Long-Term Follow-up of Patients with Tourette Syndrome

1. Long-Term Follow-up of Patients with Tourette Syndrome Larry Burd, PhD; Jacob Kerbeshain,MD; Amy Barth, BS; Marilyn G. Klug, PhD; Karilyn Avery, MD; Becky Benz, MD Department of Pediatric, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND

2. Abstract • The goal of this study was to collect prospective longitudinal information on the development of an epidemiologically defined cohort of patients with Tourette syndrome (J Child Neurol 2001; 16:431-437).

3. Cohort established • 1985-1986 • DSM – III criteria • Statewide Study

4. Childhood Prevalence • 5.2 per 10,000 • Mean age 10.1 years

5. Results Thirty-nine of the 54 (72%) patients were located and interviewed. This sample was comprised of 30 males (77%) and nine females (23%). At the time of our initial evaluation or entry into the study cohort (between 1984 and 1985), the mean age was 122 months (10.1 years), with a minimum age of 35 months and a maximum age of 215 months. The mean age at the follow-up evaluation was 274 months (22.8 years); the youngest was 168 months, and the oldest was 336 months. This was a 507 person-years of follow-up, with a mean follow-up period of 13 years. The results are in the tables.

6. Mean age at follow up 22.8 years

7. Temporal Data on Tic Morphology from 39 Patients with Tourette Syndrome from North Dakota at Follow-up (Mean Age 22.8 Years) ___________________________________________________________________ Age When Tics Peaked Mean SD Range (in months) Total (N = 35) 99.0 82.7 0 - 300 Male (n = 27) 92.0 86.7 0 - 300 Female (n = 8) 122.9 66.5 0 – 180 ____________________________________________________________________

8. _______________________________________________ Total Males Females Time of Peak Tics N (%) n (%) n (%) _______________________________________________________________________ Morning 2 (5) 1 (3) 1 (11) Noon 1 (3) 0 - 1 (11) Afternoon 6 (15) 5 (17) 1 (11) Stress 6 (15) 6 (20) 0 - Other 6 (15) 5 (17) 1 (11) Unknown 18 (46) 13 (43) 5 (56)

9. Most Common Comorbid Diagnosis at Initial Evaluation (Mean Age 10.1 Years) and Follow-up (Mean Age 22.8 Years) in 39 Patients with Tourette Syndrome from North Dakota. ___________________________________________________________________________ Initial Evaluation Follow-up Diagnosis n (%) n (%) ___________________________________________________________________________ Tourette syndrome 39 (100) 18 (46) ADHD 8 (21) 11 (28) Depression 4 (10) 3 (8) Seizures 6 (15) 1 (3) Learning Disabilities 5 (13) 4 (10) Depression 4 (10) 3 (8) Bipolar disorder 3 (8) 1 (3) Obsessive-compulsive 2 (5) 3 (8) disorder

10. Syndromal Severity Tic Severity (Global Severity Rating Scale), Comorbidity (Number of Comorbid Neuropsychiatric Conditions Identified), and Reversed Global Assesment of Functioning Scores at Initial Evaluation

11. Initial Evaluation Follow-up Mean Mean Change (%) ____________________________________________________________ Global Severity Rating Scale (GSR) Total 3.4 1.4 2.0 (59) Male 3.4 1.6 1.8 (53) Female 3.4 0.6 2.8 (82) ____________________________________________________________

12. Initial Evaluation Follow-up Mean Mean Change (%) _____________________________________________________________ Comorbity Total 3.1 1.8 1.3 (42) Male 3.1 1.8 1.3 (42) Female 2.8 1.9 0.9 (32) _____________________________________________________________

13. Initial Evaluation Follow-up Mean Mean Change (%) ___________________________________________________ Reversed Global Assessment of Function (GAF) Total 45.1 22.5 22.6 (50) Male 46.3 23.4 22.9 (49) Female 41.0 19.4 21.6 (53) ______________________________________________________________________________

14. Differences in Mean Tic Severity (Global Severity Rating Scale), Number of Comorbidities, Reversed Global Assessment of Functioning Score, and Composite Score at Initial Evaluation (Mean Age 10.1 Years) and at Follow-up (Mean Age 22.8 Years) in 39 Patients with Tourette Syndrome from North Dakota. _________________________________________________________________________________ Measure Mean SD Range _________________________________________________________________________________ GSR at intake 3.4 0.9 1 - 5 GSR at follow-up 1.4 1.7 0 - 5 Comorbity at intake 3.1 1.8 1 - 8 Comorbity at follow-up 1.8 1.3 0 - 6 Reversed GAF at intake 45.1 13.9 15 – 75 Reversed GAF at follow-up 22.5 18.4 0 - 80 Composite Score at intake 129.6 29.5 57 - 189 Composite Score at follow-up 62.7 46.1 10 - 194

15. __________________________________________________________ Results of Paired t-tests (Measure) Mean SD T Prob>/T/ ________________________________________________________ Differences in GSR Scores 2.0 1.8 7.1 <0.0001 Differences in comorbity 1.2 2.2 3.6 <0.0005 Differences in Reversed 22.6 18.0 7.8 <0.0001 GAF Scores Difference in composite 66.9 51.4 8.1 <0.0001 scores ___________________ The composite score is a linear combination of the three severity measures.

16. Longitudinal Course for Subjects with Tourette Syndrome High Severity Low 5% 15% 80%

17. Course of Tourette Syndrome • 4 % improvement per year

18. Conclusions Tourette Syndrome is a common developmental disorder with a definable course. Based on this information close monitoring of pharmacological and other interventions is warranted. Long term treatment is likely necessary for only a minority of affected people. Strategies for management of episodic problems in TS are needed. This would be especially important for children six to thirteen years of age.