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Journal of Child Psychology and... Mar 2022Children with Tourette syndrome (TS) often have comorbid disorders, particularly attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD)....
BACKGROUND
Children with Tourette syndrome (TS) often have comorbid disorders, particularly attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). While subtle premorbid symptoms have been described in various psychiatric disorders, the presence of clinical precursors that may exist before the onset of tics is unknown. This longitudinal study aimed to find clinical precursors of tics by assessing a range of clinical characteristics prior to tic onset in comparison with children without onset of tics.
METHODS
A sample of 187 3- to 10-year-old first-degree unaffected relatives of children with TS were followed up to 7 years in the European Multicentre Tics in Children Study (EMTICS). We investigated whether clinical characteristics assessed at baseline predicted tic onset, comparing 126 children without tic onset to 61 children who developed tics. We used the least absolute shrinkage and selection operator (LASSO) method, a penalised logistic regression approach. We also explored sex differences and repeated our analyses in an age- and sex-matched subsample.
RESULTS
Children with tic onset were more frequently male (β = -0.36), had higher baseline severity of conduct problems (β = 0.23), autism spectrum disorder symptoms (ASD; β = 0.08), compulsions (β = 0.02) and emotional problems (β = 0.03) compared to children without tic onset. Conduct and ASD problems were male-specific predictors, whereas severity of compulsions and oppositional (β = 0.39) and emotional problems were female-specific predictors.
CONCLUSION
This study supports the presence of clinical precursors prior to tic onset and highlights the need of sex-specific monitoring of children at risk of developing tics. This may aid in the earlier detection of tics, particularly in females. We moreover found that tics most often persisted one year after tic onset, in contrast to the common belief that tics are mostly transient.
Topics: Attention Deficit Disorder with Hyperactivity; Autism Spectrum Disorder; Child; Child, Preschool; Comorbidity; Female; Humans; Longitudinal Studies; Male; Tic Disorders; Tics; Tourette Syndrome
PubMed: 34170010
DOI: 10.1111/jcpp.13472 -
Journal of Neuroscience Methods Dec 2014Tics are repetitive, sudden movements and/or vocalizations, typically enacted as maladaptive responses to intrusive premonitory urges. The most severe tic disorder,... (Review)
Review
Tics are repetitive, sudden movements and/or vocalizations, typically enacted as maladaptive responses to intrusive premonitory urges. The most severe tic disorder, Tourette syndrome (TS), is a childhood-onset condition featuring multiple motor and at least one phonic tic for a duration longer than 1 year. The pharmacological treatment of TS is mainly based on antipsychotic agents; while these drugs are often effective in reducing tic severity and frequency, their therapeutic compliance is limited by serious motor and cognitive side effects. The identification of novel therapeutic targets and development of better treatments for tic disorders is conditional on the development of animal models with high translational validity. In addition, these experimental tools can prove extremely useful to test hypotheses on the etiology and neurobiological bases of TS and related conditions. In recent years, the translational value of these animal models has been enhanced, thanks to a significant re-organization of our conceptual framework of neuropsychiatric disorders, with a greater focus on endophenotypes and quantitative indices, rather than qualitative descriptors. Given the complex and multifactorial nature of TS and other tic disorders, the selection of animal models that can appropriately capture specific symptomatic aspects of these conditions can pose significant theoretical and methodological challenges. In this article, we will review the state of the art on the available animal models of tic disorders, based on genetic mutations, environmental interventions as well as pharmacological manipulations. Furthermore, we will outline emerging lines of translational research showing how some of these experimental preparations have led to significant progress in the identification of novel therapeutic targets for tic disorders.
Topics: Animals; Disease Models, Animal; Endophenotypes; Tic Disorders
PubMed: 25244952
DOI: 10.1016/j.jneumeth.2014.09.008 -
Clinical Medicine (London, England) Aug 2016Movement disorders comprise hyperkinetic involuntary movements (eg tremor, myoclonus, tics, dystonia and chorea) and hypokinetic (parkinsonism) disorders. Tics are... (Review)
Review
Movement disorders comprise hyperkinetic involuntary movements (eg tremor, myoclonus, tics, dystonia and chorea) and hypokinetic (parkinsonism) disorders. Tics are cardinal features of primary tic disorders encompassing Tourette syndrome (TS), but are also found in some neurodegenerative conditions and may be induced by psychoactive substances. The first line treatment for tics is pharmacological (mainly dopamine receptor blockers or alpha-2 adrenergic agonists) and behavioural. Dystonia and chorea syndromes are considerably heterogeneous in aetiology, and age at onset, body distribution of the movement disorder, accompanying neurological motor and non-motor features, and systemic manifestations are all important to reach a correct aetiological diagnosis. While symptomatic pharmacological treatment remains the mainstay of treatment for choreas, deep brain stimulation surgery has a well-defined place in the management of medically refractory dystonia.
Topics: Chorea; Dystonic Disorders; Humans; Tic Disorders
PubMed: 27481387
DOI: 10.7861/clinmedicine.16-4-383 -
Developmental Medicine and Child... Apr 2022To investigate sex-related differences in tic severity, tic-related impairments, and psychiatric comorbidities in childhood.
AIM
To investigate sex-related differences in tic severity, tic-related impairments, and psychiatric comorbidities in childhood.
METHOD
In this cross-sectional study, tic severity/impairment and demographic factors were collected from 270 children and young people (aged 5-17y, mean 10y 6mo, SD 3y 4mo; 212 males and 58 females) with a tic disorder diagnosis at a specialty clinic. Psychiatric diagnoses and corresponding screening questionnaire scores were collected for attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), major depressive disorder, and anxiety disorders. Logistic regression was used to compare the effect of sex and age on psychiatric comorbid diagnoses. The Mann-Whitney U test and t-tests were used to assess differences in questionnaire score distribution between sexes.
RESULTS
Females had more severe motor tics (12.55 vs 10.81, p=0.01) and higher global severity scores (38.79 vs 32.66, p=0.03) on the Yale Global Tic Severity Scale. Females were less likely to be diagnosed with ADHD (odds ratio=0.48, 95% confidence interval=0.26-0.89). No significant sex difference was observed in diagnosis rates or symptom severity scores for anxiety or OCD. Females had significantly higher scores than males on the Children's Depression Inventory, Second Edition.
INTERPRETATION
The higher level of motor tic severity and global severity in females further supports the differential natural history of tic disorders in females. Females with tic disorders may be underdiagnosed for ADHD.
Topics: Adolescent; Attention Deficit Disorder with Hyperactivity; Child; Comorbidity; Cross-Sectional Studies; Depressive Disorder, Major; Female; Humans; Male; Severity of Illness Index; Tic Disorders; Tics; Tourette Syndrome
PubMed: 34672366
DOI: 10.1111/dmcn.15088 -
Child and Adolescent Psychiatric... Jul 2012This article presents an overview of the existing, as well as newly developed, cognitive behavior therapy methods for treating the child anxiety triad (separation... (Review)
Review
This article presents an overview of the existing, as well as newly developed, cognitive behavior therapy methods for treating the child anxiety triad (separation anxiety disorder, generalized anxiety disorder, and social phobia). For each disorder of the triad, the authors review diagnostic criteria, clinical presentation, disorder-specific treatment methods and innovations, and future directions for research.
Topics: Adolescent; Age of Onset; Child; Cognitive Behavioral Therapy; Diagnosis, Differential; Humans; Implosive Therapy; Obsessive-Compulsive Disorder; Prevalence; Tic Disorders
PubMed: 22800994
DOI: 10.1016/j.chc.2012.05.008 -
The Psychiatric Clinics of North America Jun 2006This article has focused on TS, and the relationship between TS and OCD has been addressed from different perspectives. In patients who have OCD, the presence of TS... (Review)
Review
This article has focused on TS, and the relationship between TS and OCD has been addressed from different perspectives. In patients who have OCD, the presence of TS seems to have some impact in the clinical manifestation of OCD symptoms. One of the main features of tic-related OCD is the frequent presence of sensory phenomena preceding the compulsions, in the absence of obsessions. Genetic epidemiologic studies provide consistent evidence for the association between TS and OCD. Although no major loci have been identified so far, family and segregation analysis studies support the assumption that genes play a major role in the etiology of TS and related disorders. Genes interact with environmental factors,which can modulate the expression of TS or OCD and determine the onset of these disorders. Neuroimaging studies suggest that the pathophysiology of TS encompasses projections of primary, secondary, and somato sensory cortex to the putamen, dorsolateral caudate nucleus, and globus pallidus,whereas the pathophysiology of OCD involves more ventral structures,such as orbitofrontal-caudate-thalamic-cortical areas. Current treatment strategies for TS include education, behavioral therapy, pharmacotherapy,and support from patients associations. Alfa-adrenergic agents such as guanfacine and clonidine are first-choice treatments for TS; typical antipsychotics are more effective but are troublesome because of their long-term side-effect profiles. For comorbid TS plus OCD, each condition should be treated with its respective first-line option. Nonetheless, for patients who have tic-related OCD who are unresponsive to monotherapy with serotonin reuptake inhibitors, augmentation of serotonin reuptake inhibitors with atypical antipsychotics may be of benefit. Despite important advances, re-search is needed to clarify further the biologic and behavioral aspects of TS and its relationship with the frequently associated conditions, with particular attention to their management and prognosis.
Topics: Humans; Obsessive-Compulsive Disorder; Rheumatic Fever; Streptococcal Infections; Tourette Syndrome
PubMed: 16650718
DOI: 10.1016/j.psc.2006.02.005 -
Journal of Psychosomatic Research Dec 2009Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder characterized by multiple motor and vocal tics lasting at least a year in duration. Children with... (Review)
Review
OBJECTIVE
Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder characterized by multiple motor and vocal tics lasting at least a year in duration. Children with TS often experience comorbid conditions such as obsessive-compulsive disorder (OCD) and attention-deficit disorder. The goal of this article was to review the long-term clinical course of tics and comorbid conditions in children with TS.
METHOD
We conducted a traditional literature search to locate relevant articles regarding long-term outcome and prognosis in TS and tic disorders.
RESULTS
Tics typically have an onset between the ages of 4 and 6 years and reach their worst-ever severity between the ages of 10 and 12 years. On average, tic severity declines during adolescence. By early adulthood, roughly three-quarters of children with TS will have greatly diminished tic symptoms and over one-third will be tic free. Comorbid conditions, such as OCD and other anxiety and depressive disorders, are more common during the adolescence and early adulthood of individuals with TS than in the general population.
CONCLUSION
Although tics are the sine qua non of TS, they are often not the most enduring or impairing symptoms in children with TS. Measures used to enhance self-esteem, such as encouraging strong friendships and the exploration of interests, are crucial to ensuring positive adulthood outcome in TS.
Topics: Attention Deficit Disorder with Hyperactivity; Disease Progression; Humans; Obsessive-Compulsive Disorder; Prognosis; Severity of Illness Index; Tourette Syndrome
PubMed: 19913654
DOI: 10.1016/j.jpsychores.2009.09.002 -
Brain : a Journal of Neurology Feb 2018Tourette syndrome is a common neurodevelopmental disorder defined by characteristic involuntary movements, tics, with both motor and phonic components. Tourette syndrome... (Review)
Review
Tourette syndrome is a common neurodevelopmental disorder defined by characteristic involuntary movements, tics, with both motor and phonic components. Tourette syndrome is usually conceptualized as a basal ganglia disorder, with an emphasis on striatal dysfunction. While considerable evidence is consistent with these concepts, imaging data suggest diffuse functional and structural abnormalities in Tourette syndrome brain. Tourette syndrome exhibits features that are difficult to explain solely based on basal ganglia circuit dysfunctions. These features include the natural history of tic expression, with typical onset of tics around ages 5 to 7 years and exacerbation during the peri-pubertal years, marked sex disparity with higher male prevalence, and the characteristic distribution of tics. The latter are usually repetitive, somewhat stereotyped involuntary eye, facial and head movements, and phonations. A major functional role of eye, face, and head movements is social signalling. Prior work in social neuroscience identified a phylogenetically conserved network of sexually dimorphic subcortical nuclei, the Social Behaviour Network, mediating many social behaviours. Social behaviour network function is modulated developmentally by gonadal steroids and social behaviour network outputs are stereotyped sex and species specific behaviours. In 2011 O'Connell and Hofmann proposed that the social behaviour network interdigitates with the basal ganglia to form a greater network, the social decision-making network. The social decision-making network may have two functionally complementary limbs: the basal ganglia component responsible for evaluation of socially relevant stimuli and actions with the social behaviour network component responsible for the performance of social acts. Social decision-making network dysfunction can explain major features of the neurobiology of Tourette syndrome. Tourette syndrome may be a disorder of social communication resulting from developmental abnormalities at several levels of the social decision-making network. The social decision-making network dysfunction hypothesis suggests new avenues for research in Tourette syndrome and new potential therapeutic targets.
Topics: Brain; Communication; Decision Making; Humans; Neural Pathways; Tourette Syndrome
PubMed: 29053770
DOI: 10.1093/brain/awx204 -
Contrast Media & Molecular Imaging 2021This work aimed to explore the analysis and diagnosis of children with tic disorder by magnetic resonance imaging (MRI) features under convolutional neural network...
This work aimed to explore the analysis and diagnosis of children with tic disorder by magnetic resonance imaging (MRI) features under convolutional neural network (CNN), to provide a certain reference basis for clinical identification. A total of 45 children diagnosed with tic disorder in hospital from January 2018 to June 2020 were selected as the research subjects. A total of 30 normal children were selected as the control group. MRI images were collected, and CNN was constructed for image processing. The results showed that the convolutional neural network could significantly improve the speed of MRI reconstruction and can improve the diagnostic accuracy. Compared with normal children, the metabolites in children with tic disorder were slightly increased, but there was no statistical significance ( > 0.05). The results of the Yale score showed that the proportion of children with moderate illness was significantly greater than that of children with mild and severe illness. In short, the pathological changes of tic disorder were effectively discovered by MRI based on CNN algorithms, which can provide a reference for clinical identification.
Topics: Algorithms; Child; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Neural Networks, Computer; Tic Disorders
PubMed: 34867117
DOI: 10.1155/2021/8997105 -
Journal of Neuropsychology Sep 2023Tourette syndrome (TS) and chronic tic disorder (CTD) are neurological disorders of childhood onset characterized by the occurrence of tics; repetitive, purposeless,... (Randomized Controlled Trial)
Randomized Controlled Trial
A double-blind, sham-controlled, trial of home-administered rhythmic 10-Hz median nerve stimulation for the reduction of tics, and suppression of the urge-to-tic, in individuals with Tourette syndrome and chronic tic disorder.
Tourette syndrome (TS) and chronic tic disorder (CTD) are neurological disorders of childhood onset characterized by the occurrence of tics; repetitive, purposeless, movements or vocalizations of short duration which can occur many times throughout a day. Currently, effective treatment for tic disorders is an area of considerable unmet clinical need. We aimed to evaluate the efficacy of a home-administered neuromodulation treatment for tics involving the delivery of rhythmic pulse trains of median nerve stimulation (MNS) delivered via a wearable 'watch-like' device worn at the wrist. We conducted a UK-wide parallel double-blind sham-controlled trial for the reduction of tics in individuals with tic disorder. The device was programmed to deliver rhythmic (10 Hz) trains of low-intensity (1-19 mA) electrical stimulation to the median nerve for a pre-determined duration each day, and was intended to be used by each participant in their home once each day, 5 days each week, for a period of 4 weeks. Between 18th March 2022 and 26th September 2022, 135 participants (45 per group) were initially allocated, using stratified randomization, to one of the following groups; active stimulation; sham stimulation or to a waitlist (i.e. treatment as usual) control group. Recruited participants were individuals with confirmed or suspected TS/CTD aged 12 years of age or upward with moderate to severe tics. Researchers involved in the collection or processing of measurement outcomes and assessing the outcomes, as well as participants in the active and sham groups and their legal guardians were all blind to the group allocation. The primary outcome measure used to assess the 'offline' or treatment effect of stimulation was the Yale Global Tic Severity Scale-Total Tic Severity Score (YGTSS-TTSS) assessed at the conclusion of 4 weeks of stimulation. The primary outcome measure used to assess the 'online' effects of stimulation was tic frequency, measured as the number of tics per minute (TPM) observed, based upon blind analysis of daily video recordings obtained while stimulation was delivered. The results demonstrated that after 4-week stimulation, tic severity (YGTSS-TTSS) had reduced by 7.1 points (35 percentile reduction) for the active stimulation group compared to 2.13/2.11 points for the sham stimulation and waitlist control groups. The reduction in YGTSS-TTSS for the active stimulation group was substantially larger, clinically meaningful (effect size = .5) and statistically significant (p = .02) compared to both the sham stimulation and waitlist control groups, which did not differ from one another (effect size = -.03). Furthermore, blind analyses of video recordings demonstrated that tic frequency (tics per minute) reduced substantially (-15.6 TPM) during active stimulation compared to sham stimulation (-7.7 TPM). This difference represents a statistically significant (p < .03) and clinically meaningful reduction in tic frequency (>25 percentile reduction: effect size = .3). These findings indicate that home-administered rhythmic MNS delivered through a wearable wrist-worn device has the potential to be an effective community-based treatment for tic disorders.
Topics: Humans; Child; Tourette Syndrome; Tics; Median Nerve; Tic Disorders; Treatment Outcome; Severity of Illness Index
PubMed: 37133932
DOI: 10.1111/jnp.12313