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Factor-analytic study of the Yale Global Tic Severity Scale.

We report on the factor structure of the Yale Global Tic Severity Scale. Participants were 76 children and adolescents diagnosed with tic disorders. Overall, the model proposed by Leckman et al. [Leckman, J.F., Riddle, M.A., Hardin, M.T., Ort, S.I., Swartz, K.L., Stevenson, J., Cohen, D.J., 1989. The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. Journal of the American Academy of Child and Adolescent Psychiatry 28, 566-573.] represented an adequate fit. The internal consistency of the factors was acceptable and the convergent and divergent validity was supported vis-à-vis correlations with parent ratings of Tourette's Disorder symptoms. These findings support the use of the original scoring structure in assessing pediatric tic severity.

Adolescent↗

Somatic complaints in childhood tic disorders.

Twenty-six children diagnosed with chronic tic disorders (18 with Gilles de la Tourette syndrome and 8 with chronic motor tic disorder) were studied for unexplained physical complaints. Compared to normal controls, an excess of somatic complaints was found in the tic disorders group; this was similar to an excess of somatic complaints in a mixed psychiatric clinic group. Medication produced no significant effect on somatic complaints for patients in the tic and psychiatric clinic groups. Within the tic disorders group, no significant correlation was found between the increased somatic complaints and the severity of anxiety, dysphoria, or movement disorder.

Adolescent↗

Premonitory sensory phenomena and suppressibility of tics in Tourette syndrome: developmental aspects in children and adolescents.

Although premonitory sensory phenomena (PSP) and suppressibility of tics (SPT) are important in Tourette syndrome not only when behavioural therapeutic approaches in children are considered, there is a lack of developmental information on these phenomena. Therefore, a cross-sectional survey of these factors in children and adolescents was carried out. Rates of PSP and SPT were gathered using a questionnaire for the assessment of Tourette syndrome. The 254 outpatients (212 males, 42 females) with Tourette syndrome investigated had an age range of 8 to 19 years, normal intelligence, and diagnosis according to DSM-IV-TR/ICD-10. To test for developmental effects, the total group was stratified into three age groups (8 to 10, 11 to 14, and 15 to 19 years). Data were statistically evaluated using chi2 tests. Of the 254 participants, 37% reported PSP, while 64% were able to suppress their tics. Only a subgroup of 119 patients gave unequivocal answers to both questions and only 60% of these experienced both PSP and SPT. Statistically significant stepwise increases were found at two different age levels. One was around 10 years (PSP 'Yes' or 'No' and SPT), the other around age 14 (PSP 'Yes'). There was no influence of tic duration and age at tic onset on PSP/SPT. The reported data suggest that PSP is experienced rarely in younger children with Tourette syndrome and is not a necessary prerequisite for SPT. Increasing PSP with age merely seems to reflect cognitive development rather than intrinsic aspects of Tourette syndrome. In children under 10 years of age, SPT might require more awareness of tics than in older age groups. Developmental aspects of PSP and SPT should be taken into consideration when studies of cognitive behavioural treatment for children and adolescents with Tourette syndrome are planned.

Adolescent↗

Crystal structures of dipeptides containing the Dmt-Tic pharmacophore.

The crystal structures of three analogues of the potent delta-opioid receptor antagonist H-Dmt-Tic-OH (2',6'-dimethyl-L-tyrosine-L-1,2,3,4-tetrahydroisoquinoline-3-carboxylate), N,N (CH(3))(2)-Dmt-Tic-OH (1), H-Dmt-Tic-NH-1-adamantane (2), and N,N(CH(3))(2)-Dmt-Tic-NH-1-adamantane (3) were determined by X-ray single-crystal analysis. Crystals of 1 were grown by slow evaporation, while those of 2 and 3 were grown by vapor diffusion. Compounds 1 and 3 crystallized in the monoclinic space group P2(1), and 2 crystallized in the tetragonal space group P4(3). Common backbone atom superimpositions of structures derived from X-ray diffraction studies resulted in root-mean-square (rms) deviations of 0.2-0.5 A, while all-atom superimpositions gave higher rms deviations from 0.8 to 1.2 A. Intramolecular distances between the aromatic ring centers of Dmt and Tic were 5.1 A in 1, 6.3 A in 2, and 6.5 A in 3. The orientation of the C-terminal substituent 1-adamantane in 2 and 3 was affected by differences in the psi torsion angles and strong hydrogen bonds with adjacent molecules. Despite the high delta-opioid receptor affinity exhibited by each analogue (K(i) < 0.3 nM), high mu receptor affinity (K(i) < 1 nM) was manifested only with the bulky C-terminal 1-adamantane analogues 2 and 3. Furthermore, the bioactivity of both 2 and 3 exhibited mu-agonism, while 3 also had potent delta-antagonist activity. Those data demonstrated that a C-terminal hydrophobic group was an important determinant for eliciting mu-agonism, whereas N-methylation maintained delta-antagonism. Furthermore, the structural results support the hypothesis that expanded dimensions between aromatic nuclei is important for acquiring mu-agonism.

Adamantane↗

Direct influence of C-terminally substituted amino acids in the Dmt-Tic pharmacophore on delta-opioid receptor selectivity and antagonism.

A series of 17 analogues were developed on the basis of the general formula H-Dmt-Tic-NH-CH(R)-R' (denotes chirality; R = charged, neutral, or aromatic functional group; R' = -OH or -NH(2)). These compounds were designed to test the following hypothesis: the physicochemical properties of third-residue substitutions C-terminal to Tic in the Dmt-Tic pharmacophore modify delta-opioid receptor selectivity and delta-opioid receptor antagonism through enhanced interactions with the mu-opioid receptor. The data substantiate the following conclusions: (i) all compounds had high receptor affinity [K(i)(delta) = 0.034-1.1 nM], while that for the mu-opioid receptor fluctuated by orders of magnitude [K(i)(mu) = 15.1-3966 nM]; (ii) delta-opioid receptor selectivity [K(i)(mu)/K(i)(delta)] declined 1000-fold from 22,600 to 21; (iii) a C-terminal carboxyl group enhanced selectivity but only as a consequence of the specific residue; (iv) amidated, positive charged residues [Lys-NH(2) (6), Arg-NH(2) (7)], and a negatively charged aromatic residue [Trp-OH (11)] enhanced mu-opioid affinity [K(i)(mu) = 17.0, 15.1, and 15.7 nM, respectively], while Gly-NH(2) (8), Ser-NH(2) (10), and His-OH (12) were nearly one-tenth as active; and (v) D-isomers exhibited mixed effects on mu-opioid receptor affinity (2' << 3' < 4' < 1' < 5') and decreased delta-selectivity in D-Asp-NH(2) (1') and D-Lys(Ac)-OH (5'). The analogues exhibited delta-opioid receptor antagonism (pA(2) = 6.9-10.07) and weak mu-opioid receptor agonism (IC(50) > 1 microM) except H-Dmt-Tic-Glu-NH(2) (3), which was a partial delta-opioid receptor agonist (IC(50) = 2.5 nM). Thus, these C-terminally extended analogues indicated that an amino acid residue containing a single charge, amino or guanidino functionality, or aromatic group substantially altered the delta-opioid receptor activity profile (selectivity and antagonism) of the Dmt-Tic pharmacophore, which suggests that the C-terminal constituent plays a major role in determining opioid receptor activity as an "address domain".

Amino Acid Substitution↗

Chronic paroxysmal hemicrania-tic syndrome.

We report the coexistence of both chronic paroxysmal hemicrania (CPH) and trigeminal neuralgia (tic douloureux) in a female patient. The clinical features combined to make a configuration of CPH-tic syndrome. The two components of the syndrome appeared synchronously in the same orbital region--first branch of the trigeminal nerve--with a latency of several years after the onset of isolated tic attacks of the second and third trigeminal divisions. The concurrence of both types of pain in the same symptomatic area may have some significance for pathogenic, clinical, and pharmacological aspects of such a syndrome. We discuss all these and postulate a provisional distinction between CPH-V2,3 tic and CPH-V1 tic.

Aged↗

The interaction of oxygen with TiC(001): photoemission and first-principles studies.

High-resolution photoemission and first-principles density-functional slab calculations were used to study the interaction of oxygen with a TiC(001) surface. Atomic oxygen is present on the TiC(001) substrate after small doses of O(2) at room temperature. A big positive shift (1.5-1.8 eV) was detected for the C 1s core level. These photoemission studies suggest the existence of strong O<-->C interactions. A phenomenon corroborated by the results of first-principles calculations, which show a CTiTi hollow as the most stable site for the adsorption of O. Ti and C atoms are involved in the adsorption and dissociation of the O(2) molecule. In general, the bond between O and the TiC(001) surface contains a large degree of ionic character. The carbide-->O charge transfer is substantial even at high coverages (>0.5 ML) of oxygen. At 500 K and large doses of O(2), oxidation of the carbide surface occurs with the removal of C and formation of titanium oxides. There is an activation barrier for the exchange of Ti-C and Ti-O bonds which is overcome only by the formation of C-C or C-O bonds on the surface. The mechanism for the removal of a C atom as CO gas involves a minimum of two O adatoms, and three O adatoms are required for the formation of CO(2) gas. Due to the high stability of TiC, an O adatom alone cannot induce the generation of a C vacancy in a flat TiC(001) surface.

Journal Article↗

Fluoxetine has no marked effect on tic symptoms in patients with Tourette's syndrome: a double-blind placebo-controlled study.

To evaluate the efficacy of fluoxetine in the treatment of tics and obsessive-compulsive symptoms in patients with Tourette's syndrome (TS), 14 subjects (8-33 years old) with TS participated in a 20-week, fixed-dose (20 mg daily), double-blind, placebo-controlled crossover trial of fluoxetine monotherapy. Five subjects met criteria for obsessive-compulsive disorder (OCD), 6 additional subjects had obsessive-compulsive features, and 3 subjects had TS without obsessive-compulsive symptoms. There was no improvement in tics after 8 weeks of treatment with fluoxetine (p = 0.58). In contrast, fluoxetine treatment was associated with a significant reduction in obsessive-compulsive symptoms for the group of 6 subjects initially randomized to fluoxetine (p = 0.04). Crossover analysis showed that fluoxetine had no marked effect on tics (n = 10, p = 0.30, but produced a modest decrease in obsessive-compulsive symptoms (n = 8, p = 0.06). Order effects and carry-over effects were not significant. Withdrawal to placebo was associated with a 55% increase in obsessive-compulsive symptoms (p = 0.05), but there was no effect on tics. The most common side effect was transient behavioral activation, which occurred in about half of the subjects and was more common in children. Fluoxetine may be useful for the treatment of obsessive-compulsive symptoms in some patients with TS, but does not appear to be effective for tics.

Adolescent↗

Comparison of percutaneous radiofrequency gangliolysis and microvascular decompression for the surgical management of tic douloureux.

Forty-two patients with tic douloureux underwent posterior fossa craniectomy and microvascular decompression (MVD) or partial rhizotomy of the trigeminal nerve and were followed an average of 25 months after operation. Thirty-six patients were found to have anatomical distortions of the nerve by an artery, vein, bony prominence, or a combination of factors, and 30 patients (83%) of this groups hav remained pain-free postoperatively. Six patients had no discernible pathological condition at the time of operation and underwent partial trigeminal rhizotomy. No patient underwent repeated MVD or rhizotomy, although 4 patients whose pain recurred after MVD underwent rhizotomy at a second operation. Eight of the 10 patients treated by rhizotomy are currently pain-free. The overall success rate of the entire group is 90%; 2% experienced a complication, and there was 1 perioperative death. Seventy-eight patients with tic douloureux who underwent 92 percutaneous radiofrequency trigeminal gangliolysis (PRTG) procedures were evaluated on average of 56 months postoperatively. Sixty-eight per cent of these patients when evaluated 1 year postoperatively were pain-free. However, only 35% of the PRTG procedures resulted in continued pain relief 5 years after operation. Twelve of the 78 patients (15%) required repeat gangliolysis because of recurrent tic pain. Considering all 78 patients treated with 92 PRTG procedures, 64% were pain-free at follow-up examination. PRTG was associated wtih an 8% risk of complications, which included anesthesia dolorosa, corneal anesthesia with keratitis, and significant facial paresthesias. Both PRTG and MVD have advantages. MVD should be considered because: (a) it attacks what is believed to be the primary etiology of tic douloureux, (b) the trigeminal nerve is preserved, (c) postoperative pain relief dose not depend upon the production of sensory deficit, and (d) it may have a greater potential for producing long-lasting pain relief. However, PRTG has other advantages: (a) it avoids the risks of craniectomy, (b) it is repeated easily if tic pain recurs, (c) morbidity is minimal and there is essentially no risk of mortality, and (d) it is much less expensive.

Adult↗

Tic douloureux caused by primitive trigeminal artery or its variant.

Primitive trigeminal artery (PTA) is an extremely rare cause of tic douloureux. None of the reports on PTA variant, which is an anomalous cerebellar artery arising from the internal carotid artery without anastomosis to the basilar artery, has suggested the possibility of this vessel causing tic douloureux. Eight cases of tic douloureux are reported in which a PTA or PTA variant was found during microvascular decompression (MVD). These cases were derived from a series of 1257 patients treated with MVD for tic douloureux. In one patient, the neuralgia was caused by a combination of vessels: a PTA, the superior cerebellar artery, and the anterior inferior cerebellar artery. In the other seven cases, a PTA variant was compressing the root entry zone of the trigeminal nerve. All eight patients gained excellent pain relief after MVD of the root entry zone. The significance of PTA's and PTA variants as the cause of tic douloureux and the effectiveness of MVD in the management of such cases are discussed.

Aged↗

[Tic disorders in children and adolescents. Clinical and genetic features, comorbidity].

UNLABELLED: Tic disorders in children and adolescents. Clinical and genetic features, comorbidity. BACKGROUND: Aim of the study is to evaluate the clinical and genetic characteristics of tic disorders, in view of individuating similarities or differences relevant to the prognosis among different nosological groups. METHODS: A retrospective study of 79 children and adolescents (average age 9.3 yrs) was performed. The cases were diagnosed according to DSM-IV as: transitory tics (TT) 13 cases; chronic tics (CT) 50 cases; Tourette disease (TD) 16 cases. They were compared to a control group of 18 school age children without any neurological or psychiatric disturbance. The study included: semi-structured interviews focused on natural history of the disturbances, familiarity, presence of perinatal pathology, comorbidity; neurological examination, EEG, psychodiagnostic tests and investigation. RESULTS: Mean age of onset and type of first symptoms are the same in the three groups. Compared to the control group there is a significant increase in: familiarity for tics disturbances in TD; presence of perinatal pathological factors in the three groups of patients; comorbidity for obsessive-compulsive disorder (OCD) in CT and TD, comorbidity with ADHD in CT group. Three clinical cases are reported to exemplify the mixed features in the families and the different responsivity to the pharmacological treatment.

Adolescent↗

The effect of hypoxia on photocytotoxicity of TICS tricarbocyanine dye in vitro.

AIM: To evaluate the effect of cell oxygenation on photocytotoxicity of a novel tricarbocyanine indolenine dye covalently bound to glucose (TICS). METHODS: HeLa cells were incubated with 5 microM TICS, 2 h later irradiated by laser at 740 nm with a light dose of 10 J/cm(2), delivered at a power density of 10, 20, 25 or 30 mW/cm(2), in air or in argon atmosphere, and then scored for viability. RESULTS: The photocytotoxicity of TICS increased dramatically as the power density was reduced. Under hypoxia TICS-photosensitized cell death was determined but its value was lowered, compared to photoirradiation in the air. CONCLUSION: Photosensitizing effect of TICS is only partially dependent on the oxygenation of tumor cells.

Cell Hypoxia↗

[Generalized tic (Gilles de la Tourette's syndrome) in twins].

Two pairs of monozygotic twins with tic hyperkinesis are described. One pair manifested a clinical picture of generalized tic (Gilles de la Tourette's disease), the other generalized and local tic. These observations may point to an involvement of hereditary factors in the genesis of generalized tic and to the similarity of the pathogenetic mechanisms of local and generalized tics.

Diseases in Twins↗

Tics and Tourette's: a continuum of symptoms?

Analysis of the families of 39 unselected children with Tourette syndrome revealed other members with tic disorders in twenty kindreds. In eight families there were 13 individuals with chronic multiple tics, usually motor, not vocal. Twelve different families contained 18 subjects with Tourette syndrome other than the index patient. In three of these families there were 6 additional individuals with chronic motor tics, forming a bridge to the first group. An autosomal dominant mode of inheritance was suggested in all cases. Tourette syndrome and chronic motor tics appear to represent conditions along a continuum and have, in many instances, a hereditary basis.

Child↗

Association of cortical disinhibition with tic, ADHD, and OCD severity in Tourette syndrome.

Hyperkinetic disorders may involve excess excitatory output from thalamus to cerebral cortex. Case-control, neurophysiological studies in persons with Tourette Syndrome (TS), Attention Deficit Hyperactivity Disorder (ADHD), and Obsessive-Compulsive Disorder (OCD) support this model. To compare the strength of association between motor cortex inhibition and tic, ADHD, and OCD severity in TS, we used transcranial magnetic stimulation to measure motor cortex inhibition in 36 children and adults with TS. Current symptom severity was assessed with standard clinical rating scales and compared with neurophysiological measures using correlational and multivariate regression analyses. Severity of ADHD symptoms and motor tics were associated significantly and independently with short interval intracortical inhibition (SICI) (r(2) = 0.50; F[2,27] = 13.7; P < 0.001), particularly in subjects not taking neuroleptics (r(2) = 0.68; F[2,17] = 17.8; P < 0.0001). The correlation of cortical disinhibition was greater with ADHD symptoms severity (r = 0.53; P = 0.003) than with tic severity (r = 0.42; P = 0.02), suggesting that in TS, the association between SICI and ADHD symptoms may be more consistent or direct than the association between SICI and tics.

Adolescent↗

A case of post-traumatic tic disorder.

We present the case of a 27-year-old man who developed multiple motor tics following closed head trauma with loss of consciousness. Age of onset, lack of family history of tics, and atypical progression of tic severity and location make it unlikely that the patient had Gilles de la Tourette syndrome. Previous reports of post-traumatic tic syndrome are discussed.

Adult↗

[Relationship between tics and compulsion].

In children and adolescents motor/vocal tics and obsessive-compulsive behavior are known to be closely related. Thereby, a continuum of symptoms ranging from single tics to a mixed picture of tics/rituals/obsessive-compulsive traits to clinically relevant obsessions and compulsions could be described. As neurobiological substrates dysfunctions in corresponding cortico-striato-thalamocortical circuits (sensorimotor circuit in tic symptomatology, orbitofrontal circuit in obsessive-compulsive behavior) were postulated. For both disturbances behavioral therapy can be used to improve control mechanisms to counterregulate tics and obsessive-compulsive behavior, respectively, and psychopharmacological agents can be administered to compensate dysbalances in neurotransmitter systems. In case of a mixed symptomatologic picture it is necessary to include interventions for both pols of the symptom-continuum in the therapeutic programme to achieve extensive improvement as a basis for a further positive development of the patient.

Adolescent↗

Detecting pediatric autoimmune neuropsychiatric disorders associated with streptococcus in children with obsessive-compulsive disorder and tics.

BACKGROUND: A subgroup of children with obsessive-compulsive and tic disorders are proposed to have an infectious trigger. The purpose of this study was to investigate the relationship between group A streptococcal titers and symptom fluctuations in children with a clinical course resembling that described for pediatric autoimmune neuropsychiatric disorders associated with streptococcus. METHODS: Twenty-five children with obsessive-compulsive disorder and/or tic disorder were evaluated for neuropsychiatric severity and group A streptococcal antibody titers (streptolysin O, deoxyribonuclease B, and carbohydrate A) at 6-week intervals for > or = six consecutive evaluations (total visits=277). RESULTS: Children with large symptom fluctuations (n=15) were compared with children without dramatic fluctuations (n=10). Co-movements of obsessive-compulsive/tic severity and group A streptococcal antibodies were assessed. In subjects with large symptom changes, positive correlations were found between streptococcal titers and obsessive-compulsive severity rating changes (p=.0130). These subjects were also more likely to have elevated group A streptococcal titers during the majority of observations (p=.001). Tic symptom exacerbations occurred more often in the fall/winter months than spring/summer months (p=.03). CONCLUSIONS: Patients with marked obsessive-compulsive/tic symptom changes may be characterized by streptococcal titer elevations and exhibit evidence of seasonal tic exacerbations.

Antibodies, Bacterial↗