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PubMed1999

Deficient motor control in children with tic disorder: evidence from transcranial magnetic stimulation.

Decreased motor inhibition was reported in adult patients with tic disorder (TD) using the technique of transcranial magnetic stimulation. Since tics usually begin during childhood, motor threshold, cortical silent period (CSP) and intracortical inhibition/facilitation were measured in 21 TD children and 25 healthy children aged 10-16 years. In TD children motor threshold was normal. The CSP was significantly shortened compared to healthy controls but did not depend on tic localization. Intracortical inhibition and facilitation did not differ between the two groups. This study confirms that the finding of decreased motor control in adult patients also holds true for children wherever the tics in the latter group were located.

Adolescent↗
PubMed2003

Tourette's syndrome in Taiwan: an epidemiological study of tic disorders in an elementary school at Taipei County.

We have done an epidemiological study in an elementary school with 2000 Taiwanese children aged from 6 to 12 years, and found 11 of them with Tourette's syndrome. The prevalence rate of Tourette's syndrome was around 0.56%. The ratio of male to female was 9 to 2. The comorbid rate of attention-deficit/hyperactivity disorder was 36%, self-injurious behaviors 27%, and obsessive-compulsive behaviors 18%. The familial rate of Tourette's syndrome was 27%. We also found that another 98 children had transient tic disorders. For 73% of patients with mild tics, understanding and acceptance from family, teachers, and friends are the most important things. When tics are so severe that medication is necessary, haloperidol is no longer the first or only choice. We tried clonidine, atypical neuroleptics such as risperidone or olanzapine, or pergolide. The first support group was established in 1999 for children with tics in Taiwan and transformed to Taiwan Tourette Family association in June 2001 to provide further service for Tourette's syndrome.

Antipsychotic Agents↗
PubMed2003

Clinical characteristics of adult patients with tics and/or Tourette's syndrome.

OBJECTIVE: This study was conducted to describe the natural course of tic disorders over a long period of time in Japanese adults patients with Tourette's syndrome (TS) in terms of symptomatology. METHODS: An extensive literature on TS cases was reviewed selectively and 31 TS patients (mean age: 31.4 years; sex: 28 males and 3 females) at our outpatient clinic were examined. The mean follow-up period of the patients was 7.6 years (SD: 8.1; 0 to 26). All the data available for this study, including medical charts, were examined systematically by two experienced child psychiatrists. RESULTS: The adult patients with tic disorders could be classified into the four groups: group A - tics only, group B - tics + comorbidities, group C - comorbidities only and group D - sub-clinical (remission) cases. Our 31 subjects consisted of 10 patients (32.3%) for group A, 14 (45.2%) for group B, 7 (22.6%) for group C, and 0 for group D. CONCLUSIONS: Further investigation into the natural course and clinical characteristics of adult TS needs to be done in order to acquire a better understanding of the broad spectrum of TS and to make improvements to the treatment for this illness.

Adult↗
PubMed2006

Obsessive-compulsive disorder, tics and anxiety in 6-year-old twins.

BACKGROUND: Previous reports of genetic influences on obsessive-compulsive disorder (OCD) symptoms have suggested moderate heritability. Family history studies of co-morbidity have found familial aggregation with tics, especially for early-onset OCD, and familial aggregation with anxiety disorders. METHOD: Heritability of OCD and familial aggregation of OCD, tics and anxiety disorders were investigated in a community sample of 6-year-old twins using a two-phase design in which 4662 twin pairs were sampled and 854 pairs were assessed in the second phase by maternal-informant diagnostic interview using DSM-IV criteria. RESULTS: In the multivariate model combined additive genetic and common environmental effects were estimated as 47% for sub-threshold OCD, and the model was unable to distinguish these sources of familial aggregation. There were strong familial aggregations between sub-threshold OCD and tics and between sub-threshold OCD and other anxiety disorders (80% and 97% respectively), although again specific sources could not be distinguished. CONCLUSIONS: The findings are consistent with the hypothesis of a tic-related early-onset OCD phenotype, but also with the hypothesis of an anxiety-related early-onset OCD phenotype.

Anxiety Disorders↗
PubMed1997

HMPAO SPET does not distinguish obsessive-compulsive and tic syndromes in families multiply affected with Gilles de la Tourette's syndrome.

BACKGROUND: Gilles de la Tourette's syndrome (GTS) is a familial neuropsychiatric disorder characterized by tics and obsessive-compulsive behaviours (OCB). Previous HMPAO SPET studies of subjects with GTS have shown hypoperfusion of striatal and frontal areas. Studies of patients with primary obsessive-compulsive disorder have shown, in contrast, hyperperfusion of similar areas. METHODS: Twenty subjects from five families affected by GTS, including individuals with OCB but no tics, were examined using HMPAO SPET. RESULTS: There were abnormalities of regional cerebral perfusion in individuals with GTS, OCB and tics. Hypoperfusion was in striatal, frontal and temporal areas. There was no hyperperfusion. CONCLUSIONS: Regional cerebral blood flow patterns in individuals with OCB in families affected by GTS are comparable to their relatives with GTS and differ from individuals with primary OCD in the absence of a family history of tic disorders.

Adolescent↗
PubMed2004

A case of adult onset tic disorder following carbon monoxide intoxication.

BACKGROUND: Adult onset tic disorders are usually secondary in origin. We report a case of adult onset tic disorder following carbon monoxide (CO) intoxication with typical magnetic resonance imaging features. CASE REPORT: A 36-year-old woman developed temporarily suppressible patterned movements on her face, neck, and shoulder associated with sensory discomfort after CO poisoning. Magnetic resonance images showed bilateral symmetric cavitary changes in the globus pallidus. Clonazepam relieved much of her symptoms. CONCLUSION: Our patient developed a monosymptomatic tic disorder following CO intoxication. This further supports that altered outflow signals from the basal ganglia, especially the globus pallidus, may contribute to the development of tic disorders.

Adult↗
PubMed2003

[Compulsive phenomena in children with tic disorder and attention deficit-hyperactive disorder].

Tic disorders (TD), obsessive-compulsive disorders (OCD) and attention-deficit/hyperactivity disorder (ADHD) are often associated with deficits of impulse control and aggressive behavior. Tic disorders and OCD are closely related on epidemiological, psychopathological and neurobiological levels, whereas ADHD and OCD phenomena seem to be at opposite poles. Research evidence on the clinical significance of associated obsessive-compulsive behavior is reviewed and linked to our own new data. Thus the analyses of a worldwide database on Tourette's Syndrome (TS) (N = 4,833) showed that that the associated symptomatology of the OCD spectrum has to emphasized. In further investigations, premonitory sensorimotor phenomena reminiscent of OCD were more frequent in children with tic disorders as they grew older. Obsessive-compulsive behavior concomitant with TS was particularly associated with impulsive and aggressive behavior, as well as with depression and anxiety. The data suggest a reduced serotonergic transmission. Self-reports by children with ADHD, as opposed to those by their parents, mentioned a significantly higher quantitative degree of OC phenomena than those by children with TS. These findings suggest that OC symptoms in children with ADHD have so far been neglected in assessments by others. In summary, a complex psychopathological pattern of tic, OC behavior, impulsivity and internalizing symptomatology emerges that requires discriminating assessment and treatment.

Adolescent↗
PubMed2005

Reliability and validity of the Yale Global Tic Severity Scale.

To investigate the reliability and validity of the Yale Global Tic Severity Scale (YGTSS), 28 youth aged 6 to 17 years with Tourette's syndrome (TS) participated in the study. Data included clinician reports of tics and obsessive-compulsive disorder (OCD) severity, parent reports of tics, internalizing and externalizing problems, and child reports of depression and anxiety. All children participated in a 2nd YGTSS administration by the same rater 48 days later. Good internal consistency and stability were found for the YGTSS scores. YGTSS scores demonstrated strong correlations with parent-rated tic severity (r = .58-.68). YGTSS scores were not significantly related to measures of clinician ratings of OCD severity (r = .01-.15), parent ratings of externalizing and internalizing behavior (r = -.07-.20), and child ratings of depression (r = .02-.26) and anxiety (r = -.06 -.28). Findings suggest that the YGTSS is a reliable and valid instrument for the assessment of pediatric TS.

Adolescent↗
PubMed2004

Olanzapine in the treatment of aggression and tics in children with Tourette's syndrome--a pilot study.

OBJECTIVE: The aim of this study was to examine the effects of olanzapine on aggressive behaviour and tic severity in children with Tourette's Syndrome (TS). METHOD: Ten (10) subjects (aged 7-13 years) with a primary diagnosis of TS and a history of aggressive behaviour were treated in a single-blind, 2-week placebo run-in, 8-week treatment phase trial. The starting dose of olanzapine was 1.25-2.5 mg/day and was titrated at biweekly intervals, as tolerated. The mean dosage at the end of the trial was 14.5 mg/day. RESULTS: All 10 subjects completed the study. Olanzapine produced clinically and statistically significant reductions of aggression and tic severity from baseline to trial completion, as measured by the Achenbach Child Behavior Checklist (CBCL) and Yale Global Tic Severity Scale (YGTSS). Weight gain during the treatment period was the most common adverse effect (range 2-20 lbs: group mean 12.0 lbs +/- 5.71). No other significant adverse effects were observed during the 10-week trial. CONCLUSION: The results of this trial confirm clinical observations that olanzapine may be an effective treatment for aggression and tics in children with Tourette's syndrome. Olanzapine was generally well tolerated, although significant weight gain was observed throughout the trial.

Adolescent↗
PubMed1989

Carbamazepine-induced tics.

Although a variety of dyskinesias are known to develop during anticonvulsant therapy, carbamazepine-induced tics are rarely recognized. We report three patients with an underlying movement disorder (Huntington's disease, tardive dyskinesia, and Tourette's syndrome) who experienced the onset or exacerbation of tics after the introduction of carbamazepine. These cases confirm the phenomenon of carbamazepine-induced tics and suggest that basal ganglia neuropathology may be an important predisposing factor. The dopaminergic effects of carbamazepine may be responsible for the induction of tics.

Adolescent↗
PubMedDate not supplied

Premonitory urges as "attentional tics" in Tourette's syndrome.

The author, a graduate student with Gilles de la Tourette's syndrome, proposes that pre-tic sensory experiences result from a specific attentional deficit. Based on his own introspective case study, the author argues that the premonitory urges that precede tics are not unique sensory events, but rather are manifestations of somatosensory hyperawareness which serves as the aversive stimulus toward which tics are purposively directed. An "attentional tic" theoretical framework for the study of Tourette's syndrome is suggested and discussed in reference to inhibitory theories of attention.

Adult↗
PubMed2003

Tics.

PURPOSE OF REVIEW: This paper reviews the recent literature concerning Tourette syndrome and related disorders. RECENT FINDINGS: Tourette syndrome is a common disorder in children and adolescents, with an established association with attention deficit hyperactivity disorder, obsessive compulsive disorder, and a number of other psychiatric disorders. Both autoimmune and genetic mechanisms are implicated in the pathophysiology of the syndrome, while neuroimaging studies have identified abnormalities in the composition of the basal ganglia and frontal lobe white matter, as well as alterations in dopaminergic activity. When necessary, treatment of tics can be successful with neuroleptics and alpha-2-adrenergic agonists. The use of stimulants in children with Tourette syndrome and comorbid attention deficit hyperactivity disorder does not appear to worsen tics. SUMMARY: As a result of the recent literature, clinicians can feel comfortable treating children with co-morbid attention deficit hyperactivity disorder and Tourette syndrome with stimulant medications. It has also been established that transient tics are very common in children, and for the most part, non-disabling. In those children with persistent tics, behavioural disorders are associated which may impair success in school and psychosocial functioning. Clinicians have a number of therapeutic options, with recent double-blinded randomized trials of clonidine, risperidone, and desipramine showing benefit. Scientists continue to search for the cause of Tourette syndrome.

Brain↗
PubMedDate not supplied

Amisulpride-induced tardive motor and phonic tics.

OBJECTIVE: To report a patient with tardive tics possibly induced by the atypical neuroleptic drug amisulpride. CASE REPORT: A 55-year-old woman developed motor and phonic tics after a prolonged treatment with amisulpride. Tics improved and finally disappeared after amisulpride withdrawal. CONCLUSIONS: Tardive motor and phonic tics should be considered as a possible adverse effect of amisulpride.

Amisulpride↗
PubMed1980

Incidence of tics in the offspring of childhood tiquers: a controlled follow-up study.

A five-year follow-up study of children whose parents had manifested tic in their childhood was carried out to see if they are more prone to develop tic than control children. The prevalence of tics was 20 per cent in the index group and 10 per cent in the controls, a statistically significant difference. This result could not be explained by the children's imitation of their parents. The mothers of the index children and 1000 unselected mothers were also compared for the prevalence of psychological and psychosomatic symptoms when their children were three years of age. There was no indication that the former were more psychologically distressed. It is suggested that there is a genetic basis for the susceptibility to develop tic.

Child, Preschool↗
PubMed1981

Simple tics in Gilles de la Tourette's syndrome are not prefaced by a normal premovement EEG potential.

EEG events prior to simple tics have been examined in six patients with Gilles de la Tourette's syndrome, and compared to EEG changes occurring when the same subjects voluntarily mimicked their own tics. Voluntary jerks were prefaced by a premovement negative potential commencing about 500 ms prior to the muscle EMG discharge and reaching an amplitude of about 7 muV. No such premovement potential was evident in the EEG prior to spontaneous tics in five of the six patients; a very small event was seen in the sixth patient but it was only about one-tenth of the size of the premovement potential seen prefacing voluntary jerks in the same subject. These data indicate that simple tics in Gilles de la Tourette's syndrome are physiologically distinct from normal self-paced willed movements.

Action Potentials↗
PubMed1999

Late onset startle induced tics.

Three cases of late onset Gilles de la Tourette's syndrome are presented. The motor tics were mainly induced by an unexpected startling stimulus, but the startle reflex was not exaggerated. The tics developed after physical trauma or a period of undue emotional stress. Reflex tics may occur in Gilles de la Tourette's syndrome, but have not been described in late onset Tourette's syndrome. Such tics must be distinguished from psychogenic myoclonus and the culture bound startle syndromes.

Adult↗
PubMed1999

Quantitative study of spontaneous eye blinks and eye tics in Gilles de la Tourette's syndrome.

Spontaneous eye blink rate and frequency of eye tics were studied in nine Tourette patients during periods of rest, conversation, and video watching. In comparison with controls, the Tourette patients showed a significantly higher blink rate during rest and video watching. Conversation induced a significant increase in blink rate in the control group, but not in the Tourette patients, whereas video watching significantly increased blink rate in both groups. The frequency of eye tics showed a significant decrease during conversation and increased significantly during video watching in Tourette patients. In five patients, a significant positive correlation between blink rate and eye tic frequency was found, whereas one patient showed a significant negative correlation. Our results show that, even though some of our patients were on neuroleptic treatment, blink rate was about twofold to threefold increased versus healthy controls, suggesting increased central dopaminergic activity. Furthermore, these first quantitative data illustrate task specific effects on eye tic frequency and the complexity of their relation with eye blinks.

Adult↗
PubMed2000

MRI assessment of children with obsessive-compulsive disorder or tics associated with streptococcal infection.

OBJECTIVE: The authors assessed selective basal ganglia involvement in a subgroup of children with obsessive-compulsive disorder (OCD) and/or tics believed to be associated with streptococcal infection. METHOD: Using computer-assisted morphometric techniques, they analyzed the cerebral magnetic resonance images of 34 children with presumed streptococcus-associated OCD and/or tics and 82 healthy comparison children who were matched for age and sex. RESULTS: The average sizes of the caudate, putamen, and globus pallidus, but not of the thalamus or total cerebrum, were significantly greater in the group of children with streptococcus-associated OCD and/or tics than in the healthy children. The differences were similar to those found previously for subjects with Sydenham's chorea compared with normal subjects. CONCLUSIONS: These results support the hypothesis that there is a distinct subgroup of subjects with OCD and/or tics who have enlarged basal ganglia. These findings are consistent with the hypothesis of an autoimmune response to streptococcal infection.

Autoimmune Diseases↗