Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Tic Disorders”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMed2004

Characterisation of group A streptococcal (GAS) isolates from children with tic disorders.

BACKGROUND & OBJECTIVES: An association between the onset or recrudescence of some neuropsychiatric disorders in children such as tic disorders and group A streptococcal (GAS) infections has been suggested. No information is available on the characterization of GAS strains associated with such disorders. The present study was undertaken to characterize the GAS strains isolated from children with tic disorders and to determine and correlate the antistreptolysin O (ASO) titre with the presence of GAS. METHODS: During 1996-2001, 368 children with tic disorders were investigated for possible exposition to streptococcal antigens. All children, at the time of the first visit and during the follow up visits were apparently healthy and showed no clinical evidence of streptococcal infections or post streptococcal sequelae. Blood and throat swab samples were collected and serological and bacteriological tests done. The isolates obtained were investigated for T pattern, M protein and emm type, as well as for the production of protease. RESULTS: Of the 800 throat swabs studied 100, corresponding to 67 patients, were positive for GAS; 49 children were found positive for GAS only once during the study, 18 had more than one sample positive for different serotypes, 8 were positive twice or more for the same type. ASO titres of these children were, in general, elevated. Five types, namely type M12, 3, 13, 11, 1, accounted for 39 per cent of the isolates, M12 being the most common, but a large number of different types were also found. A large number of isolates (62%) showed an elevated prodution of protease in the casein plate assay. INTERPRETATION & CONCLUSION: Despite the high level of ASO titres found, the results were not in favour of a particular virulence or invasivity of the isolates. Only a few colonies per sample were found indicating that factors different from the microbial virulence play a role in this type of disease.

Adolescent↗
PubMed1993

Definitions and classification of tic disorders. The Tourette Syndrome Classification Study Group.

Tics are brief movements (motor tics) or sounds (vocal tics) that occur intermittently and unpredictably out of a background of normal motor activity. Although tics can appear as the result of direct brain injury (so-called symptomatic, eg, from head trauma or encephalitis), they most commonly are idiopathic and are part of the spectrum of Gilles de la Tourette syndrome or other idiopathic tic disorders. To aid investigators searching for the gene(s) causing Tourette syndrome, criteria are proposed to classify the idiopathic tic disorders. Although some of these separate entities may ultimately be shown to be caused by the same gene, until that is established, it is considered best when searching for the Tourette's gene to have tic disorders classified into distinct, homogeneous entities. The proposed classification will likely change over time as better diagnostic techniques become available and can both expand and consolidate, particularly after the Tourette gene is located.

Humans↗
PubMed1986

Semiology, nosology and criteria for tic disorders.

Precise description of the signs, symptoms, classification and criteria for Tic Disorder and Gilles de la Tourette Syndrome (GTS) is important to reduce heterogeneity in studies and to develop hypotheses about the pathophysiology of these disorders. Previous diagnostic categories and criteria for Tic Disorders and GTS in DSM-III and ICD-9 were derived from our study of 114 consecutive patients, questionnaire responses by 31 patients and data on 76 patients from 8 published reports. During the past 20 years we have evaluated 1490 patients for movement disorders, of whom 1210 had GTS and 137 had another tic disorder. Analysis of these data and review of the literature serve as the basis for proposed revision of the signs, symptoms, nosology and criteria for Tic Disorders and GTS.

Compulsive Behavior↗
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↗
PubMed2004

Prevalence of tic disorders among primary school students in the city of Pavia, Italy.

BACKGROUND: The prevalence of tic disorders in children varies from 1% to 29% depending on the characteristics of the study population, the diagnostic criteria, and the study design and methods. AIMS: To calculate the prevalence of tic disorders among primary school children in Italy. METHODS: The study population comprised 2347 primary school children from the city of Pavia (pop. 80 073), Northern Italy. Using trained school teachers as the source of cases, all children with motor or vocal tics occurring intermittently and unpredictably out of a background of normal motor activity were accepted. The type, frequency, and circumstances of tic disorders were noted. School performance was correlated to the presence of tics. RESULTS: A total of 68 children (56 boys, 12 girls) aged 6-11 years were identified with tic disorders. The period prevalence was 2.9% (95% CI 2.3 to 3.7). The prevalence was 4.4% in boys and 1.1% in girls, with no detectable trends at age 6-11. Motor tics were present in 46 cases, vocal tics in 6, and motor and vocal tics in 16. Situation related tics were noted in 37 cases. A significant correlation was found between the presence of tic disorders and impaired school performance. DISCUSSIONS: Tic disorders are a fairly uncommon but disabling clinical disorder among primary school children from an urban community. The fairly low prevalence of this clinical condition, as compared to other reports, can be explained by the choice of stringent diagnostic criteria and the exclusion of patients with other movement disorders.

Chi-Square Distribution↗
PubMed2001

[Transcranial magnetic stimulation in child and adolescent psychiatry: excitability of the motor system in tic disorders and/or attention deficit hyperactivity disorders].

Motor system excitability can be investigated in vivo by means of single and paired pulse transcranial magnetic stimulation (TMS). Whereas the cortical silent period reflects the general degree of inhibitory mechanisms mainly within the sensorimotor loop, intracortical excitability measures the focused degree of inhibitory and facilitatory mechanisms within the motor cortex. In child and adolescent psychiatric disorders with uncontrollable motor behavior such as tics in tic disorder or motoric hyperactivity in attention deficit hyperactivity disorder (ADHD), different dysfunctional patterns of motor system excitability could be demonstrated compared to age-matched healthy controls: (1) In tic disorder, a shortened cortical silent period was observed, providing evidence of deficient inhibitory mechanisms within the sensorimotor loop, probably primarily at the level of the basal ganglia. (2) In ADHD, a decreased intracortical inhibition was found, probably reflecting deficient inhibitory mechanisms within the motor cortex (but enhancement of intracortical inhibition after oral intake of 10 mg methylphenidate). In order to investigate neurophysiological aspects of comorbidity, (3) motor system excitability was also measured in children with combined ADHD and tic disorder. The findings of a reduced intracortical inhibition as well as a shortened cortical silent period in these comorbid children provide evidence of additive effects at the level of motor system excitability. These decreased inhibitory mechanisms within the entire sensorimotor loop and especially the motor cortex could be essential neurobiological substrates of the deficient inhibitory motor control and regulation, respectively, in tic disorder and ADHD.

Adolescent↗
PubMed2001

Differences in 99mTc-HMPAO brain SPET perfusion imaging between Tourette's syndrome and chronic tic disorder in children.

Early differential diagnosis between Tourette's syndrome and chronic tic disorder is difficult but important because both the outcome and the treatment of these two childhood-onset diseases are distinct. We assessed the sensitivity and specificity of brain single-photon emission tomography (SPET) perfusion imaging in distinguishing the two diseases, and characterized their different cerebral perfusion patterns. Twenty-seven children with Tourette's syndrome and 11 with chronic tic disorder (mean age 9.5 and 8.6 years, respectively) underwent brain SPET with technetium-99m hexamethylpropylene amine oxime (HMPAO). Visual interpretation and semiquantitative analysis of SPET images were performed. On visual interpretation, 22 of 27 (82%) of the Tourette's syndrome group had lesions characterized by decreased perfusion. The left hemisphere was more frequently involved. None of the children with chronic tic disorder had a visible abnormality. Semi-quantitative analysis showed that, compared with children with chronic tic disorder, children with Tourette's syndrome had significantly lower perfusion in the left lateral temporal area and asymmetric perfusion in the dorsolateral frontal, lateral and medial temporal areas. In conclusion, using the visual approach, brain SPET perfusion imaging is sensitive and specific in differentiating Tourette's syndrome and chronic tic disorder. The perfusion difference between the two groups, demonstrated by semi-quantitative analysis, may be related more to the co-morbidity in Tourette's syndrome than to tics per se.

Adolescent↗
PubMed2000

Pharmacologic treatment of tic disorders.

The approach to treating children and adolescents with tic disorders has evolved in recent years such that complete elimination of tics is no longer the primary goal of treatment. Indeed, given the high frequency of psychiatric comorbidity in TS, treatment planning begins with identification of target symptoms. Although traditional neuroleptics still represent standard treatment for tics, many families and clinicians are reluctant to use these agents because of concern about the potential for short- and long-term side effects. Thus, there is great interest in the newer atypical neuroleptics. Interest in the atypical neuroleptics is understandable, but much more study is needed before these agents can become first-line treatments for tics. A small group of non-neuroleptic medications have been used in the treatment of tics. Of these, clonidine, guanfacine, tetrabenazine, pergolide, and botulinum toxin injections have shown some promise for suppressing tics. To date, however, only clonidine has been evaluated in randomized, controlled trials, and the results are not consistent across studies. Although comorbid ADHD is common in children with TS, treatment with stimulant medications was not recommended in children with tics. Recent data suggest that stimulants may be used in some children with TS without adverse effects. Until more is known about which children with ADHD and tic disorders can be safely treated with stimulants, however, the use of stimulants in this population should be undertaken with caution. A handful of nonstimulant medications have been used in the treatment of ADHD with some success, but more study is needed for most of these agents. Evaluation of the stimulants and nonstimulants for the treatment of ADHD in children and adolescents with tic disorders is an area worthy of large controlled trials.

Adolescent↗
PubMed2003

A placebo-controlled study of lofexidine in the treatment of children with tic disorders and attention deficit hyperactivity disorder.

This study evaluated the efficacy and safety of Lofexidine in treating children with tic disorders and attention deficit hyperactivity disorder (ADHD). Subjects from a specialty tic disorders clinic were randomly assigned to receive 8 weeks of treatment with lofexidine or placebo under double-blind conditions. Follow-up visits occurred every 2 weeks for safety monitoring and dose adjustment. Fourty-four medication-free subjects (41 boys and three girls; mean age of 10.4 years) with ADHD, combined type, and a tic disorder participated. After 8 weeks of treatment, lofexidine was associated with a mean improvement of 41% in the total score on the teacher-rated ADHD Rating Scale compared to 7% improvement for placebo. Eleven of 22 subjects who received lofexidine were blindly rated on the Clinical Global Scale-Improvement as either much improved or very much improved compared to none of 22 subjects who received placebo. The mean score on the parent-rated hyperactivity index improved by 29% in the lofexidine group and 18% in the placebo group, which was not a significant difference. On the Continuous Performance Test, commission errors decreased by 25% and omission errors by 20% in the lofexidine group, compared with increases of 33% in commission errors and of 36% in omission errors in the placebo group. Tic severity decreased by 27% in the lofexidine group, compared to 0% in the placebo group. One lofexidine subject with sedation withdrew at week 4. Lofexidine was associated with insignificant decreases in blood pressure and pulse. Lofexidine appears to be a safe and effective treatment for children with tic disorders and ADHD.

Adolescent↗
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↗
PubMed2004

Candidate locus for Gilles de la Tourette syndrome/obsessive compulsive disorder/chronic tic disorder at 18q22.

Gilles de la Tourette syndrome (GTS), obsessive compulsive disorder (OCD), and chronic tic disorder (CTD) are chronic, potentially debilitating neuropsychiatric disorders that often cluster in families. Comorbidity data and family and linkage studies support the hypothesis that these phenotypes, in some cases, share a common etiology. Studies of chromosomal abnormalities associated with this phenotypic spectrum further show that GTS, OCD, and CTD may represent alternate manifestations of a shared genetic condition. We report on a 14-year-old girl with severe OCD and a t(2;18)(p12;q22) translocation. The patient's chromosome 18 breakpoint localizes to the same chromosomal band as two previously reported rearrangements associated with GTS, OCD, and CTD, and fine maps to a genomic position approximately 5 Mb from these rearrangements. The clustering of these three breakpoints within a relatively small genetic interval suggests that 18q22 is a promising region for containing a gene or genes of etiologic importance in the development of the GTS/OCD/CTD phenotypic spectrum.

Adolescent↗
PubMed2005

Public health significance of tic disorders in children and adolescents.

In conclusion, data from community surveys suggest that tic disorders, including TS, exist on a spectrum from transient to persistent, multiple motor, and vocal tics that interfere with activities of daily living. The presence of isolated and transitory tics is common and appears to be of minimal consequence. On the other hand, persistent tics, even mild tics, appear to be associated with ADHD, disruptive behavior, and learning problems (though not necessarily formal learning disability). The presence of ADHD with tics increases the likelihood of disruptive behavior and learning problems, but learning problems can be observed in community samples of children with tic disorders, even in the absence of ADHD. To date, few studies have clearly defined the nature of the learning problems in children with tic disorders. Nonetheless, the data do suggest that having chronic tics is associated with impairment independent of ADHD. Community samples and recent investigations in clinical samples confirm that the presence of ADHD predicts greater disability than that associated with tic disorders alone.

Adolescent↗
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↗
PubMed2001

A placebo-controlled study of guanfacine in the treatment of children with tic disorders and attention deficit hyperactivity disorder.

OBJECTIVE: This study evaluated the efficacy and safety of guanfacine in treating children with tic disorders and attention deficit hyperactivity disorder (ADHD). METHOD: Subjects from a specialty tic disorders clinic were randomly assigned to receive 8 weeks of treatment with guanfacine or placebo under double-blind conditions. Follow-up visits occurred every 2 weeks for safety monitoring and dose adjustment. RESULTS: Thirty-four medication-free subjects (31 boys and three girls with a mean age of 10.4 years) with ADHD, combined type, and a tic disorder participated. After 8 weeks of treatment, guanfacine was associated with a mean improvement of 37% in the total score on the teacher-rated ADHD Rating Scale, compared to 8% improvement for placebo. Nine of 17 subjects who received guanfacine were blindly rated on the Clinical Global Improvement scale as either much improved or very much improved, compared with none of 17 subjects who received placebo. The mean score on the parent-rated hyperactivity index improved by 27% in the guanfacine group and 21% in the placebo group, not a significant difference. On the Continuous Performance Test, commission errors decreased by 22% and omission errors by 17% in the guanfacine group, compared with increases of 29% in commission errors and of 31% in omission errors in the placebo group. Tic severity decreased by 31% in the guanfacine group, compared to 0% in the placebo group. One guanfacine subject with sedation withdrew at week 4. Guanfacine was associated with insignificant decreases in blood pressure and pulse. CONCLUSIONS: Guanfacine appears to be a safe and effective treatment for children with tic disorders and ADHD.

Adolescent↗
PubMed2004

Psychopathological problems in children affected by tic disorders - study on a large Italian population.

AIM: The aim of this study was to assess the psychopathological and behavioural problems in patients affected by any tic disorder and their relationship with the severity of tic symptomatology. METHODS: A cross-sectional assessment was made of 125 children and adolescents affected by any tic disorder, all at their first neuropsychiatric evaluation and all drug naïve. Tic disorder diagnoses were established by using The Tourette Syndrome Classification Study Group criteria; the procedures included the administration of Yale Global Tic Severity Scale (YGTSS), Children Yale-Brown-Obsessive-Compulsive Scale (CY-BOCS) and Child Behaviour Checklist (CBCL). RESULTS: The patients showed a mild to moderate tic disorder (mean YGTSS score = 27). Of the patients, 19% had Obsessive-Compulsive Disorder (OCD), but another 46% showed Obsessive-Compulsive (OC) symptoms. CBCL T total was pathologic in 17% of the children, with higher percentages in the Internalization and Attention Problems subscales. Statistical analysis pointed out a significant relationship between YGTSS and CY-BOCS scores as well as a significant relationship between the duration of tic symptomatology and several CBCL subscales (Internalization, Depressed/Anxious, Thought and Attention Problems). CONCLUSION: Our data can be summarized in three main points: a large number of patients have milder tics without any psychopathological comorbidity; OC symptoms are frequently associated with tics, mainly in children with more severe symptomatology; psychopathological problems, in particular internalizing difficulties, are present in children with long standing tic disorders.

Adolescent↗
PubMed2004

Tic disorders in children with frequent eye blinking.

PURPOSE: To prospectively evaluate the significance of psychiatric consultation in children with frequent eye blinking. METHODS: Fifty children < 16 years of age with frequent eye blinking underwent a psychiatric examination after undergoing a detailed ophthalmologic examination and receiving appropriate treatment. Patients with squinting related to intermittent exotropia or uncorrected refractive errors were excluded. The severity of tic symptoms and the differences in mothering behavior and childhood behavioral problems between the children with tic and normal children were assessed. RESULTS: Tic disorders were diagnosed in 43 children: 39 had transient tic disorders, 2 had chronic tic disorders, and 2 had Tourette's syndrome. Ten patients had complex motor tics, and 4 had motor and vocal tics. Two children with Tourette's syndrome, and another 2 who returned to the clinic with aggravated symptoms after 6 months without any ophthalmologic abnormalities, were treated with psychiatric medication. There was no difference in mothering behavior or childhood behavior problems between the children with tic and normal children. The severity of tic was significantly correlated with the duration of tic symptoms, the score of somatic complaints, and attention problems. CONCLUSIONS: Most of the children with frequent eye blinking had a transient tic disorder. Tics become more severe with a longer duration of symptoms and may have influenced the somatic symptoms and the patient's level of attention. Psychiatric consultation may be necessary for children with long-standing and frequent eye blinking.

Attention↗
PubMed2002

A double-blind comparison of desipramine and placebo in children and adolescents with chronic tic disorder and comorbid attention-deficit/hyperactivity disorder.

BACKGROUND: Currently, there is no consensus on the best therapeutic approach to chronic tic disorders and comorbid attention-deficit/hyperactivity disorder (ADHD). To address this issue, we evaluated the tolerability and efficacy of the noradrenergic tricyclic antidepressant desipramine hydrochloride in the treatment of children and adolescents with chronic tic disorders and comorbid ADHD. METHODS: Forty-one children and adolescents with chronic tic disorders, including Tourette disorder and comorbid ADHD, were studied in a 6-week, double-blind, placebo-controlled, parallel trial. Desipramine was titrated weekly up to 3.5 mg/kg per day. We rated ADHD and tic symptoms weekly and monitored adverse effects, laboratory findings, and cardiovascular parameters. RESULTS: Treatment with desipramine (mean total daily dose, 3.4 mg/kg per day) was well tolerated without meaningful adverse effects. Desipramine significantly reduced core symptoms of ADHD (ADHD Rating Scale; 42% decrease from baseline relative to placebo, P<.001), with equal response in inattentive symptoms and hyperactive/impulsive symptoms (P<.001 for both). The ADHD response rate was robust (71% vs 0%; desipramine vs placebo, P<.001). Likewise, desipramine significantly reduced tic symptoms (Yale Global Tic Severity Scale; 30% decrease from baseline relative to placebo, P<.001), with equal response in motor and phonic tic symptoms (P<.01 for both). The tic response rate was substantial (58% vs 5%; desipramine vs placebo, P<.001). There were small but statistically significant differences between desipramine and placebo in heart rate and blood pressure. CONCLUSIONS: Treatment with desipramine was well tolerated and was associated with robust clinically significant reductions in tic and ADHD symptoms in children and adolescents with chronic tic disorders and ADHD diagnoses.

Adolescent↗
PubMed1994

Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders.

Despite advances in our understanding of the pathology and genetics of obsessive compulsive disorder (OCD) and in our ability to successfully treat patients with medications and behavioral psychotherapy, the identification of homogeneous subgroups of patients with OCD has remained elusive. Once identified, such subgroups may be found related to treatment response, biological markers, or genetic transmission of OCD. To clarify identification of symptom subtypes, my colleagues and I administered the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist to 107 patients with OCD and applied principal components analysis (e.g., factor analysis) to these data. We then examined the correlations between these factor scores and the presence of comorbid tic and personality disorders, which are thought to be related to OCD. We found that three factors, which we named "symmetry/hoarding," "contamination/cleaning," and "pure obsessions," best explained the symptoms of the Y-BOCS Symptom Checklist. Only the first factor was significantly related to comorbid obsessive compulsive personality disorder or to a lifetime history of Tourette's syndrome or chronic tic disorder. Implications of these findings regarding possible clinical utility are discussed.

Adolescent↗