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Tourette Syndrome (TS)

Tourette Syndrome (TS). TS is a neurodevelopmental disorder that is characterized by involuntary motor movements and vocalizations called Tics 1 Tics are rapid, repetitive, and stereotyped movements or vocalizations The quantity and complexity of the tics fluctuate over time

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Tourette Syndrome (TS)

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  1. Tourette Syndrome (TS) • TS is a neurodevelopmental disorder that is characterized by involuntary motor movements and vocalizations called Tics1 • Tics are rapid, repetitive, and stereotyped movements or vocalizations • The quantity and complexity of the tics fluctuate over time • TS is a chronic condition that is frequently associated with difficulties in self-esteem, school performance, social acceptance, and family life. • TS is chronic and usually emerges between ages 2 to 15 (~50% affected by age 7) 1-2 • TS is more common in males than females by a ratio of about 5 to 1. 1-2 • TS is not a rare disorder, with the number of children affected estimated to be 7 in 1000. 1-2

  2. Other Characteristics of TS Other symptoms associated with TS: 3-4 speech and conduct problems mood instability, anxiety, obsessive-compulsive symptoms impulsivity, distractibility, motor hyperactivity, learning problems Common Co-morbidities: ADHD (55%)5 Obsessive-Compulsive Disorder (OCD) (20-60%)6-8 Referred to as ‘TS-plus’ More severe tics, higher the psychiatric co-morbidity Neuropsychological deficits9

  3. Causes of TS Serotonogic & dopaminergic neurotransmitter systems1 Tics and comorbidities improve with use of SSRIs and dopamine-receptor blockers TS has been linked to disruption of brain areas:1,10,11 Frontal areas basal ganglia Caudate Genetics plays a role1 Relatives have higher rates of Tics, OCD, and ADHD High concordance rate in monozygotic twins

  4. Prognosis Tics peak between 8 and 12 years12 Most Tics are gone by adulthood (only 20% still have significant Tics in adulthood)12 Treatment:1 Medications Behavior Therapy Counseling Cognitive therapy Relaxation theory Awareness and assertiveness training Habit reversal training

  5. References • Kenney C, Kuo S, Jimenez-Shahed J. Tourette's Syndrome. Am Fam Physician. 2008;77:651-658. • Hirtz D, Thurman D, Gwinn-Hardy K, Mohamed M, Chaudhuri A, Zalutsky R. How common are the "Common" Neurologic disorders? Neurology. 2007;68:326-337. • Lekman J, Yeh C, Lombroso P. Neurobiology of tic disorders, including Tourette's Syndrome. Pediatric Psychopharmacology: Oxford University Press. 2003;164-174. • Shapiro A, Shapiro E, Young J, Feinberg T, eds. Gilles de la Tourette Syndrome, 2nd ed. New York: Raven Press;1988. • Freeman R. Tic disorders and ADHD: Answers from a world-wide clinical dataset on Tourette Syndrome. Eur Child Adolesc Psychiatry. 2007;16(Suppl 1):15-23. • Apter A, Pauls D, Bleich A, et al. An epidemiologic study of Gilles de la Tourette's Syndrome in Israel. Arch Gen Psychiatry. 1993;50:734-738. • Cath D, Spinhoven P, van Woerkom T, et al. Gilles de la Tourette's Syndrome with and without obsessive-compulsive disorder compared with obsessive-compulsive disorder without tics: Which symptoms discriminate? J Nerv Ment Dis. 2001;189:219-228. • Pitman R, Green R, Jenike M, Mesulam M. Clinical comparison of Tourette's disorder and obsessive-compulsive disorder. Am J Psychiatry. 1987;144:1166-1171. • Bornstein R, King G, Carroll A. Neuropsychological abnormalities in Gilles de la Tourette's Syndrome. J Nerv Ment Dis. 1983;171:497-502. • Robertson M. Tourette Syndrome, associated conditions and the complexities of treatment. Brain. 2000;123(Pt 3):425-462. • Mink JW. Neurobiology of basal ganglia circuits in Tourette Syndrome: Faulty inhibition of unwanted motor patterns? Adv Neurol. 2001;85:113-122. • Leckman, JF., Bloch, M., Scahill, L., & King, R. (2006). Tourette Syndrome: The self under siege, Journal of Child Neurology, 21.

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