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PubMed2004

[Therapy of tic-disorders].

BACKGROUND: Within the last decade therapeutic approaches to tic disorders are reflected in many new studies. The advent of novel neuroleptics and the more sophisticated behavioural therapeutic techniques may give new hope to children and adolescents with tic disorders. OBJECTIVE: Hence, the progress in the field should be explored to find out the state of the art. METHOD: A critical review of the empirically based literature and practical experience. RESULTS: Worldwide, drug treatment with clonidine and (from the group of novel antipsychotics) risperidone show the broadest empirical basis while in Europe benzamides have a good empirical clinical background. Behaviour therapy presents more and more helpful empirical data. CONCLUSIONS: Risperidone may become the first-line drug in treatment of tic disorders and behaviour therapy might be increasingly used within a multimodal treatment program.

Antipsychotic Agents↗

PubMed1989

Tic disorders in childhood (and beyond).

Tic disorders are classified into three main categories: transient (duration more than 1 month but less than 1 year), chronic (duration more than 1 year), and Tourette's syndrome (multiple motor and vocal tics lasting more than 1 year to life). Typically, symptoms increase with emotional stress, diminish with distraction or concentration, and disappear during sleep. Because of the risks involved and the lack of any truly curative value, drug therapy should be used only when tics are seriously disabling. Haloperidol (Haldol), the most widely prescribed medication, is efficacious in about 80% of patients with Tourette's syndrome. Psychotherapy is not effective as a primary therapeutic strategy; it may, however, be indicated in selected cases to relieve the grief and frustration of parents and to help affected children deal with the disorder.

Adolescent↗

PubMed2005

Tic disorders and obsessive-compulsive disorder: is autoimmunity involved?

The precise cause of tic disorders and paediatric obsessive-compulsive disorder (OCD) is unknown. In addition to genetic factors, autoimmunity may play a role, possibly as a sequela of preceding streptococcal throat infections in susceptible children. Here we review the most recent findings, from July 2003 onwards, with regard to a possible relationship between tics/OCD and autoimmunity. Evidence about an intriguing correlation between streptococcal infections and tic disorders and OCD is accumulating. Specific criteria have been outlined for paediatric autoimmune disorders associated with streptococcal infections (PANDAS), but autoimmunity may also be involved in tic disorders and/or OCD in general. Anti-basal ganglia auto-antibodies are an important potential indicator of autoimmunity. Although the lack of a standardized methodology makes comparisons of findings difficult, new data has emerged pointing to the possible involvement of specific auto-antigens. Earlier findings of increased D8/17 B cell expression as a putative susceptibility marker could not be replicated, possibly due to instability of the D8/17-binding antibody. Although PANDAS patients have been reported to improve after therapeutic plasma exchange, and antibiotics may prevent symptom exacerbations, immune-based treatments should not be routinely given. In future studies, demonstrating the pathogenetic significance of anti-basal ganglia antibodies in animals is a major challenge to draw any firm conclusions about a role for autoimmunity. Future longitudinal studies should be aimed at assessing the precise relationship between symptom exacerbations, infections, and immune parameters, possibly along with gene expression profiles.

Animals↗

PubMed2003

Childhood-onset obsessive-compulsive disorder and tic disorders: case report and literature review.

A subgroup of childhood-onset obsessive-compulsive disorder (OCD) and tic disorders has been found to have a postinfectious autoimmune-mediated etiology. Clinical observations and systematic investigations have shown that a subgroup of children with OCD and/or tic disorders have the onset and subsequent exacerbations of their symptoms following infections with group A beta-hemolytic streptococci (GABHS). This subgroup has been designated by the acronym PANDAS: pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Five clinical characteristics define the PANDAS subgroup: presence of OCD and/or tic disorder, prepubertal symptom onset, sudden onset or abrupt exacerbations, association with neurological abnormalities during exacerbations (adventitious movements or motoric hyperactivity), and the temporal association between symptom exacerbations and GABHS infections. The proposed poststreptococcal inflammatory etiology provides a unique opportunity for treatment and prevention, including immunomodulatory therapies such as plasma exchange and intravenous immunoglobulin. A placebo-controlled trial revealed that both intravenous immunoglobulin and plasma exchange were effective in reducing neuropsychiatric symptom severity (40 and 55% reductions, respectively) for a group of severely ill children in the PANDAS subgroup. Further research is required to determine why the treatments are helpful and to ascertain whether or not antibiotic prophylaxis can help prevent poststreptococcal symptom exacerbations.

Anti-Bacterial Agents↗

PubMed1997

Children with ADHD and tic disorder and their classmates: behavioral normalization with methylphenidate.

OBJECTIVES: To examine behavioral differences between children with attention-deficit hyperactivity disorder (ADHD) and tics and their peers and the extent to which methylphenidate (0.1, 0.3, and 0.5 mg/kg) normalized the behavior of probands and indirectly influenced the behavior of peers (treatment spillover). METHOD: Thirty-four prepubertal children with ADHD and chronic tic disorder (who were participating in a double-blind, placebo-controlled methylphenidate evaluation) and their peers were observed for approximately 20 hours in the school setting (classroom seatwork activities, lunchroom, and playground). RESULTS: Children with ADHD and tics were more inattentive and more disruptive in the classroom and more aggressive in all school settings than their peers. Although treatment with methylphenidate made probands less easily distinguished from their peers (normalization), many children still scored in the deviant range for at least one ADHD behavior when receiving the 0.5-mg/kg dose. There was little evidence that peer behavior improved as a function of the proband's dose of medication. CONCLUSIONS: Although conventional doses of methylphenidate produced dramatic clinical improvement in ADHD-related behavior, complete behavioral normalization is often not attained.

Analysis of Variance↗

PubMed2000

Anxiety disorders and tic severity in juveniles with Tourette's disorder.

OBJECTIVE: It was hypothesized that comorbidity with anxiety disorders would predict tic severity in youths with Tourette's disorder (TD). METHOD: Subjects were 190 youths meeting DSM-III-R diagnostic criteria for TD who were consecutively referred to a pediatric psychopharmacology program between 1994 and 1997. Subjects were initially evaluated with a clinical interview and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic version. Statistical analysis used t tests, chi 2 tests, and logistic regression analysis. RESULTS: One hundred thirty-four subjects were classified as mild/moderate and 56 as severe TD cases. No meaningful differences were found in socioeconomic status, gender distribution, or age at onset of TD between the 2 groups. The 2 groups could not be differentiated by the presence of comorbid mood or disruptive behavior disorders including attention-deficit hyperactivity disorder. Although obsessive-compulsive disorder (OCD) was overrepresented among the severe TD cases, the difference failed to reach statistical significance. Excluding social and simple phobias, all other anxiety disorders were more clearly overrepresented among subjects with severe TD; separation anxiety disorder most robustly predicted tic severity, irrespective of the presence of OCD or other anxiety disorders. CONCLUSION: Findings suggest that non-OCD anxiety disorders in general and separation anxiety disorder in particular may be significantly associated with tic severity in referred TD patients.

Anxiety Disorders↗

PubMed2005

Brain-behavior relations during motor processing in chronic tic and habit disorder.

OBJECTIVE: This study examined electrophysiological indices of preparation (readiness potential, RP) and execution (movement-associated potential, MAP) during automated and controlled reaction time (RT) in 13 chronic tic disorder, 17 habit disorder, and 14 control participants. BACKGROUND: Both tic and habit disorders are hypothesized to involve states of heightened activation, which could impede initiation and the control of complex motor actions. METHOD: The electrophysiological signal was recorded from 4 electrodes (Fz, C3, C4, Pz) during a fixed 4-second foreperiod reaction time task. RESULTS: During automated responses, controls showed a shorter RP peak onset, and during controlled responses a longer MAP peak onset, compared with both clinical groups. The controls were the only group who showed a consistent linear relationship between RP and RT. CONCLUSIONS: Patients with chronic tic as well as habit disorder may not modulate cortical activation optimally in planning and executing both automated and controlled responses.

Adult↗

PubMed1997

Obsessive-compulsive disorder with and without tics in an epidemiological sample of adolescents.

OBJECTIVE: This study was undertaken to discriminate subtypes of obsessive-compulsive disorder in adolescents. METHOD: Forty individuals with obsessive-compulsive spectrum disorders were ascertained from an epidemiological sample of 861 adolescents. Interviews were conducted by child psychiatrists using semistructured diagnostic interviews, including a clinician-rated Yale-Brown Obsessive Compulsive Scale. Discriminant analysis was performed to compare the scores on the Yale-Brown scale of groups with and without comorbid tics and to compare boys and girls. RESULTS: Adolescents with tics were more prone to aggressive and sexual images and obsessions than were adolescents without tics; these differences could not be wholly attributed to sex differences. CONCLUSIONS: The subtypes among unreferred adolescents are similar to those of adult patients with obsessive-compulsive disorder with and without Gilles de la Tourette syndrome. Subtypes evident in adulthood may be established relatively early in the natural course of obsessive-compulsive disorder.

Adolescent↗

PubMed2005

Habit reversal treatment of tic disorders: a methodological critique of the literature.

One of the most commonly reported and successful behavioral interventions for tic disorders is habit reversal (HR). Several narrative literature reviews have adequately summarized the outcomes of these studies. The purpose of this article was to review studies that used HR to treat tics in terms of their methodological characteristics and rigor. Guidelines developed by the Task Force on Promotion and Dissemination of Psychological Procedures were used to evaluate the state of the literature. From an initial database that included 29 studies, 12 were included in the final analysis. Results indicate that although research has been conducted in this area for almost three decades, the majority of studies contain considerable methodological shortcomings. Based on the Task Force guidelines, the existing literature on the use of HR to treat tics can currently be classified as probably efficacious, and it almost meets the criteria for the well-established classification. Directions for future research are discussed.

Behavior Therapy↗

PubMed2005

Brief antecedent assessment and treatment of tics in the general education classroom: a preliminary investigation.

The purpose of this study was to determine if specific classroom antecedents were associated with motor and vocal tics in two males diagnosed with Tourette's syndrome. A functional assessment consisting of teacher and student interviews, direct observations, brief functional analysis, and confirmatory naturalistic observations indicated that specific antecedents could be identified for each participant. Simplified habit reversal was then implemented only under the antecedent condition that resulted in the highest rate of tics. The rate of tics decreased under the specific antecedent condition as well as at other times as validated by behavioral observations conducted at random times. The discussion focuses on the utility of conducting such assessments, the methodological and applied limitations of the current study, and avenues for further research.

Behavior Therapy↗

PubMed1996

Habits, tics, and stuttering. Prevalence and relation to anxiety and somatic awareness.

This study examines the prevalence of nervous habits, tics and stuttering in 256 college students, as well as the relationship between these behaviors and self-reported general anxiety and awareness of bodily sensations. Improving on previous studies, this study strengthens the operational definition of a nervous habit by using a more stringent operational definition, giving what is arguably a more valid set of prevalence statistics. Participants were asked to complete self-report measures of general anxiety and somatic awareness. Relationships were found between number of nervous habits and tics that participants endorsed and their self-reported awareness of bodily sensations, as well as between number of habits endorsed and self-reported general anxiety. This article concludes with suggestions for future research in the area of nervous habits and motor tics.

Adult↗

PubMed2000

Asperger's syndrome, X-linked mental retardation (MRX23), and chronic vocal tic disorder.

Pervasive developmental disorders are severe disorders of development with no consistent neurobiologic etiology and most often an idiopathic etiology. We report a 12-year-old male who met criteria for a pervasive developmental disorder (Asperger's syndrome) and a chronic tic disorder. The child also has an X-linked cognitive impairment (MRX23). The presence of tic symptomatology, pervasive developmental disorder, and fragile X syndrome has previously been reported. Since no singular etiology for Asperger's syndrome has been found, the possibility of other cases of Asperger's syndrome occurring with concurrent abnormalities on the X chromosome should be considered by clinicians, especially if tic symptomatology is present.

Asperger Syndrome↗

PubMed2003

Neuropsychologic characteristics of children with attention-deficit hyperactivity disorder (ADHD), learning disorder, and tic disorder on the Rey-Osterreith Complex Figure.

This study examined the performance of Korean children diagnosed with attention-deficit hyperactivity disorder (ADHD), learning disorder, ADHD with learning disorder, and tic disorder on the Rey-Osterreith Complex Figure. The clinical group consisted of 57 children between the ages of 6 and 13 years (15 with ADHD, 13 with learning disorder, 15 with ADHD + learning disorder, and 15 with tic disorder), and the control group included 20 children recruited from an elementary school. Rey-Osterreith Complex Figure productions were scored according to the Developmental Scoring System. The children in the control group showed a clear developmental trend--organization score increasing with age--that was similar to the performance of American children. No such age-related effect was found in the three clinical groups. The organization scores of the children with ADHD were lower than those of other groups, suggesting an organizational deficit in ADHD. Performance on the immediate recall condition was poorest in the tic disorder and ADHD + learning disorder groups, suggesting the presence of nonverbal memory problems in those groups.

Adolescent↗

PubMed2004

Functional brain imaging in Sydenham's chorea and streptococcal tic disorders.

Group A streptococcal infections cause a wide range of neuropsychiatric disorders, such as Sydenham's chorea, tics, obsessive-compulsive disorders, and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Structural (computed tomography and magnetic resonance imaging) and functional (positron emission tomography, single-photon emission computed tomography) imaging studies in patients with Sydenham's chorea have suggested reversible striatal abnormalities. The objective of this study was to investigate the cerebral perfusion patterns of the subcortical structures by using hexamethylpropylenamine oxime single-photon emission computed tomography (HMPAO-SPECT) in seven cases of Sydenham's chorea and two cases of streptococcal tic disorder. HMPAO-SPECT studies revealed a hyperperfusion pattern in two and a hypoperfusion pattern in five of the chorea patients and in two patients with tic disorder. The results are discussed in relation to the duration and severity of the symptoms and the response to therapy. Functional imaging findings can be variable in Sydenham's chorea, and hyperperfusion of the striatum and thalamus could be an indicator of the response to therapy and the severity of symptoms. However, the number of cases so far investigated by either SPECT or positron emission tomography is still too limited to draw any firm conclusions.

Adolescent↗

PubMed1987

Tics and heredity. A study of the relatives of child tiqueurs.

The limited literature on the pedigrees of tiqueurs, including those with Gilles de la Tourette's syndrome, is reviewed. Most statistical analyses have been restricted to affected family members without specifying the unaffected ones. The present statistical analysis of a series of child tiqueurs, including 91 probands and 1293 first- and second-degree relatives, 46 of whom were tiqueurs, predicts the odds on being a tiqueur for individuals, and establishes how those odds are affected by certain explanatory variables using log-linear models. The data do not confirm a familial pattern beyond reasonable doubt, but if the suggested prevalence of tics in the population is 10% then the figure for parents is large enough to support a familial hypothesis. The pedigrees do not indicate a simple mode of genetic transmission. Further research is needed to confirm that there is a connection between childhood tics and Gilles de la Tourette's syndrome, to establish that the predisposition to tics is familial, and, if so, whether there is a complex genetic mechanism involved, or some other environmental aetiology so far undisclosed.

Adolescent↗

PubMed2005

Psychiatric telephone interview with parents for screening of childhood autism - tics, attention-deficit hyperactivity disorder and other comorbidities (A-TAC): preliminary reliability and validity.

BACKGROUND: Reliable, valid and easily administered screening instruments would greatly facilitate large-scale neuropsychiatric research. AIMS: To test a parent telephone interview focused on autism - tics, attention-deficit hyperactivity disorder (ADHD) and other comorbidities (A-TAC). METHOD: Parents of 84 children in contact with a child neuropsychiatric clinic and 27 control children were interviewed. Validity and interrater and test - retest reliability were assessed. RESULTS: Interrater and test - retest reliability were very good. Areas under receiver operating characteristics curves between interview scores and clinical diagnoses were around 0.90 for ADHD and autistic spectrum disorders, and above 0.70 for tics, learning disorders and developmental coordination disorder. Using optimal cut-off scores for autistic spectrum disorder and ADHD, good to excellent kappa levels for interviews and clinical diagnoses were noted. CONCLUSIONS: The A-TAC appears to be a reliable and valid instrument for identifying autistic spectrum disorder, ADHD, tics, learning disorders and developmental coordination disorder.

Adolescent↗

PubMed1997

Disappearance of motor tics after Wernicke's encephalopathy in a patient with Tourette's syndrome.

Tourette's syndrome (TS) is a disease characterized by multiple motor and vocal tics as well as behavioral abnormalities. The anatomic substrates of this syndrome are not defined. We report a 48-year-old man with TS in whom motor tics disappeared after the onset of a midbrain syndrome related to thiamine deficiency (Wernicke's encephalopathy). MRI study showed a lesion in the dorsal area of the midbrain. This case suggests that loops located in the midbrain tegmentum may influence the presence of motor tics in patients with TS.

Humans↗

PubMed1998

Tourette's syndrome: [I-123]beta-CIT SPECT correlates of vocal tic severity.

OBJECTIVE: To examine in vivo the density of brain monoaminergic transporters in Tourette's syndrome (TS). BACKGROUND: TS is a heritable neuropsychiatric disorder characterized by chronic vocal and motor tics and is often associated with obsessive-compulsive symptoms. Hyperstimulation of dopamine receptors and dysfunction of serotonergic transmission have been implicated in its pathogenesis, but direct evidence of involvement of these neurochemical systems has been limited. METHODS: Symptom severity and the availability of presynaptic monoaminergic transporters in the basal ganglia, midbrain, and thalamus were measured using SPECT and the radioligand [I-123]2beta-carbomethoxy-3beta-(4-iodophenyl)tropane ([I-123]beta-CIT) in 10 patients with TS and in 10 age- and sex-matched normal volunteers. RESULTS: A significant negative correlation was found between a measure of overall tic severity and beta-CIT binding in the midbrain (r = -0.73, p = 0.02) and the thalamus (r = -0.82, p < 0.01). When examined post hoc, these correlations were determined largely by vocal tic severity. No other significant correlations were found between symptom severity and beta-CIT binding in the striatum or cortex. CONCLUSIONS: These findings indicate that serotonergic neurotransmission in the midbrain and serotonergic or noradrenergic neurotransmission in the thalamus may be important factors in the expression of TS and may suggest novel targets for treatment.

Adult↗