crossover, sham-controlled trial of tDCS (Trial ID: ACTRN12615000592549, registered at www.anzctr.org.au) investigating the efficacy, feasibility, safety, and tolerability of tDCS in patients with TS aged 12 years and over. The intervention consists of cathodal tDCS positioned over the Supplementary Motor Area. Patients receive either sham tDCS for three weeks followed by six weeks of active tDCS (1.4 mA, 18 sessions over six weeks), or six weeks of active sessions followed by three weeks of sham sessions, with follow-up at three and six months. Pilot findings from two patients are presented. There was a reduction in the frequency and intensity of patients’ tics and premonitory urges, as well as evidence of improvements in inhibitory function, over the course of treatment. Larger scale studies are indicated to ascertain the maintenance of symptom improvement over time, as well as the long-term consequences of the repetitions of sessions.
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Affiliation(s)
- Valsamma Eapen
- Academic Unit of Child Psychiatry South West Sydney and Ingham Institute, Liverpool Hospital, Sydney 2170, Australia.
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney 2052, Australia.
| | - Richard Baker
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney 2052, Australia.
- The Sydney Children's Hospital at Randwick, Sydney 2031, Australia.
| | - Amelia Walter
- Academic Unit of Child Psychiatry South West Sydney and Ingham Institute, Liverpool Hospital, Sydney 2170, Australia.
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney 2052, Australia.
| | | | - Jordan J Wehrman
- Department of Cognitive Science, Macquarie University, Sydney 2109, Australia.
- Perception and Action Research Centre, Faculty of Human Sciences, Macquarie University, Sydney 2109, Australia.
- ARC Centre of Excellence for Cognition and Its Disorders (CCD), Sydney 2109, Australia.
| | - Paul F Sowman
- Department of Cognitive Science, Macquarie University, Sydney 2109, Australia.
- Perception and Action Research Centre, Faculty of Human Sciences, Macquarie University, Sydney 2109, Australia.
- ARC Centre of Excellence for Cognition and Its Disorders (CCD), Sydney 2109, Australia.
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33
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Abstract
Tourette's Syndrome (TS) is a complex disorder characterized by repetitive, sudden, and involuntary movements or vocalizations, called tics. Tics usually appear in childhood, and their severity varies over time. In addition to frequent tics, people with TS are at risk for associated problems including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, depression, and problems with sleep. TS occurs in most populations and ethnic groups worldwide, and it is more common in males than in females. Previous family and twin studies have shown that the majority of cases of TS are inherited. TS was previously thought to have an autosomal dominant pattern of inheritance. However, several decades of research have shown that this is unlikely the case. Instead TS most likely results from a variety of genetic and environmental factors, not changes in a single gene. In the past decade, there has been a rapid development of innovative genetic technologies and methodologies, as well as significant progresses in genetic studies of psychiatric disorders. In this review, we will briefly summarize previous genetic epidemiological studies of TS and related disorders. We will also review previous genetic studies based on genome-wide linkage analyses and candidate gene association studies to comment on problems of previous methodological and strategic issues. Our main purpose for this review will be to summarize the new genetic discoveries of TS based on novel genetic methods and strategies, such as genome-wide association studies (GWASs), whole exome sequencing (WES) and whole genome sequencing (WGS). We will also compare the new genetic discoveries of TS with other major psychiatric disorders in order to understand the current status of TS genetics and its relationship with other psychiatric disorders.
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Affiliation(s)
- Yanjie Qi
- Laboratoire de Neurogénétique, Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada.
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China.
| | - Yi Zheng
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China.
- Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing 100088, China.
| | - Zhanjiang Li
- Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China.
- Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing 100088, China.
| | - Lan Xiong
- Laboratoire de Neurogénétique, Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada.
- Département de Psychiatrie, Faculté de Médecine, Université de Montréal, Montreal, QC H3C 3J7, Canada.
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC H3A 2B4, Canada.
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34
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Albin RL, Minderovic C, Koeppe RA. Normal Striatal Vesicular Acetylcholine Transporter Expression in Tourette Syndrome. eNeuro 2017; 4:ENEURO. [PMID: 28791334 DOI: 10.1523/ENEURO.0178-17.2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/28/2017] [Accepted: 07/10/2017] [Indexed: 12/02/2022] Open
Abstract
Considerable prior work suggests basal ganglia dysfunction in Tourette syndrome (TS). Analysis of a small number of postmortem specimens suggests deficits of some striatal interneuron populations, including striatal cholinergic interneurons. To assess the integrity of striatal cholinergic interneurons in TS, we used [18F]FEOBV positron emission tomography (PET) to quantify striatal vesicular acetylcholine transporter (VAChT) expression, a measure of cholinergic terminal density, in human TS and control subjects. We found no evidence of striatal cholinergic deficits. Discrepant imaging and postmortem analysis results may reflect agonal or postmortem changes, medication effects, or significant disease heterogeneity.
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35
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Polyanska L, Critchley HD, Rae CL. Centrality of prefrontal and motor preparation cortices to Tourette Syndrome revealed by meta-analysis of task-based neuroimaging studies. Neuroimage Clin 2017; 16:257-267. [PMID: 28831377 PMCID: PMC5554925 DOI: 10.1016/j.nicl.2017.08.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/01/2017] [Accepted: 08/02/2017] [Indexed: 01/31/2023]
Abstract
Tourette Syndrome (TS) is a neurodevelopmental condition characterized by chronic multiple tics, which are experienced as compulsive and 'unwilled'. Patients with TS can differ markedly in the frequency, severity, and bodily distribution of tics. Moreover, there are high comorbidity rates with attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), anxiety disorders, and depression. This complex clinical profile may account for apparent variability of findings across neuroimaging studies that connect neural function to cognitive and motor behavior in TS. Here we crystalized information from neuroimaging regarding the functional circuitry of TS, and furthermore, tested specifically for neural determinants of tic severity, by applying activation likelihood estimation (ALE) meta-analyses to neuroimaging (activation) studies of TS. Fourteen task-based studies (13 fMRI and one H2O-PET) met rigorous inclusion criteria. These studies, encompassing 25 experiments and 651 participants, tested for differences between TS participants and healthy controls across cognitive, motor, perceptual and somatosensory domains. Relative to controls, TS participants showed distributed differences in the activation of prefrontal (inferior, middle, and superior frontal gyri), anterior cingulate, and motor preparation cortices (lateral premotor cortex and supplementary motor area; SMA). Differences also extended into sensory (somatosensory cortex and the lingual gyrus; V4); and temporo-parietal association cortices (posterior superior temporal sulcus, supramarginal gyrus, and retrosplenial cortex). Within TS participants, tic severity (reported using the Yale Global Tic Severity Scale; YGTSS) selectively correlated with engagement of SMA, precentral gyrus, and middle frontal gyrus across tasks. The dispersed involvement of multiple cortical regions with differences in functional reactivity may account for heterogeneity in the symptomatic expression of TS and its comorbidities. More specifically for tics and tic severity, the findings reinforce previously proposed contributions of premotor and lateral prefrontal cortices to tic expression.
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Affiliation(s)
- Liliana Polyanska
- Sackler Centre for Consciousness Science, University of Sussex, Falmer BN1 9RY, UK.,Department of Neuroscience, Brighton & Sussex Medical School, Falmer BN1 9RY, UK.,Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Hugo D Critchley
- Sackler Centre for Consciousness Science, University of Sussex, Falmer BN1 9RY, UK.,Department of Neuroscience, Brighton & Sussex Medical School, Falmer BN1 9RY, UK
| | - Charlotte L Rae
- Sackler Centre for Consciousness Science, University of Sussex, Falmer BN1 9RY, UK.,Department of Neuroscience, Brighton & Sussex Medical School, Falmer BN1 9RY, UK
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36
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Barfell KSF, Snyder RR, Isaacs-Cloes KM, Garris JF, Roeckner AR, Horn PS, Guthrie MD, Wu SW, Gilbert DL. Parent and Patient Perceptions of Functional Impairment Due to Tourette Syndrome: Development of a Shortened Version of the Child Tourette Syndrome Impairment Scale. J Child Neurol 2017; 32:725-730. [PMID: 28429606 DOI: 10.1177/0883073817702782] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 11/15/2022]
Abstract
The Child Tourette Syndrome Impairment Scale (CTIM) rates 37 problems in school, social, and home domains separately for tics and for comorbid diagnoses. However, a shorter version would be easier to implement in busy clinics. Using published data from 85 children with Tourette syndrome, 92 controls, and parents, factor analysis was used to generate a "mini-CTIM" composed of 12 items applied to tic and comorbid diagnoses. Child- and parent-rated mini-CTIM scores were compared and correlated across raters and accounting for clinician-rated tic severity and presence of attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). The mini-CTIM achieved domain Cronbach alphas ranging from 0.71 to 0.94 and intra-item correlation coefficients ranging from 0.84 to 0.96. The resulting scale correlated with clinician-rated tic severity and reflected the presence of ADHD and OCD. The mini-CTIM appears promising as a practical assessment tool for tic- and non-tic-related impairment in children with Tourette syndrome.
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Affiliation(s)
- Kara S Francis Barfell
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Ryan R Snyder
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | | | - Jordan F Garris
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Alyssa R Roeckner
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Paul S Horn
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Michael D Guthrie
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Steve W Wu
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Donald L Gilbert
- 1 Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
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37
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Huang AY, Yu D, Davis LK, Sul JH, Tsetsos F, Ramensky V, Zelaya I, Ramos EM, Osiecki L, Chen JA, McGrath LM, Illmann C, Sandor P, Barr CL, Grados M, Singer HS, Nöthen MM, Hebebrand J, King RA, Dion Y, Rouleau G, Budman CL, Depienne C, Worbe Y, Hartmann A, Müller-Vahl KR, Stuhrmann M, Aschauer H, Stamenkovic M, Schloegelhofer M, Konstantinidis A, Lyon GJ, McMahon WM, Barta C, Tarnok Z, Nagy P, Batterson JR, Rizzo R, Cath DC, Wolanczyk T, Berlin C, Malaty IA, Okun MS, Woods DW, Rees E, Pato CN, Pato MT, Knowles JA, Posthuma D, Pauls DL, Cox NJ, Neale BM, Freimer NB, Paschou P, Mathews CA, Scharf JM, Coppola G. Rare Copy Number Variants in NRXN1 and CNTN6 Increase Risk for Tourette Syndrome. Neuron 2017; 94:1101-1111.e7. [PMID: 28641109 PMCID: PMC5568251 DOI: 10.1016/j.neuron.2017.06.010] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [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: 03/20/2017] [Revised: 04/14/2017] [Accepted: 06/06/2017] [Indexed: 11/16/2022]
Abstract
Tourette syndrome (TS) is a model neuropsychiatric disorder thought to arise from abnormal development and/or maintenance of cortico-striato-thalamo-cortical circuits. TS is highly heritable, but its underlying genetic causes are still elusive, and no genome-wide significant loci have been discovered to date. We analyzed a European ancestry sample of 2,434 TS cases and 4,093 ancestry-matched controls for rare (< 1% frequency) copy-number variants (CNVs) using SNP microarray data. We observed an enrichment of global CNV burden that was prominent for large (> 1 Mb), singleton events (OR = 2.28, 95% CI [1.39-3.79], p = 1.2 × 10-3) and known, pathogenic CNVs (OR = 3.03 [1.85-5.07], p = 1.5 × 10-5). We also identified two individual, genome-wide significant loci, each conferring a substantial increase in TS risk (NRXN1 deletions, OR = 20.3, 95% CI [2.6-156.2]; CNTN6 duplications, OR = 10.1, 95% CI [2.3-45.4]). Approximately 1% of TS cases carry one of these CNVs, indicating that rare structural variation contributes significantly to the genetic architecture of TS.
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Affiliation(s)
- Alden Y Huang
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095, USA; Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Dongmei Yu
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Lea K Davis
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jae Hoon Sul
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Fotis Tsetsos
- Department of Biological Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Vasily Ramensky
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095, USA; Moscow Institute of Physics and Technology, Dolgoprudny, Institusky 9, Moscow 141701, Russian Federation
| | - Ivette Zelaya
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095, USA; Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Eliana Marisa Ramos
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jason A Chen
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095, USA; Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Lauren M McGrath
- Department of Psychology, University of Denver, Denver, CO 80210, USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Paul Sandor
- Toronto Western Research Institute, University Health Network and Youthdale Treatment Centres, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Cathy L Barr
- Krembil Research Institute, University Health Network, Toronto, ON M5G 1L7, Canada
| | - Marco Grados
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Harvey S Singer
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Markus M Nöthen
- Department of Genomics, Life & Brain Center, University of Bonn, 53127 Bonn, Germany; Institute of Human Genetics, University of Bonn, 53127 Bonn, Germany
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Robert A King
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Yves Dion
- University of Montréal, Montréal, QC H3T 1J4, Canada
| | - Guy Rouleau
- Department of Neurology and Neurosurgery, Montréal Neurological Institute, McGill University, Montréal, QC H3A 2B4, Canada
| | - Cathy L Budman
- Hofstra Northwell School of Medicine, Hempstead, NY 11549, USA
| | - Christel Depienne
- IGBMC, CNRS UMR 7104/INSERM U964/Université de Strasbourg, 67404 Illkirch Cedex, France; Brain and Spine Institute, UPMC/INSERM UMR_S1127, 75013 Paris Cedex 05, France
| | - Yulia Worbe
- Brain and Spine Institute, UPMC/INSERM UMR_S1127, 75013 Paris Cedex 05, France
| | - Andreas Hartmann
- Brain and Spine Institute, UPMC/INSERM UMR_S1127, 75013 Paris Cedex 05, France
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - Manfred Stuhrmann
- Institute of Human Genetics, Hannover Medical School, 30625 Hannover, Germany
| | - Harald Aschauer
- Department of Psychiatry and Psychotherapy, Medical University Vienna, 1090 Vienna, Austria; Biopsychosocial Corporation, 1090 Vienna, Austria
| | - Mara Stamenkovic
- Department of Psychiatry and Psychotherapy, Medical University Vienna, 1090 Vienna, Austria
| | - Monika Schloegelhofer
- Department of Psychiatry and Psychotherapy, Medical University Vienna, 1090 Vienna, Austria
| | - Anastasios Konstantinidis
- Department of Psychiatry and Psychotherapy, Medical University Vienna, 1090 Vienna, Austria; Center for Mental Health Muldenstrasse, BBRZMed, 4020 Linz, Austria
| | - Gholson J Lyon
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY 11724, USA
| | - William M McMahon
- Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, 1085 Budapest, Hungary
| | - Zsanett Tarnok
- Vadaskert Child and Adolescent Psychiatric Hospital, 1021 Budapest, Hungary
| | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, 1021 Budapest, Hungary
| | | | - Renata Rizzo
- Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, 95131 Catania, Italy
| | - Danielle C Cath
- Department of Psychiatry, University Medical Center Groningen & Drenthe Mental Health Center, 9700 RB Groningen, the Netherlands; Department of Clinical Psychology, Utrecht University, 3584 CS Utrecht, the Netherlands
| | - Tomasz Wolanczyk
- Department of Child Psychiatry, Medical University of Warsaw, 00-001 Warsaw, Poland
| | - Cheston Berlin
- Penn State University College of Medicine, Hershey, PA 17033, USA
| | - Irene A Malaty
- Department of Neurology and Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL 32607, USA
| | - Michael S Okun
- Department of Neurology and Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL 32607, USA
| | - Douglas W Woods
- Marquette University, Milwaukee, WI 53233, USA; University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Elliott Rees
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff CF24 4HQ, Wales, UK
| | - Carlos N Pato
- SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
| | | | - James A Knowles
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Danielle Posthuma
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, VU University Amsterdam, 1081 HV Amsterdam, the Netherlands
| | - David L Pauls
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nancy J Cox
- Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Benjamin M Neale
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nelson B Freimer
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Carol A Mathews
- Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL 32611, USA
| | - Jeremiah M Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Neurology, Brigham and Women's Hospital, Boston, MA 02115, USA.
| | - Giovanni Coppola
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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Edwards KR, Mendlowitz S, Jackson E, Champigny C, Specht M, Arnold P, Gorman D, Dimitropoulos G. A Qualitative Exploration of the Experiences of Children and Adolescents with Tourette Syndrome. J Can Acad Child Adolesc Psychiatry 2017; 26:39-44. [PMID: 28331502 PMCID: PMC5349281] [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] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The purpose of this qualitative study was to explore the experiences of youth with Tourette Syndrome (TS). METHOD Thirteen participants with TS were recruited from a large tertiary care hospital to complete semi-structured interviews and two questionnaires pertaining to demographic information and tic severity. Thematic analysis was utilized to systematically analyze the data. RESULTS Three main themes were identified: 1) beliefs about TS; 2) TS related distress and impairment; and, 3) coping with TS. CONCLUSION The findings from this study suggest that most participants were aware of their tics but unaware of the cause of tics/TS. The interviews also highlighted that, for most participants, TS caused emotional, social, physical, and/or occupational impairment. Despite their distress, participants provided several suggestions for coping with TS and for supporting those who are diagnosed with this condition.
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Affiliation(s)
| | | | - Elana Jackson
- McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | | | - Matt Specht
- Weill Cornell Medical College and New York-Presbyterian Hospital-Westchester, Youth Anxiety Center, New York, NY USA
| | - Paul Arnold
- Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Gorman
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Kious BM, Jimenez-Shahed J, Shprecher DR. Treatment-refractory Tourette Syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:227-36. [PMID: 26875502 DOI: 10.1016/j.pnpbp.2016.02.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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] [Received: 10/26/2015] [Revised: 02/02/2016] [Accepted: 02/08/2016] [Indexed: 12/27/2022]
Abstract
Tourette Syndrome (TS) is a complex neurodevelopmental condition marked by tics and frequently associated with psychiatric comorbidities. While most cases are mild and improve with age, some are treatment-refractory. Here, we review strategies for the management of this population. We begin by examining the diagnosis of TS and routine management strategies. We then consider emerging treatments for refractory cases, including deep brain stimulation (DBS), electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and novel pharmacological approaches such as new vesicular monoamine transporter type 2 inhibitors, cannabinoids, and anti-glutamatergic drugs.
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Affiliation(s)
- Brent M Kious
- University of Utah, Department of Psychiatry, 501 Chipeta Way, Salt Lake City, UT 84108, United States.
| | - Joohi Jimenez-Shahed
- Baylor College of Medicine, Department of Neurology, 7200 Cambridge, Suite 9a/MS: BCM 609, Houston, TX 77030, United States
| | - David R Shprecher
- University of Utah, Department of Neurology, 729 Arapeen Drive, Salt Lake City, UT 84108, United States; Banner Sun Health Research Institute, 10515 W. Santa Fe Drive, Sun City, AZ 85351, United States
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Gerasch S, Kanaan AS, Jakubovski E, Müller-Vahl KR. Aripiprazole Improves Associated Comorbid Conditions in Addition to Tics in Adult Patients with Gilles de la Tourette Syndrome. Front Neurosci 2016; 10:416. [PMID: 27672358 PMCID: PMC5018494 DOI: 10.3389/fnins.2016.00416] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 03/30/2016] [Accepted: 08/26/2016] [Indexed: 12/13/2022] Open
Abstract
Gilles de la Tourette Syndrome (GTS) is characterized by motor and vocal tics, as well as associated comorbid conditions including obsessive-compulsive disorder (OCD), attention deficit/hyperactivity disorder (ADHD), depression, and anxiety which are present in a substantial number of patients. Although randomized controlled trials including a large number of patients are still missing, aripiprazole is currently considered as a first choice drug for the treatment of tics. The aim of this study was to further investigate efficacy and safety of aripiprazole in a group of drug-free, adult patients. Specifically, we investigated the influence of aripiprazole on tic severity, comorbidities, premonitory urge (PU), and quality of life (QoL). Moreover, we were interested in the factors that influence a patient's decision in electing for-or against- pharmacological treatment. In this prospective uncontrolled open-label study, we included 44 patients and used a number of rating scales to assess tic severity, PU, comorbidities, and QoL at baseline and during treatment with aripiprazole. Eighteen out of fortyfour patients decided for undergoing treatment for their tics with aripiprazole and completed follow-up assessments after 4–6 weeks. Our major findings were (1) aripiprazole resulted in significant reduction of tics, but did not affect PU; (2) aripiprazole significantly improved OCD and showed a trend toward improvement of other comorbidities including depression, anxiety, and ADHD; (3) neither severity of tics, nor PU or QoL influenced patients' decisions for or against treatment of tics with aripiprazole; instead patients with comorbid OCD tended to decide in favor of, while patients with comorbid ADHD tended to decide against tic treatment; (4) most frequently reported adverse effects were sleeping problems; (5) patients' QoL was mostly impaired by comorbid depression. Our results suggest that aripiprazole may improve associated comorbid conditions in addition to tics in patients with GTS. It can be hypothesized that these beneficial effects are related to aripiprazole's adaptive pharmacological profile, which exhibits an influence on the dopaminergic as well as a number of other neurotransmitter systems. For the first time, our data provide evidence that patients' decision making process for or against medical treatment is influenced by other factors than tic severity and QoL.
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Affiliation(s)
- Sarah Gerasch
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
| | - Ahmad Seif Kanaan
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical SchoolHannover, Germany; Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School Hannover, Germany
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Tsetsos F, Padmanabhuni SS, Alexander J, Karagiannidis I, Tsifintaris M, Topaloudi A, Mantzaris D, Georgitsi M, Drineas P, Paschou P. Meta-Analysis of Tourette Syndrome and Attention Deficit Hyperactivity Disorder Provides Support for a Shared Genetic Basis. Front Neurosci 2016; 10:340. [PMID: 27499730 PMCID: PMC4956656 DOI: 10.3389/fnins.2016.00340] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/06/2016] [Indexed: 12/21/2022] Open
Abstract
Gilles de la Tourette Sydrome (TS) is a childhood onset neurodevelopmental disorder, characterized phenotypically by the presence of multiple motor and vocal tics. It is often accompanied by multiple psychiatric comorbidities, with Attention Deficit/Hyperactivity Disorder (ADHD) among the most common. The extensive co-occurrence of the two disorders suggests a shared genetic background. A major step toward the elucidation of the genetic architecture of TS was undertaken by the first TS Genome-wide Association Study (GWAS) reporting 552 SNPs that were moderately associated with TS (p < 1E-3). Similarly, initial ADHD GWAS attempts and meta-analysis were not able to produce genome-wide significant findings, but have provided insight to the genetic basis of the disorder. Here, we examine the common genetic background of the two neuropsychiatric phenotypes, by meta-analyzing the 552 top hits in the TS GWAS with the results of ADHD first GWASs. We identify 19 significant SNPs, with the top four implicated genes being TBC1D7, GUCY1A3, RAP1GDS1, and CHST11. TBCD17 harbors the top scoring SNP, rs1866863 (p:3.23E-07), located in a regulatory region downstream of the gene, and the third best-scoring SNP, rs2458304 (p:2.54E-06), located within an intron of the gene. Both variants were in linkage disequilibrium with eQTL rs499818, indicating a role in the expression levels of the gene. TBC1D7 is the third subunit of the TSC1/TSC2 complex, an inhibitor of the mTOR signaling pathway, with a central role in cell growth and autophagy. The top genes implicated by our study indicate a complex and intricate interplay between them, warranting further investigation into a possibly shared etiological mechanism for TS and ADHD.
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Affiliation(s)
- Fotis Tsetsos
- Department of Molecular Biology and Genetics, Democritus University of Thrace Alexandroupolis, Greece
| | - Shanmukha S Padmanabhuni
- Department of Molecular Biology and Genetics, Democritus University of Thrace Alexandroupolis, Greece
| | - John Alexander
- Department of Molecular Biology and Genetics, Democritus University of Thrace Alexandroupolis, Greece
| | - Iordanis Karagiannidis
- Department of Molecular Biology and Genetics, Democritus University of Thrace Alexandroupolis, Greece
| | - Margaritis Tsifintaris
- Department of Molecular Biology and Genetics, Democritus University of Thrace Alexandroupolis, Greece
| | - Apostolia Topaloudi
- Department of Molecular Biology and Genetics, Democritus University of Thrace Alexandroupolis, Greece
| | - Dimitrios Mantzaris
- Department of Molecular Biology and Genetics, Democritus University of Thrace Alexandroupolis, Greece
| | - Marianthi Georgitsi
- Department of Molecular Biology and Genetics, Democritus University of ThraceAlexandroupolis, Greece; Laboratory of General Biology, Department of Medicine, Aristotle University of ThessalonikiThessaloniki, Greece
| | - Petros Drineas
- Computer Science Department, Rensselaer Polytechnic Institute Troy, NY, USA
| | - Peristera Paschou
- Department of Molecular Biology and Genetics, Democritus University of Thrace Alexandroupolis, Greece
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Pagliaroli L, Vető B, Arányi T, Barta C. From Genetics to Epigenetics: New Perspectives in Tourette Syndrome Research. Front Neurosci 2016; 10:277. [PMID: 27462201 PMCID: PMC4940402 DOI: 10.3389/fnins.2016.00277] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 04/29/2016] [Accepted: 06/06/2016] [Indexed: 11/13/2022] Open
Abstract
Gilles de la Tourette Syndrome (TS) is a neurodevelopmental disorder marked by the appearance of multiple involuntary motor and vocal tics. TS presents high comorbidity rates with other disorders such as attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD). TS is highly heritable and has a complex polygenic background. However, environmental factors also play a role in the manifestation of symptoms. Different epigenetic mechanisms may represent the link between these two causalities. Epigenetic regulation has been shown to have an impact in the development of many neuropsychiatric disorders, however very little is known about its effects on Tourette Syndrome. This review provides a summary of the recent findings in genetic background of TS, followed by an overview on different epigenetic mechanisms, such as DNA methylation, histone modifications, and non-coding RNAs in the regulation of gene expression. Epigenetic studies in other neurological and psychiatric disorders are discussed along with the TS-related epigenetic findings available in the literature to date. Moreover, we are proposing that some general epigenetic mechanisms seen in other neuropsychiatric disorders may also play a role in the pathogenesis of TS.
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Affiliation(s)
- Luca Pagliaroli
- Institute of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis UniversityBudapest, Hungary; Research Centre for Natural Sciences, Institute of Enzymology, Hungarian Academy of SciencesBudapest, Hungary
| | - Borbála Vető
- Research Centre for Natural Sciences, Institute of Enzymology, Hungarian Academy of Sciences Budapest, Hungary
| | - Tamás Arányi
- Research Centre for Natural Sciences, Institute of Enzymology, Hungarian Academy of SciencesBudapest, Hungary; Centre National de la Recherche Scientifique UMR 6214, Institut National de la Santé et de la Recherche Médicale U1083, University of AngersAngers, France
| | - Csaba Barta
- Institute of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University Budapest, Hungary
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Abstract
OBJECTIVES It has been hypothesised that altered sensorimotor gating might be a core problem in Tourette Syndrome (TS). However, the underlying neurophysiological mechanisms are elusive. METHODS We applied functional magnetic resonance imaging (fMRI) to investigate the neural correlates of altered sensorimotor gating by means of prepulse inhibition (PPI) in 22 boys with TS and 22 healthy boys using tactile PPI. The electromyography of the startle response was recorded simultaneously to the acquisition of the fMRI images. RESULTS As expected, PPI of the startle response was reduced in boys with TS compared to the healthy boys. We found decreased PPI-related blood oxygen level-dependent (BOLD) activity in boys with TS in the middle frontal gyrus, postcentral gyrus, superior parietal cortex, cingulate gyrus and caudate body. In boys with TS PPI of the startle response was positively correlated to PPI-related BOLD activity in the superior parietal cortex. CONCLUSIONS Our findings indicate that deficient sensorimotor gating in boys with TS is associated with reduced recruitment of brain regions responsible for the higher-order integration of somatosensory stimuli. Due to our strict sample selection we were able to reduce confounding by neural adaptation processes, long-term medication, gender or comorbidities.
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Affiliation(s)
- Judith Buse
- a Department of Child and Adolescent Psychiatry , Faculty of Medicine of the TU Dresden , Dresden , Germany
| | - Christian Beste
- a Department of Child and Adolescent Psychiatry , Faculty of Medicine of the TU Dresden , Dresden , Germany
| | - Elisabeth Herrmann
- a Department of Child and Adolescent Psychiatry , Faculty of Medicine of the TU Dresden , Dresden , Germany
| | - Veit Roessner
- a Department of Child and Adolescent Psychiatry , Faculty of Medicine of the TU Dresden , Dresden , Germany
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Smeets AYJM, Duits AA, Plantinga BR, Leentjens AFG, Oosterloo M, Visser-Vandewalle V, Temel Y, Ackermans L. Deep Brain Stimulation of the internal globus pallidus in refractory Tourette Syndrome. Clin Neurol Neurosurg 2016; 142:54-59. [PMID: 26811866 DOI: 10.1016/j.clineuro.2016.01.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 12/12/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Deep Brain Stimulation in psychiatric disorders is becoming an increasingly performed surgery. At present, seven different targets have been stimulated in Tourette Syndrome, including the internal globus pallidus. We describe the effects on tics and comorbid behavioral disorders of Deep Brain Stimulation of the anterior internal globus pallidus in five patients with refractory Tourette Syndrome. METHODS This study was performed as an open label study with follow-up assessment between 12 and 38 months. Patients were evaluated twice, one month before surgery and at long-term follow-up. Primary outcome was tic severity, assessed by several scales. Secondary outcomes were comorbid behavioral disorders, mood and cognition. The final position of the active contacts of the implanted electrodes was investigated and side effects were reported. RESULTS Three males and two females were included with a mean age of 41.6 years (SD 9.7). The total post-operative score on the Yale Global Tic Severity Scale was significantly lower than the pre-operative score (42.2±4.8 versus 12.8±3.8, P=0.043). There was also a significant reduction on the modified Rush Video-Based Tic Rating Scale (13.0±2.0 versus 7.0±1.6, P=0.041) and in the total number of video-rated tics (259.6±107.3 versus 49.6±24.8, P=0.043). No significant difference on the secondary outcomes was found, however, there was an improvement on an individual level for obsessive-compulsive behavior. The final position of the active contacts was variable in our sample and no relationship between position and stimulation effects could be established. CONCLUSION Our study suggests that Deep Brain Stimulation of the anterior internal globus pallidus is effective in reducing tic severity, and possibly also obsessive-compulsive behavior, in refractory Tourette patients without serious adverse events or side-effects.
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Affiliation(s)
- A Y J M Smeets
- Departments of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - A A Duits
- Departments of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - B R Plantinga
- Biomedical Image Analysis, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - A F G Leentjens
- Departments of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M Oosterloo
- Departments of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - V Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany
| | - Y Temel
- Departments of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L Ackermans
- Departments of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
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45
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Abstract
This manuscript considers the central but neglected role of the autonomic nervous system in the expression and control of seizures in epilepsy (small) and tics in Tourette Syndrome (TS). In epilepsy, consideration of autonomic involvement is typically confined to differential diagnoses (e.g., syncope), or in relation to Sudden Unexpected Death in Epilepsy (SUDEP). Investigation is more limited in Tourette Syndrome. The role of the autonomic nervous system in the generation and prevention of epileptic seizures is largely overlooked. Emotional stimuli such as anxiety and stress are potent causes of seizures and tic activity in epilepsy and TS, respectively. This manuscript will describe a possible neural mechanism by which afferent autonomic projections linked to cognition and behavior influence central thalamo-cortical regulation, which appears to be an important means for controlling both seizure and tic activity. It also summarizes the link between the integrity of the default mode network and autonomic regulation in patients with epilepsy as well as the link between impaired motor control and autonomic regulation in patients with TS. Two neurological conditions; epilepsy and TS were chosen, as seizures and tics represent parameters that can be easily measured to investigate influences of autonomic functions. The EDA biofeedback approach is anticipated to gain a strong position within the next generation of treatment for epilepsy, as a non-invasive technique with minimal side effects. This approach also takes advantage of the current practical opportunity to utilize growing digital health technology.
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Affiliation(s)
- Yoko Nagai
- Department of Clinical Medicine, Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of SussexBrighton, UK
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46
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Darrow SM, Illmann C, Gauvin C, Osiecki L, Egan CA, Greenberg E, Eckfield M, Hirschtritt ME, Pauls DL, Batterson JR, Berlin CM, Malaty IA, Woods DW, Scharf J, Mathews C. Web-based phenotyping for Tourette Syndrome: Reliability of common co-morbid diagnoses. Psychiatry Res 2015; 228:816-25. [PMID: 26054936 PMCID: PMC4532555 DOI: 10.1016/j.psychres.2015.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Received: 03/30/2015] [Revised: 05/04/2015] [Accepted: 05/18/2015] [Indexed: 11/28/2022]
Abstract
Collecting phenotypic data necessary for genetic analyses of neuropsychiatric disorders is time consuming and costly. Development of web-based phenotype assessments would greatly improve the efficiency and cost-effectiveness of genetic research. However, evaluating the reliability of this approach compared to standard, in-depth clinical interviews is essential. The current study replicates and extends a preliminary report on the utility of a web-based screen for Tourette Syndrome (TS) and common comorbid diagnoses (obsessive compulsive disorder (OCD) and attention deficit/hyperactivity disorder (ADHD)). A subset of individuals who completed a web-based phenotyping assessment for a TS genetic study was invited to participate in semi-structured diagnostic clinical interviews. The data from these interviews were used to determine participants' diagnostic status for TS, OCD, and ADHD using best estimate procedures, which then served as the gold standard to compare diagnoses assigned using web-based screen data. The results show high rates of agreement for TS. Kappas for OCD and ADHD diagnoses were also high and together demonstrate the utility of this self-report data in comparison previous diagnoses from clinicians and dimensional assessment methods.
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Affiliation(s)
- Sabrina M. Darrow
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Cornelia Illmann
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 185 Cambridge St., Boston, MA 02114 USA
| | - Caitlin Gauvin
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 185 Cambridge St., Boston, MA 02114 USA
| | - Lisa Osiecki
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 185 Cambridge St., Boston, MA 02114 USA
| | - Crystelle A. Egan
- Martinez Outpatient Clinic and Community Living Center, Northern California VA Health Care System, 150 Muir Road, Martinez, CA 94553 USA
| | - Erica Greenberg
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 185 Cambridge St., Boston, MA 02114 USA
| | - Monika Eckfield
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143 USA,School of Nursing, University of California San Francisco 2 Koret Way, #N-319X, San Francisco, CA 94143 USA,Department of Nursing and Health Sciences, California State University East Bay 25800 Carlos Bee Blvd., Hayward, CA 94542 USA
| | - Matthew E. Hirschtritt
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143 USA
| | - David L. Pauls
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 185 Cambridge St., Boston, MA 02114 USA
| | - James R. Batterson
- Children’s Mercy Hospitals & Clinics, University of Missouri, Kansas City School of Medicine, 2401 Gilham Road, Kansas City, MO 64108 USA
| | - Cheston M. Berlin
- Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State, 500 University Dr., Hershey, PA 17033 USA
| | - Irene A. Malaty
- UF Center for Movement Disorders and Neurorestoration, Department of Neurology, College of Medicine, University of Florida, 3450 Hull Road, Gainesville, FL 32607 USA
| | - Douglas W. Woods
- Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843 USA
| | - Jeremiah Scharf
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 185 Cambridge St., Boston, MA 02114 USA,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, 415 Main St., Cambridge, MA 02142 USA,Division of Cognitive and Behavioral Neurology, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115 USA,Department of Neurology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Carol Mathews
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143 USA,Address correspondence to Carol A. Mathews, M.D., Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, Box F-0984, San Francisco, CA 94143-0984; ; phone: 415-476-7702; fax: 415-476-7389
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47
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Abstract
Tourette Syndrome (ts) is a developmental neuropsychiatric disorder of the central nervous system defined by the presence of chronic tics. While investigations of the underlying brain mechanisms have provided valuable information, a complete understanding of the pathophysiology of ts remains elusive. Neuroimaging methods provide remarkable tools for examining the human brain, and have been used to study brain structure and function in ts. In this article, we review ts neuroimaging studies published in 2014-2015. We highlight a number of noteworthy studies due to their innovative methods and interesting findings. Yet, we note that many of the recent studies share common concerns, specifically susceptibility to motion artifacts and modest sample sizes. Thus, we encourage future work to carefully address potential methodological confounds and to study larger samples to increase the potential for replicable results.
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Affiliation(s)
- Deanna J Greene
- Department of Psychiatry, Washington University School of Medicine ; Department of Radiology, Washington University School of Medicine
| | - Bradley L Schlaggar
- Department of Psychiatry, Washington University School of Medicine ; Department of Radiology, Washington University School of Medicine ; Department of Neurology, Washington University School of Medicine ; Department of Anatomy & Neurobiology, Washington University School of Medicine ; Department of Pediatrics, Washington University School of Medicine
| | - Kevin J Black
- Department of Psychiatry, Washington University School of Medicine ; Department of Radiology, Washington University School of Medicine ; Department of Neurology, Washington University School of Medicine ; Department of Anatomy & Neurobiology, Washington University School of Medicine
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48
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Abstract
Tourette Syndrome (TS) is a neurodevelopmental disorder, consisting of multiple involuntary movements (motor tics) and one or more vocal (phonic) tics. It affects up to one percent of children worldwide, of whom about one third continue to experience symptoms into adulthood. The central neural mechanisms of tic generation are not clearly understood, however recent neuroimaging investigations suggest impaired cortico-striato-thalamo-cortical activity during motor control. In the current manuscript, we will tackle the relatively under-investigated role of the peripheral autonomic nervous system, and its central influences, on tic activity. There is emerging evidence that both sympathetic and parasympathetic nervous activity influences tic expression. Pharmacological treatments which act on sympathetic tone are often helpful: for example, Clonidine (an alpha-2 adrenoreceptor agonist) is often used as first choice medication for treating TS in children due to its good tolerability profile and potential usefulness for co-morbid attention-deficit and hyperactivity disorder. Clonidine suppresses sympathetic activity, reducing the triggering of motor tics. A general elevation of sympathetic tone is reported in patients with TS compared to healthy people, however this observation may reflect transient responses coupled to tic activity. Thus, the presence of autonomic impairments in patients with TS remains unclear. Effect of autonomic afferent input to cortico-striato-thalamo-cortical circuit will be discussed schematically. We additionally review how TS is affected by modulation of central autonomic control through biofeedback and Vagus Nerve Stimulation (VNS). Biofeedback training can enable a patient to gain voluntary control over covert physiological responses by making these responses explicit. Electrodermal biofeedback training to elicit a reduction in sympathetic tone has a demonstrated association with reduced tic frequency. VNS, achieved through an implanted device that gives pulsatile electrical stimulation to the vagus nerve, directly modulates afferent interoceptive signals. The potential efficacy of biofeedback/VNS in TS and the implications for understanding the underlying neural mechanisms of tics will be discussed.
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Affiliation(s)
- Jack Hawksley
- North Essex Partnership University NHS Foundation Trust Colchester, UK
| | - Andrea E Cavanna
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Trust and School of Clinical and Experimental Medicine, University of Birmingham Birmingham, UK
| | - Yoko Nagai
- Department of Clinical Medicine, Clinical Imaging Sciences Center, Brighton and Sussex Medical School, University of Sussex Brighton, UK ; Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London London, UK
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49
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Robertson MM, Eapen V. Tourette's: syndrome, disorder or spectrum? Classificatory challenges and an appraisal of the DSM criteria. Asian J Psychiatr 2014; 11:106-13. [PMID: 25453712 DOI: 10.1016/j.ajp.2014.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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] [Received: 03/29/2014] [Revised: 04/29/2014] [Accepted: 05/25/2014] [Indexed: 10/25/2022]
Abstract
The fifth version of the Diagnostic and statistical manual of mental disorders (DSM-5) was released in May 2013 after 14 years of development and almost two decades after the last edition DSM-IV was published in 1994. We review the DSM journey with regards to Tourette Syndrome from the original publication of DSM 1 in 1952 till date. In terms of changes in DSM 5, the major shift has come in the placement of Tourette Syndrome under the 'Neurodevelopmental Disorders' alongside other disorders with a developmental origin. This review provides an overview of the changes in DSM-5 highlighting key points for clinical practice and research along with a snap shot of the current use of DSM as a classificatory system in different parts of the world and suggestions for improving the subtyping and the diagnostic confidence.
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Affiliation(s)
- Mary May Robertson
- University College London, United Kingdom; Department of Neurology, Room 148, Atkinson Morley Wing, St. Georges Hospital & Medical School, Blackshaw Road, London SW17 0QT, United Kingdom.
| | - Valsamma Eapen
- School of Psychiatry & Ingham Institute, University of New South Wales; Academic Unit of Child Psychiatry, South West Sydney (AUCS), ICAMHS, Mental Health Centre, L1, Liverpool Hospital, Elizabeth Street, Liverpool, NSW 2170, Australia.
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50
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Heym N, Kantini E, Checkley HLR, Cassaday HJ. Tourette-like behaviors in the normal population are associated with hyperactive/impulsive ADHD-like behaviors but do not relate to deficits in conditioned inhibition or response inhibition. Front Psychol 2014; 5:946. [PMID: 25228890 PMCID: PMC4151087 DOI: 10.3389/fpsyg.2014.00946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 08/07/2014] [Indexed: 11/21/2022] Open
Abstract
Attention-Deficit Hyperactivity Disorder (ADHD) and Tourette Syndrome (TS) present as distinct conditions clinically; however, comorbidity and inhibitory control deficits have been proposed for both. Whilst such deficits have been studied widely within clinical populations, findings are mixed—partly due to comorbidity and/or medication effects—and studies have rarely distinguished between subtypes of the disorders. Studies in the general population are sparse. Using a continuity approach, the present study examined (i) the relationships between inattentive and hyperactive/impulsive aspects of ADHD and TS-like behaviors in the general population, and (ii) their unique associations with automatic and executive inhibitory control, as well as (iii) yawning (a proposed behavioral model of TS). One hundred and thirty-eight participants completed self-report measures for ADHD and TS-like behaviors as well as yawning, and a conditioned inhibition task to assess automatic inhibition. A sub-sample of fifty-four participants completed three executive inhibition tasks. An exploratory factor analysis of the TS behavior checklist supported a distinction between phonic and motor like pure TS behaviors. Whilst hyperactive/impulsive aspects of ADHD were associated with increased pure and compulsive TS-like behaviors, inattention in isolation was related to reduced obsessive-compulsive TS-like behaviors. TS-like behaviors were associated with yawning during situations of inactivity, and specifically motor TS was related to yawning during stress. Phonic TS and inattention aspects of ADHD were associated with yawning during concentration/activity. Whilst executive interference control deficits were linked to hyperactive/impulsive ADHD-like behaviors, this was not the case for inattentive ADHD or TS-like behaviors, which instead related to increased performance on some measures. No associations were observed for automatic conditioned inhibition.
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Affiliation(s)
- Nadja Heym
- School of Psychology, University of Nottingham Nottingham, UK ; Division of Psychology, School of Social Science, Nottingham Trent University Nottingham, UK
| | - Ebrahim Kantini
- School of Psychology, University of Nottingham Nottingham, UK
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