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Tourette syndrome

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Tourette syndrome
Other namesTourette's syndrome, Tourette's disorder, Gilles de la Tourette syndrome (GTS)
Head and shoulders of a man with a shorter Edwardian beard and closely cropped hair, in a circa-1900 French coat and collar
Georges Gilles de la Tourette (1857–1904), namesake of Tourette syndrome
SpecialtyPediatrics, neurology
SymptomsTics[1]
Usual onsetTypically in childhood[1]
DurationLong term[2]
CausesGenetic with environmental influence[2]
Diagnostic methodBased on history and symptoms[1]
ManagementEducation, behavioral therapy[1][3]
MedicationUsually none, occasionally antipsychotics and noradrenergics[1]
PrognosisImprovement to disappearance of tics beginning in late teens[2]
FrequencyAbout 1%[1]

Tourette syndrome (TS or simply Tourette's) is a common neurodevelopmental disorder with onset in childhood,[4] characterized by multiple motor tics and at least one vocal (phonic) tic. Some common tics are blinking, coughing, throat clearing, sniffing, and facial movements. These tics are typically preceded by an unwanted urge or sensation in the affected muscles, can sometimes be suppressed temporarily, and characteristically change in location, strength, and frequency. Tics are often unnoticed by casual observers.

Once regarded as a rare and bizarre syndrome, Tourette's has popularly been associated with coprolalia (the utterance of obscene words or socially inappropriate and derogatory remarks), but this symptom is present in only a minority of people with Tourette's.[3] It is no longer considered a rare condition; about 1% of school-age children and adolescents are estimated to have Tourette's,[1] though many go undiagnosed or never seek medical care. There are no specific tests for diagnosing Tourette's; it is not always correctly identified because most cases are mild and the severity of tics decreases for most children as they pass through adolescence. Extreme Tourette's in adulthood, though sensationalized in the media, is rare. Tourette's does not affect intelligence or life expectancy.

Education is an important part of any treatment plan, and explanation and reassurance alone are often sufficient.[1][5] In most cases, medication for tics is not necessary, and behavioral therapies are the first-line treatment. Among those who are seen in specialty clinics, attention-deficit hyperactivity disorder (ADHD) and obsessive–compulsive disorder (OCD) are present at higher rates. These co-occurring diagnoses often cause more impairment to the individual than the tics; hence, it is important to correctly distinguish co-occurring conditions and treat them.

Tourette's is defined as part of a spectrum of tic disorders, which includes provisional, transient and persistent (chronic) tics. While the exact cause is unknown, it is believed to involve a combination of genetic and environmental factors. The mechanism appears to involve dysfunction in neural circuits between the basal ganglia and related structures in the brain. Compared to the successful efforts seen in other conditions, research into the genetics of Tourette's is underfunded in the US. The condition was named by Jean-Martin Charcot on behalf of his resident, Georges Gilles de la Tourette, a French neurologist, who published an account of nine patients with Tourette's in 1885.

Classification

Tourette's was classified by the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as one of several tic disorders "usually first diagnosed in infancy, childhood, or adolescence" according to type (motor or phonic tics) and duration (transient or chronic). Transient tic disorders consisted of multiple motor tics, phonic tics or both, with a duration between four weeks and twelve months. Chronic tic disorder was either single or multiple, motor or phonic tics (but not both), which were present for more than a year.[6] Tourette's was diagnosed when multiple motor tics, and at least one phonic tic, are present for more than a year.[7]

The fifth version of the DSM (DSM-5), published in May 2013, reclassified Tourette's and tic disorders as motor disorders listed in the neurodevelopmental disorder category, and replaced transient tic disorder with provisional tic disorder, but made few other significant changes.[8][9][10] Tic disorders are defined only slightly differently by the World Health Organization. In its ICD-10, the International Statistical Classification of Diseases and Related Health Problems, code F95.2 is for "combined vocal and multiple motor tic disorder [de la Tourette]".[11][12]

Between 2008 and 2014, studies suggested that Tourette's is not a unitary condition with a distinct mechanism as described in the existing classification systems.[11][13] Likewise, genetic studies do not support the distinctions between tic categories in the existing classification framework.[14] Distinguishing between TS accompanied by other conditions and "pure TS"—referring to Tourette syndrome in the absence of attention-deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder (OCD) and other disorders—has implications for the management of symptoms.[11] Some experts believe that TS and chronic tic disorder should be considered the same disorder, because vocal tics are also muscular contractions, albeit nasal or respiratory muscles,[15] and should not be distinguished from motor tics.[16]

Characteristics

Tics

Examples of motor tics

Tics are movements or sounds that take place "intermittently and unpredictably out of a background of normal motor activity".[17] They are sudden, repetitive, nonrhythmic movements (motor tics) and utterances (phonic tics) that involve discrete muscle groups,[6] having the appearance of "normal behaviors gone wrong".[18] Joseph Jankovic describes vocal or phonic tics as "motor tics that involve respiratory, laryngeal, pharyngeal, oral, and nasal musculature".[19] Tics associated with Tourette's change in number, frequency, severity and anatomical location, and each individual experiences a unique pattern of fluctuation in their severity and frequency. Tics may also occur in "bouts of bouts", which vary for each person.[6] The variation in tic severity may occur over hours, days, or weeks.[13] Tics may increase when an individual is experiencing stress, fatigue, anxiety, or illness,[14][20] or when engaged in relaxing activities like watching TV. They sometimes decrease when an individual is engrossed in or focused on an activity like playing a musical instrument.[14][21]

Coprolalia (the spontaneous utterance of socially objectionable or taboo words or phrases) is the most publicized symptom of Tourette's, but it is not required for a diagnosis, and only about 10% of people with Tourette's exhibit it.[1][3] Echolalia (repeating the words of others) and palilalia (repeating one's own words) occur in a minority of cases.[6]

In contrast to the abnormal movements of other movement disorders such as choreas, dystonias, myoclonus, and dyskinesias, the tics of Tourette's are temporarily suppressible, nonrhythmic, and often preceded by an unwanted urge.[22] Over time, about 90% of individuals with Tourette's feel an urge that precedes tic onset,[13] similar to the need to sneeze or scratch an itch. Individuals describe the need to express the tic as a buildup of tension, pressure, or energy[23][24] which they consciously choose to release, as if they "had to do it"[25] to relieve the sensation[23] or until it feels "just right".[25][26] Examples of this urge are the feeling of having something in one's throat, or a localized discomfort in the shoulders, leading to the need to clear one's throat or shrug the shoulders. The actual tic may be felt as relieving this tension or sensation, similar to scratching an itch or blinking to relieve an uncomfortable feeling in the eye. The urges and sensations that precede the expression of a tic are referred to as "premonitory sensory phenomena" or premonitory urges. Because of the urges that precede them, tics are described as semi-voluntary or "unvoluntary",[1][17] rather than specifically involuntary; they may be experienced as a voluntary, suppressible response to the unwanted premonitory urge.[3][21] Published descriptions of the tics of Tourette's identify sensory phenomena as the core symptom of the syndrome, even though these phenomena are not included in the diagnostic criteria.[24][27][28]

Individuals with tics are sometimes able to suppress them for limited periods of time, but doing so often results in tension or mental exhaustion.[1][3] People with Tourette's may seek a secluded spot to release their symptoms, or there may be a marked increase in tics after a period of suppression at school or at work.[13][18] Some people with Tourette's may not be aware of the premonitory urge associated with tics. Children may be less aware of it than are adults,[13] but their awareness tends to increase with maturity;[17] by the age of ten, most children recognize the premonitory urge.[21] Children may suppress tics while in the doctor's office, so may need to be observed while they are not aware of being watched.[29] The ability to suppress tics varies among individuals, and may be more developed in adults than children.

Onset and progression

Although there is no such thing as a typical case of Tourette syndrome,[30] the condition follows a fairly reliable course in terms of the age of onset and the history of the severity of symptoms. The typical age of onset of tics is from five to seven, and it is usually before adolescence. Onset may occur as late as eighteen.[1] A 1998 study published by Leckman and colleagues from the Yale Child Study Center[31] showed that the ages of highest tic severity are eight to twelve (with an average age of ten), with tics steadily declining for most children as they pass through adolescence.[13][32] Fewer than 20% of individuals see continued (or more severe) symptoms in adulthood, while at least one child in three has a complete remission of tics.[14]

Common tics typically presenting first affect the head, face, and shoulders, and include blinking, facial movements, sniffing and throat clearing.[13] Vocal tics usually appear years after motor tics, although they can appear first.[16] Complex tics may develop in people who experience more severe tics, such as "arm straightening, touching, tapping, jumping, hopping and twirling".[13] In contrasting disorders, such as the autism spectrum, there are different movements such as self-stimulation and stereotypies. These stereotyped movements typically have an earlier age of onset; are more symmetrical, rhythmical and bilateral; and involve the extremities (for example, flapping the hands).[33]

Tourette's is the more severe expression of the spectrum of tic disorders.[14] The severity of symptoms varies widely among people with Tourette's, and many cases may be undetected.[1][6][11][16] Most cases are mild and almost unnoticeable.[34][35] Adults with TS presenting in clinics are atypical.[1]

Co-occurring conditions

Three men and two women stand near the Mona Lisa. All are dressed formally, one woman in a spectacular pink gown.
André Malraux (center) was a French Minister of Culture, author and adventurer who had Tourette syndrome.[36][37][38][39][40]

When symptoms are severe enough to warrant referral to clinics, ADHD and OCD are often also found.[1] In specialty clinics, 30% of individuals with TS also have mood or anxiety disorders, or disruptive behaviors.[13][41] In the absence of ADHD, tic disorders do not appear to be associated with disruptive behavior or functional impairment,[42] while impairment in school, family, or peer relations is greater in individuals who have more comorbid conditions.[18] When ADHD is present along with tics, the occurrence of conduct disorder and oppositional defiant disorder increases.[13] Aggressive behaviors and angry outbursts in persons with TS are not well understood; they are not associated with severe tics, but are associated with the presence of ADHD.[43] People with "full-blown Tourette's" have significant comorbid conditions in addition to tics.[18]

Compulsions that resemble tics are present in some individuals with OCD; "tic-related OCD" is hypothesized to be a subgroup of OCD, distinguished from non-tic related OCD by the type and nature of obsessions and compulsions.[44] Compared to the more typical compulsions of OCD without tics that relate to contamination, tic-related OCD presents with more "counting, aggressive thoughts, symmetry and touching" compulsions.[13] Compulsions associated with OCD without tics are usually related to obsessions and anxiety, while those in tic-related OCD are more likely to be a response to a premonitory urge.[13]

Among individuals with TS studied in clinics, between 2.9% and 20% have been reported to have autism spectrum disorders,[45] but one study indicates that a high association of autism and TS may be partly due to difficulties distinguishing between tics and tic-like behaviors or OCD symptoms seen in people with autism.[46]

Not all people with Tourette's have ADHD or OCD or other comorbid conditions, although in clinical populations, a high percentage of those under care do have ADHD.[26][47] Over time, 85% of people with Tourette's will have a co-occurring condition, according to Dale (2017).[13] Denckla (2006) reported that a review of patient records revealed that about 40% of people with Tourette's have "TS-only" or "pure TS".[48][49] Dure and DeWolfe (2006) reported that 57% of individuals presenting with tic disorders had uncomplicated tics, while 43% had tics plus comorbid conditions.[18] In a 2017 literature review, Sukhodolsky, et al. stated that 37% of individuals in clinical samples have pure TS.[47] Children and adolescents with pure TS are not significantly different from their peers without TS on ratings of aggressive behaviors or conduct disorders, or measures of social adaptation.[11] Similarly, adults with pure TS do not appear to have the social difficulties present in those with TS plus ADHD.[11]

Neuropsychological function

There are no major impairments in neuropsychological function among people with Tourette's, but conditions that occur along with tics can cause variation in neurocognitive function. A better understanding of comorbid conditions is needed to untangle any neuropsychological differences between TS-only individuals and those with comorbid conditions.[50]

Only slight impairments are found in intellectual ability, attentional ability, and nonverbal memory—but ADHD, other comorbid disorders, or tic severity could account for these differences. In contrast with earlier findings, visual motor integration and visuoconstructive skills are not found to be impaired, while comorbid conditions may have a small effect on motor skills. Comorbid conditions and severity of tics may account for variable results in verbal fluency, which can be slightly impaired. There might be slight impairment in social cognition, but not in the ability to plan or make decisions.[50] Referring to children with TS-only, Denckla said, "there is reason to give some credence to common clinical lore, namely, that these children are unusually gifted youngsters who showed no cognitive deficits"; for example, they are faster than average for their age on timed tests of motor coordination.[11][49]

Causes

The exact cause of Tourette's is unknown, but it is well established that both genetic and environmental factors are involved.[13][14][51] Genetic epidemiology studies have shown that the overwhelming majority of cases of Tourette's are inherited, but the exact mode of inheritance is not known and no gene has been identified.[52][53][54] In other cases, tics are associated with disorders other than Tourette's, known as tourettism.[55]

A person with Tourette's has about a 50% chance of passing the gene(s) to his or her child. Tourette's is a condition of variable expression and incomplete penetrance;[14][56] thus, not everyone who inherits the genetic vulnerability will show symptoms. Only a minority of the children who inherit the gene(s) have symptoms severe enough to require medical attention.[57] Gender appears to affect the expression of the genetic vulnerability: males are more likely than females to express tics.[29]

Non-genetic, environmental, or psychosocial factors—while not causing Tourette's—can affect the severity of TS in vulnerable individuals.[11][30][51] Autoimmune processes may affect the onset of tics or exacerbate them. Both OCD and tic disorders may arise in a subset of children as a result of a poststreptococcal autoimmune process.[34] Its potential effect is described by the hypothesis called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections), which proposes five criteria for diagnosis in children.[58][59] The controversial hypothesis includes the newer PANS hypothesis, and both are the focus of clinical and laboratory research, but remain unproven. There is also a broader hypothesis that links immune system abnormalities and immune dysregulation with TS.[3][13][34]

There is evidence that pre-natal and peri-natal events increase the risk of tic disorders or comorbid OCD in those with a genetic vulnerability. These include complications of pregnancy or delivery; stress or severe nausea during pregnancy; maternal use of nicotine, caffeine or alcohol during pregnancy; paternal age; and forceps delivery. Babies who are born premature with low birthweight, or who have low Apgar scores, are also at increased risk; in premature twins, the lower-birthweight twin is more likely to develop TS.[11]

Some forms of OCD may be genetically linked to Tourette's,[26] although the genetic factors in OCD with and without tics may differ.[14] The genetic relationship of ADHD to Tourette syndrome, however, has not been fully established.[49]

Mechanism

The basal ganglia at the brain's center with the thalamus next to it. Nearby related brain structures are also shown.
The basal ganglia and thalamus are implicated in Tourette syndrome.

The exact mechanism affecting the inherited vulnerability to Tourette's is not well established.[14] Tics are believed to result from dysfunction in cortical and subcortical brain regions: the thalamus, basal ganglia and frontal cortex.[60] Neuroanatomic models suggest failures in circuits connecting the brain's cortex and subcortex,[30] while imaging techniques implicate the basal ganglia and frontal cortex.[53] Neuroimaging and postmortem brain studies, animal, and genetic studies[50][61] in the 2010s made progress towards better understanding the neurobiological mechanisms leading to Tourette's.[50] These studies support the basal ganglia model, in which neurons in the striatum are activated and inhibit outputs from the basal ganglia.[43]

Cortico-striato-thalamo-cortical (CSTC) circuits provide inputs to the basal ganglia from the brain's cortex. There are five CSTC circuits that communicate information for "planning, movement execution and inhibition, motivational regulation of behavior, error detection, and associative learning".[50] Behavior is regulated by cross-connections that "allow the integration of information" from these CSTC circuits.[50] Involuntary movements might result from impairments in these CSTC circuits.[50] The caudate nuclei may be smaller compared to subjects without tics, supporting the hypothesis of pathology in CSTC circuits.[50] These impairments together may result in tics, while the ability to suppress tics depends on brain circuits that "regulate response inhibition and cognitive control of motor behavior".[61]

Studies have found thinning of the sensorimotor cortex, with greater thinning related to higher tic severity.[50] Children with TS are found to have a larger prefrontal cortex, which may be the result of an adaptation to help regulate tics.[61] It is likely that tics decrease with maturity as the capacity of the frontal cortex increases.[61] Cortico-basal ganglia (CBG) circuits may also be impaired, contributing to "sensory, limbic and executive" features.[13] The release of dopamine in the basal ganglia is higher in persons with Tourette's, implicating biochemical changes from "overactive and dysregulated dopaminergic transmissions".[51]

In the pathophysiology of TS, the role of histamine and the H3 receptor came into focus after 2010[13][62] as integral in the modulation of striatal circuitry.[63][64] A reduced level of histamine in the H3 receptor may disrupt other neurotransmitters, causing tics.[65] Postmortem studies have also implicated "dysregulation of neuroinflammatory processes".[14]

Diagnosis

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Tourette's may be diagnosed when, over a period of one year, a person exhibits both multiple motor tics and one or more vocal tics; the motor and vocal tics need not be concurrent. The onset must have occurred before the age of 18 and cannot be attributed to the effects of another condition or substance (such as cocaine).[7] Hence, other medical conditions that include tics or tic-like movements—such as autism or other causes of tics—must be ruled out before conferring a Tourette's diagnosis. The DSM has recognized since 2000 that individuals who meet all the criteria for Tourette's may not have distress or impairment.[66][67][68] Diagnosis does not require the presence of a comorbid condition, such as ADHD or OCD.[3]

There are no specific medical or screening tests that can be used in diagnosis;[26] the diagnosis is made based on observation of the individual's symptoms and family history,[3] and after ruling out secondary causes of tic disorders.[69] Most cases are diagnosed merely by observing a history of tics.[30] In individuals with a typical onset and a family history of tics or OCD, a basic physical and neurological examination may be sufficient.[70] If another condition might better explain the tics, tests may be done; for example, if there is diagnostic confusion between tics and seizure activity, an EEG may be ordered. An MRI can rule out brain abnormalities,[71] but such brain imaging studies are not usually warranted.[71] Measuring TSH levels in blood can rule out hypothyroidism, which can be a cause of tics. In teenagers and adults presenting with a sudden onset of tics and other behavioral symptoms, a urine drug screen for cocaine and stimulants might be necessary. If there is a family history of liver disease, serum copper and ceruloplasmin levels can rule out Wilson's disease.[70]

Tourette's may be misdiagnosed because of the wide expression of severity, ranging from mild (in the majority of cases) or moderate, to severe (the rare but more widely recognized and publicized cases).[31] Tics that appear early in the course of TS are often confused with other conditions, such as allergies, asthma, and vision problems. Pediatricians, allergists and ophthalmologists are typically the first to identify a child as having tics.[6] Coughing, blinking, and tics that mimic unrelated conditions such as asthma are commonly misdiagnosed.[3] In the UK, there is an average delay of three years between symptom onset and diagnosis.[11]

Dystonias, choreas, other genetic conditions, and tics that occur secondary to other conditions (tourettism) should be ruled out in the differential diagnosis for Tourette syndrome.[55][70] Most of these conditions are rarer than tic disorders, and a thorough history and examination may be enough to rule them out without medical or screening tests.[30] Other conditions that may manifest tics or stereotyped movements include developmental disorders; autism spectrum disorders[72] and stereotypic movement disorder;[73][74] Sydenham's chorea; idiopathic dystonia; and genetic conditions such as Huntington's disease, neuroacanthocytosis, pantothenate kinase-associated neurodegeneration, Duchenne muscular dystrophy, Wilson's disease, and tuberous sclerosis. Other possibilities include chromosomal disorders such as Down syndrome, Klinefelter syndrome, XYY syndrome and fragile X syndrome. Acquired causes of tics include drug-induced tics, head trauma, encephalitis, stroke, and carbon monoxide poisoning.[55][70] The symptoms of Lesch–Nyhan syndrome may also be confused with Tourette syndrome.[33]

Screening

Although not all those with Tourette's have comorbid conditions, most presenting for clinical care exhibit symptoms of other conditions along with their motor and phonic tics.[49] Learning disabilities and sleep disorders may be present;[3] complications may include depression, social discomfort, self-injury,[70] anxiety, personality disorders, oppositional defiant disorder, and conduct disorders.[75] A higher rate of migraines than the general population and sleep disturbances are reported.[76] Disruptive behaviors, impaired functioning, or cognitive impairment in individuals with comorbid Tourette's and ADHD may be accounted for by the comorbid ADHD, highlighting the importance of identifying comorbid conditions.[3][13][26][77] Disruption from tics is commonly overshadowed by comorbid conditions that present greater interference to the child.[15][30]

Because comorbid conditions such as OCD and ADHD can be more impairing than tics, and cause greater impact on overall functioning, these conditions are included in an evaluation of people presenting with tics. "It is critical to note that the comorbid conditions may determine functional status more strongly than the tic disorder", according to Samuel Zinner, MD.[30] A thorough evaluation for comorbidity is called for when symptoms and impairment warrant.[70][78] The initial assessment of a person referred for a tic disorder includes a family history of tics, ADHD, obsessive–compulsive symptoms, and other chronic medical, psychiatric and neurological conditions. Children and adolescents with TS who have learning difficulties are candidates for psychoeducational testing, particularly if the child also has ADHD.[71][78]

The main screening and assessment tools are:[79][80]

Management

Practice guidelines for the treatment of tics were published by the American Academy of Neurology in 2019.[32] Management of Tourette's is individualized and involves a collaboration between the clinician, patient and caregivers where applicable.[32] Treatment is focused on identifying and helping the individual manage the most troubling or impairing symptoms.[3] When comorbid conditions are present, they are often a larger source of impairment than the tics themselves,[71] and often take treatment priority.[32]

There is no cure for Tourette's and no medication that works universally for all individuals without significant adverse effects. Knowledge, education and understanding are uppermost in management plans for tic disorders.[3] Symptom management may include pharmacological, behavioral and psychological therapies. While pharmacological intervention is reserved for more severe symptoms, other treatments, such as supportive psychotherapy or cognitive behavioral therapy (CBT), may help to avoid or ameliorate depression and social isolation, and to improve family support. Educating a patient, family, and surrounding community (such as friends, school, and church) is a key management strategy; psychobehavioral therapy, education, and reassurance may be sufficient in most cases,[81] which are mild.[3][82] Watchful waiting "is an acceptable approach" for those who are not functionally impaired.[32] The decision to use behavioral or pharmacological treatment is "usually made after the educational and supportive interventions have been in place for a period of months, and it is clear that the tic symptoms are persistently severe and are themselves a source of impairment in terms of self-esteem, relationships with the family or peers, or school performance".[79]

Behavioral

Behavioral therapies using habit reversal training (HRT) and exposure and response prevention (ERP) are first-line interventions,[83] and have been shown effective.[14] When an individual is aware of the premonitory urge that precedes a tic, and because tics are somewhat suppressible, individuals can be trained to develop a response to the urge that competes with the tic.[13][83]

Comprehensive behavioral intervention for tics (CBIT) is based on HRT; the best researched behavioral therapy for tics.[83] With a high level of confidence, CBIT has been shown to be more likely to lead to a reduction in tics than other supportive therapies or psychoeducation.[15] Some limitations are: children younger than ten may not understand the treatment, people with severe tics or ADHD may not be able to suppress their tics or sustain the required focus to benefit from behavioral treatments, there is a lack of therapists trained in behavioral interventions,[84] finding practitioners outside of specialty clinics can be difficult,[14] and costs may limit accessibility.[83] Whether increased awareness of tics through HRT/CBIT (as opposed to moving attention away from them) leads to further increases in tics later in life is a subject of discussion among TS experts.[83]

When comorbid disruptive behaviors exist, anger control training and parent management training can be effective.[11][85][86] CBT is a useful treatment when OCD is present.[13] Relaxation techniques, such as exercise, yoga or meditation, may be useful in relieving the stress that may aggravate tics, but the majority of behavioral interventions (such as relaxation training and biofeedback, with the exception of habit reversal) have not been systematically evaluated and are not empirically supported therapies for Tourette's.[87]

Medication

Little white pills on a counter, next to a pill bottle and labels
Clonidine (or the clonidine patch) is one of the medications typically tried first when medication is needed for Tourette's.

Children with tics typically present to physicians when their tics are most severe, and tics wax and wane, so medication is not started immediately or changed often.[30] Tics may subside with explanation, reassurance, understanding of the condition and a supportive environment.[30] When medication is used, the goal is not to eliminate symptoms: it is used at the lowest dose that manages symptoms without adverse effects, given that these may be more disturbing than the symptoms for which the medication was prescribed.[30]

The classes of medication with proven efficacy in treating tics—typical and atypical neuroleptics—can have long-term and short-term adverse effects.[71] The antihypertensive agents are also used to treat tics; studies show variable efficacy, but a lower side effect profile than the neuroleptics.[88] There is moderate evidence that the antihypertensive clonidine, along with aripiprazole, haloperidol, risperidone, and tiapride, reduce tics more than placebo.[15] Aripiprazole and risperidone are likely to lead to weight gain and sedation or fatigue; haloperidol may increase prolactin levels; tiapride may produce sleep disturbances and tiredness; and clonidine may produce sedation. Risperidone and haloperidol may produce extrapyramidal symptoms.[15]

Stimulants and other medications may be useful in treating ADHD when it co-occurs with tic disorders. Drugs from several other classes of medications can be used when stimulants fail.[71] There is moderate evidence supporting that clonidine combined with methylphenidate, desipramine, and methylphenidate alone reduce tics more than placebo when ADHD is also present; desipramine is rarely used following reports of sudden death in children.[15] Atomoxetine does not increase tics, but may lead to weight loss and an increased heart rate.[15]

Clomipramine, a tricyclic, and SSRIs—a class of antidepressants including fluoxetine, sertraline, and fluvoxamine—may be prescribed when a person also has OCD, and can augment the effect of CBT.[13][71]

Other

Complementary and alternative medicine approaches, such as dietary modification, allergy testing and allergen control, and neurofeedback, have popular appeal, but no role has been proven for any of these in the management of Tourette syndrome.[89][90] In spite of no evidence base supporting dietary approaches to management of TS symptoms, anecdotal reports indicate that parents, caregivers, and individuals with TS are using dietary approaches and nutritional supplements.[20]

There is low confidence that tics are reduced with tetrahydrocannabinol;[15] there is insufficient evidence for other cannabis-based medications in the treatment of Tourette's.[32]

There is no good evidence supporting the use of acupuncture or transcranial magnetic stimulation; or for intravenous immunoglobulin, plasma exchange, or antibiotics for the treatment of PANDAS.[11]

Deep brain stimulation (DBS) has become a valid option for individuals with severe symptoms that do not respond to conventional therapy and management.[51][91] There is low-quality, limited evidence that DBS is safe, well tolerated, and yields symptom reduction ranging from no change to complete remission.[51] Selecting candidates who may benefit from DBS is challenging, and "age, tic severity, and treatment refractoriness are important factors to consider", according to Fraint and Pal (2016).[91] The ideal brain location to target has not been identified.[51][91][92]

Prognosis

Top half of a male athlete who appears to be running
Tim Howard, goalkeeper, described in 2019 by a staff writer for the Los Angeles Times as the "greatest goalkeeper in U.S. soccer history",[93] attributes his success in association football to his Tourette's.[94]

Tourette syndrome is a spectrum disorder—its severity ranges over a spectrum from mild to severe.[69] Many people with TS may not realize they have tics; because tics are more commonly expressed in private, TS may go unrecognized or undetected,[95] and casual observers might not notice tics. Symptoms typically subside as children pass through adolescence.[51] A minority of children with Tourette syndrome have severe symptoms that persist into adulthood.[60]

Regardless of symptom severity, individuals with Tourette's have a normal life span. Symptoms may be lifelong and chronic for some, but the condition is not degenerative or life-threatening. Intelligence is normal in those with Tourette's, although there may be learning disabilities.[3] Severity of tics early in life does not predict tic severity in later life,[3] and prognosis is generally favorable,[76] although there is no reliable means of predicting the outcome for a particular individual.[76]

By the time they reach adulthood, three-fourths of individuals with Tourette's experience a reduction in the severity of their tics.[13] Tics may be at their highest severity at the time that they are diagnosed, and often improve with understanding of the condition by individuals and their families and friends. One study showed no correlation between tic severity and the onset of puberty, in contrast with the popular belief that tics increase at puberty. In many cases, a complete remission of tic symptoms occurs after adolescence.[31][96] However, a study using videotape to record tics in adults found that, although tics diminished in comparison with childhood, and all measures of tic severity improved by adulthood, 90% of adults still had tics. Half of the adults who considered themselves tic-free displayed evidence of mild tics.[13][97]

Children with Tourette's may suffer socially if their tics are viewed as "bizarre". If a child has disabling tics, or tics that interfere with social or academic functioning, supportive psychotherapy or school accommodations can be helpful.[69] In children with tics, the additional presence of ADHD is associated with functional impairment, disruptive behavior, and tic severity.[75] Decreased measures in quality of life are observed in children whose tics are accompanied by ADHD, which can severely impact the child's well-being in all realms, and extend into adulthood.[98] As ADHD symptoms improve with maturity, adults report less negative impact in their occupational lives than do children in their educational lives.[98] Adults are more likely to report a reduced quality of life due to depression or anxiety.[98]

A supportive environment and family generally gives those with Tourette's the skills to manage the disorder.[98][99][100] People with Tourette's may learn to camouflage socially inappropriate tics or to channel the energy of their tics into a functional endeavor. Outcomes in adulthood are associated more with the perceived significance of having severe tics as a child than with the actual severity of the tics. A person who was misunderstood, punished, or teased at home or at school is likely to fare worse than a child who enjoyed an understanding and supportive environment.[6]

Epidemiology

Tourette syndrome is found among all social, racial and ethnic groups and has been reported in all parts of the world;[3][26] it is three to four times more frequent among males than among females.[47] Tics tend to remit or subside with maturity; thus, a diagnosis may no longer be warranted for many adults, and observed prevalence rates are higher among children than adults.[31] Up to 1% of the overall population experiences tic disorders, including chronic tics and transient tics of childhood.[42] Chronic tics affect 5% of children, and transient tics affect up to 20%.[47][86]

Most individuals with tics do not seek a diagnosis, so epidemiological studies of TS "reflect a strong ascertainment bias" towards those with co-occurring conditions.[53] The reported prevalence of TS varies "according to the source, age, and sex of the sample; the ascertainment procedures; and diagnostic system",[26] with a range reported between 0.15% and 3.0% for children and adolescents.[47] Sukhodolsky, et al. wrote in 2017 that the best estimate of TS prevalence in children was 1.4%,[47] and Stern stated in 2018 that the prevalence in children was 1%.[1] Prevalence rates in special education populations are higher.[34]

Fernandez, State and Pittenger (2018) state that the prevalence overall is between 0.5 and 0.7%.[14] Robertson (2011) suggests that the rate of Tourette's in the general population is 1%.[34] Using year 2000 census data, a prevalence range of 0.1 to 1% yields an estimate of 53,000–530,000 school-age children with Tourette's in the US,[42] and a prevalence estimate of .1% means that in 2001 about 553,000 people in the UK age five or older would have Tourette's.[35]

Tourette syndrome was once thought to be rare: in 1972, the US National Institutes of Health (NIH) believed there were fewer than 100 cases in the United States,[101] and a 1973 registry reported only 485 cases worldwide.[102] However, multiple studies published since 2000 have consistently demonstrated that the prevalence is much higher.[103] Discrepancies between current and prior prevalence estimates come from several factors: ascertainment bias in earlier samples were drawn from clinically referred cases; assessment methods failed to detect milder cases; and different diagnostic criteria and thresholds were used.[103] There were few broad-based community studies published before 2000 and most older epidemiological studies were based only on individuals referred to tertiary care or specialty clinics.[104] Individuals with mild symptoms may not have sought treatment and physicians may have avoided an official diagnosis of TS on children out of concern for stigmatization;[95] children with milder symptoms are unlikely to be referred to specialty clinics, so prevalence studies have an inherent bias towards more severe cases.[105] Studies are vulnerable to further error because tics vary in intensity and expression, are often intermittent, and are not always recognized by clinicians, individuals with TS, family members, friends or teachers.[30][106] Approximately 20% of persons with Tourette syndrome do not recognize that they have tics.[30] Newer studies—recognizing that tics may often be undiagnosed and hard to detect—use direct classroom observation and multiple informants (parents, teachers, and trained observers), and therefore record more cases than older studies.[82][107] As the diagnostic threshold and assessment methodology has moved towards recognition of milder cases, there has been an increase in estimated prevalence.[103]

History

A painting of a 19th-century medical lecture. At the front of the class, a woman faints into the arms of a man standing behind her, as another woman, apparently a nurse, reaches to help. An older man, the professor, stands beside her and gestures as if making a point. Two dozen male students watch them.
Jean-Martin Charcot (1825–1893) was a French neurologist and professor who named Tourette syndrome for his resident, Georges Gilles de la Tourette. In A Clinical Lesson at the Salpêtrière (1887), the French painter André Brouillet depicts a medical lecture with these men.

The first presentation of Tourette syndrome is thought to be in the book Malleus Maleficarum (Witch's Hammer) by Jacob Sprenger and Heinrich Kramer, published in the late 15th century and describing a priest whose tics were "believed to be related to possession by the devil".[108][109] A French doctor, Jean Marc Gaspard Itard, reported the first case of Tourette syndrome in 1825,[110] describing the Marquise de Dampierre, an important woman of nobility in her time.[111] Jean-Martin Charcot (1825–1893), an influential French physician, assigned his resident Georges Albert Édouard Brutus Gilles de la Tourette (1857–1904), a French physician and neurologist, to study patients at the Salpêtrière Hospital, with the goal of defining a condition distinct from hysteria and chorea.[29]

In 1885, Gilles de la Tourette published an account in Study of a Nervous Affliction describing nine persons with "convulsive tic disorder", concluding that a new clinical category should be defined.[112][113] The eponym was later bestowed by Charcot after and on behalf of Gilles de la Tourette.[29][114]

Little progress was made over the next century in explaining or treating tics, and a psychogenic view prevailed well into the 20th century.[29] The possibility that movement disorders, including Tourette syndrome, might have an organic origin was raised when an encephalitis epidemic from 1918–1926 led to a subsequent epidemic of tic disorders.[115]

During the 1960s and 1970s, as the beneficial effects of haloperidol (Haldol) on tics became known, the psychoanalytic approach to Tourette syndrome was questioned.[116] The turning point came in 1965, when Arthur K. Shapiro—described as "the father of modern tic disorder research"[117]—used haloperidol to treat a person with Tourette's, and published a paper criticizing the psychoanalytic approach.[115] In 1975, The New York Times headlined an article with "Bizarre outbursts of Tourette's disease victims linked to chemical disorder in brain", and Shapiro said: "The bizarre symptoms of this illness are rivaled only by the bizarre treatments used to treat it."[118]

During the 1990s, a more neutral view of Tourette's has emerged, in which biological vulnerability and adverse environmental events are seen to interact.[29][30] In 2000, the American Psychiatric Association published the DSM-IV-TR, revising the text of DSM-IV to no longer require that symptoms of tic disorders cause distress or impair functioning,[66] recognizing that clinicians often see people who meet all the other criteria for Tourette's, but do not have distress or impairment.[67][68]

Findings since 1999 have advanced TS science in the areas of genetics, neuroimaging, neurophysiology, and neuropathology. Questions remain regarding how best to classify Tourette syndrome, and how closely Tourette's is related to other movement or psychiatric disorders.[11][13][14][16] Good epidemiologic data is still lacking, and available treatments are not risk free and not always well tolerated.[119]

Society and culture

Half-length portrait of a large, squinting man with a fleshy face, dressed in brown and wearing an 18th-century wig
Samuel Johnson (1709–1784) c. 1772. Johnson is likely to have had Tourette syndrome.

Not everyone with Tourette's wants treatment or a "cure", especially if that means they may "lose" something else in the process.[120][121] Researchers Leckman and Cohen, and former US Tourette Syndrome Association (TSA) national board member Kathryn Taubert, believe that there may be latent advantages associated with an individual's genetic vulnerability to developing Tourette syndrome, such as a heightened awareness and increased attention to detail and surroundings that may have adaptive value.[122]

Accomplished musicians, athletes, public speakers, and professionals from all walks of life are found among people with Tourette's.[123] A well-known example of a person who may have used obsessive–compulsive traits to advantage is Samuel Johnson, the 18th-century English man of letters, who likely had Tourette syndrome as evidenced by the writings of James Boswell.[124][125] Johnson wrote A Dictionary of the English Language in 1747, and was a prolific writer, poet, and critic. Tim Howard, described by the Chicago Tribune as the "rarest of creatures—an American soccer hero",[126] and by the TSA as the "most notable individual with Tourette Syndrome around the world",[127] says that his neurological makeup gave him an enhanced perception and an ability to hyper-focus that contributed to his success on the field.[94]

Although it has been speculated that Mozart had Tourette's,[128][129] no Tourette's expert or organization has presented credible evidence to support such a conclusion,[129] and there are problems with the arguments supporting the diagnosis: tics are not transferred to the written form, as is supposed with Mozart's scatological writings; the medical history in retrospect is not thorough; side effects due to other conditions may be misinterpreted; "it is not proven whether written documents can account for the existence of a vocal tic" and "the evidence of motor tics in Mozart's life is doubtful".[130]

Pre-dating Gilles de la Tourette's 1885 publication, likely portrayals of TS or tic disorders in fictional literature are Mr. Pancks in Little Dorrit by Charles Dickens and Nikolai Levin in Anna Karenina by Leo Tolstoy.[131] The entertainment industry has been criticized for depicting those with Tourette syndrome as social misfits whose only tic is coprolalia, which has furthered stigmatization and the public's misunderstanding of those with Tourette's.[132][133][134] The coprolalic symptoms of Tourette's are also fodder for radio and television talk shows in the US[135] and for the British media.[136] High-profile media coverage focuses on treatments that do not have established safety or efficacy, such as deep brain stimulation, and alternative therapies involving unstudied efficacy and side effects are pursued by many parents.[137]

Research directions

Modeled after genetic breakthroughs seen with large-scale efforts in other neurodevelopmental disorders, three groups (the Tourette Syndrome Association International Consortium for Genetics, Tourette International Collaborative Genetics, and the European Multicentre Tics in Children Study) are collaborating in research of the genetics of Tourette's. Compared to the successful efforts seen in other conditions (autism, schizophrenia and bipolar disorder), these efforts are underfunded in the US.[14][138]

References

  1. ^ a b c d e f g h i j k l m n o p Stern JS (August 2018). "Tourette's syndrome and its borderland" (PDF). Pract Neurol (Historical review). 18 (4): 262–70. doi:10.1136/practneurol-2017-001755. PMID 29636375.
  2. ^ a b c "Tourette syndrome fact sheet". National Institute of Neurological Disorders and Stroke. July 6, 2018. Archived from the original on December 1, 2018. Retrieved November 30, 2018.
  3. ^ a b c d e f g h i j k l m n o p q Singer HS (2011). "Tourette syndrome and other tic disorders". Handb Clin Neurol (Historical review). 100: 641–57. doi:10.1016/B978-0-444-52014-2.00046-X. PMID 21496613. Also see Singer HS (March 2005). "Tourette's syndrome: from behaviour to biology". Lancet Neurol (Review). 4 (3): 149–59. doi:10.1016/S1474-4422(05)01012-4. PMID 15721825.
  4. ^ Jankovic (2014), p. viii.
  5. ^ Peterson BS, Cohen DJ (1998). "The treatment of Tourette's syndrome: multimodal, developmental intervention". J Clin Psychiatry (Review). 59 (Suppl 1): 62–72, discussion 73–4. PMID 9448671. Because of the understanding and hope that it provides, education is also the single most important treatment modality that we have in TS. Also see Zinner 2000, PMID 11077021.
  6. ^ a b c d e f g Leckman JF, Bloch MH, King RA, Scahill L (2006). "Phenomenology of tics and natural history of tic disorders". Adv Neurol (Historical review). 99: 1–16. PMID 16536348.
  7. ^ a b "Tourette's Disorder, 307.23 (F95.2)". Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Association. 2013. p. 81.
  8. ^ "Neurodevelopmental disorders". American Psychiatric Association. Retrieved December 29, 2011.
  9. ^ Moran M (January 18, 2013). "DSM-5 provides new take on neurodevelopment disorders". Psychiatric News. 48 (2): 6–23. doi:10.1176/appi.pn.2013.1b11.
  10. ^ "Highlights of changes from DSM-IV-TR to DSM-5" (PDF). American Psychiatric Association. 2013. Retrieved June 5, 2013.
  11. ^ a b c d e f g h i j k l m Hollis C, Pennant M, Cuenca J, et al. (January 2016). "Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis". Health Technology Assessment. Southampton (UK): NIHR Journals Library. 20 (4): 1–450. doi:10.3310/hta20040. ISSN 1366-5278.
  12. ^ "International Statistical Classification of Diseases and Related Health Problems 10th Revision". World Health Organization. 2010. Archived from the original on April 4, 2012. Retrieved January 13, 2020. See also ICD version 2007.
  13. ^ a b c d e f g h i j k l m n o p q r s t u v w x Dale RC (December 2017). "Tics and Tourette: a clinical, pathophysiological and etiological review". Curr. Opin. Pediatr. (Review). 29 (6): 665–73. doi:10.1097/MOP.0000000000000546. PMID 28915150.
  14. ^ a b c d e f g h i j k l m n o Fernandez TV, State MW, Pittenger C (2018). "Tourette disorder and other tic disorders". Handb Clin Neurol (Review). 147: 343–54. doi:10.1016/B978-0-444-63233-3.00023-3. PMID 29325623.
  15. ^ a b c d e f g h Pringsheim T, Holler-Managan Y, Okun MS, et al. (May 2019). "Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders". Neurology (Review). 92 (19): 907–15. doi:10.1212/WNL.0000000000007467. PMID 31061209.
  16. ^ a b c d Sukhodolsky, et al (2017), p. 242.
  17. ^ a b c "Definitions and classification of tic disorders. The Tourette Syndrome Classification Study Group". Arch. Neurol. (Research support). 50 (10): 1013–16. October 1993. doi:10.1001/archneur.1993.00540100012008. PMID 8215958.
  18. ^ a b c d e Dure LS, DeWolfe J (2006). "Treatment of tics". Adv Neurol (Review). 99: 191–96. PMID 16536366.
  19. ^ Jankovic J (September 2017). "Tics and Tourette syndrome" (PDF). Practical Neurology: 22–24.
  20. ^ a b Ludlow AK, Rogers SL (March 2018). "Understanding the impact of diet and nutrition on symptoms of Tourette syndrome: A scoping review". J Child Health Care (Review). 22 (1): 68–83. doi:10.1177/1367493517748373. PMID 29268618.
  21. ^ a b c Sukhodolsky, et al (2017), p. 243.
  22. ^ Jankovic J (2001). "Differential diagnosis and etiology of tics". Adv Neurol (Review). 85: 15–29. PMID 11530424.
  23. ^ a b Prado HS, Rosário MC, Lee J, Hounie AG, Shavitt RG, Miguel EC (May 2008). "Sensory phenomena in obsessive-compulsive disorder and tic disorders: a review of the literature". CNS Spectr (Review and meta-anlysis). 13 (5): 425–32. doi:10.1017/s1092852900016606. PMID 18496480.
  24. ^ a b Bliss J (December 1980). "Sensory experiences of Gilles de la Tourette syndrome". Arch. Gen. Psychiatry. 37 (12): 1343–47. doi:10.1001/archpsyc.1980.01780250029002. PMID 6934713.
  25. ^ a b Kwak C, Dat Vuong K, Jankovic J (December 2003). "Premonitory sensory phenomenon in Tourette's syndrome". Mov. Disord. 18 (12): 1530–33. doi:10.1002/mds.10618. PMID 14673893.
  26. ^ a b c d e f g Swain JE, Scahill L, Lombroso PJ, King RA, Leckman JF (August 2007). "Tourette syndrome and tic disorders: a decade of progress". J Am Acad Child Adolesc Psychiatry (Review). 46 (8): 947–68. doi:10.1097/chi.0b013e318068fbcc. PMID 17667475.
  27. ^ Scahill LD, Leckman JF, Marek KL (1995). "Sensory phenomena in Tourette's syndrome". Adv Neurol (Review). 65: 273–80. PMID 7872145.
  28. ^ Miguel EC, do Rosário-Campos MC, Prado HS, et al. (February 2000). "Sensory phenomena in obsessive-compulsive disorder and Tourette's disorder". J Clin Psychiatry. 61 (2): 150–56, quiz 157. doi:10.4088/jcp.v61n0213. PMID 10732667.
  29. ^ a b c d e f Black KJ (March 30, 2007). "Tourette syndrome and other tic disorders". eMedicine. Archived from the original on August 22, 2009. Retrieved August 10, 2009.
  30. ^ a b c d e f g h i j k l m Zinner SH (November 2000). "Tourette disorder". Pediatr Rev (Review). 21 (11): 372–83. PMID 11077021.
  31. ^ a b c d Leckman JF, Zhang H, Vitale A, et al. (July 1998). "Course of tic severity in Tourette syndrome: the first two decades" (PDF). Pediatrics (Research support). 102 (1 Pt 1): 14–19. doi:10.1542/peds.102.1.14. PMID 9651407.
  32. ^ a b c d e f Pringsheim T, Okun MS, Müller-Vahl K, et al. (May 2019). "Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders". Neurology (Review). 92 (19): 896–906. doi:10.1212/WNL.0000000000007466. PMID 31061208.
  33. ^ a b Rapin I (2001). "Autism spectrum disorders: relevance to Tourette syndrome". Adv Neurol (Review). 85: 89–101. PMID 11530449.
  34. ^ a b c d e Robertson MM (February 2011). "Gilles de la Tourette syndrome: the complexities of phenotype and treatment". Br J Hosp Med (Lond). 72 (2): 100–7. doi:10.12968/hmed.2011.72.2.100. PMID 21378617.
  35. ^ a b Robertson MM (November 2008). "The prevalence and epidemiology of Gilles de la Tourette syndrome. Part 1: the epidemiological and prevalence studies". J Psychosom Res (Review). 65 (5): 461–72. doi:10.1016/j.jpsychores.2008.03.006. PMID 18940377.
  36. ^ Kammer T (2007). "Mozart in the neurological department - who has the tic?" (PDF). Front Neurol Neurosci (Historical biography). 22: 184–92. doi:10.1159/000102880. PMID 17495512.
  37. ^ "What is Tourette Syndrome?". Tourette Syndrome Foundation of Canada. Retrieved July 2, 2013.
  38. ^ Todd O (2005). Malraux: A Life. Knopf.
  39. ^ Guidotti TL (May 1985). "André Malraux: a medical interpretation". J R Soc Med (Historical biography). 78 (5): 401–6. doi:10.1177/014107688507800511. PMC 1289723. PMID 3886907.
  40. ^ Liebmann, Lisa. "Lisa Liebmann on the Mona Lisa". TATEetc (6 / Spring 2006). Retrieved March 1, 2008.
  41. ^ Hirschtritt ME, Lee PC, Pauls DL, et al. (April 2015). "Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome". JAMA Psychiatry. 72 (4): 325–33. doi:10.1001/jamapsychiatry.2014.2650. PMC 4446055. PMID 25671412.
  42. ^ a b c Scahill L, Williams S, Schwab-Stone M, Applegate J, Leckman JF (2006). "Disruptive behavior problems in a community sample of children with tic disorders". Adv Neurol (Comparative study). 99: 184–90. PMID 16536365.
  43. ^ a b Sukhodolsky, et al (2017), p. 245.
  44. ^ Hounie AG, do Rosario-Campos MC, Diniz JB, et al. (2006). "Obsessive-compulsive disorder in Tourette syndrome". Adv Neurol (Review). 99: 22–38. PMID 16536350.
  45. ^ Cravedi E, Deniau E, Giannitelli M, et al. (2017). "Tourette syndrome and other neurodevelopmental disorders: a comprehensive review". Child Adolesc Psychiatry Ment Health (Review). 11: 59. doi:10.1186/s13034-017-0196-x. PMC 5715991. PMID 29225671.
  46. ^ Darrow SM, Grados M, Sandor P, et al. (July 2017). "Autism spectrum symptoms in a Tourette's disorder sample". J Am Acad Child Adolesc Psychiatry (Comparative study). 56 (7): 610–17.e1. doi:10.1016/j.jaac.2017.05.002. PMC 5648014. PMID 28647013.
  47. ^ a b c d e f Sukhodolsky, et al (2017), p. 244.
  48. ^ Denckla MB (August 2006). "Attention-deficit hyperactivity disorder (ADHD) comorbidity: a case for "pure" Tourette syndrome?". J. Child Neurol. (Review). 21 (8): 701–3. doi:10.1177/08830738060210080701. PMID 16970871.
  49. ^ a b c d Denckla MB (2006). "Attention deficit hyperactivity disorder: the childhood co-morbidity that most influences the disability burden in Tourette syndrome". Adv Neurol (Review). 99: 17–21. PMID 16536349.
  50. ^ a b c d e f g h i Morand-Beaulieu S, Leclerc JB, Valois P, et al. (August 2017). "A review of the neuropsychological dimensions of Tourette syndrome". Brain Sci (Review). 7 (8). doi:10.3390/brainsci7080106. PMC 5575626. PMID 28820427.
  51. ^ a b c d e f g Baldermann JC, Schüller T, Huys D, et al. (2016). "Deep brain stimulation for Tourette syndrome: a systematic review and meta-analysis". Brain Stimul (Review). 9 (2): 296–304. doi:10.1016/j.brs.2015.11.005. PMID 26827109.
  52. ^ Du JC, Chiu TF, Lee KM, et al. (October 2010). "Tourette syndrome in children: an updated review". Pediatr Neonatol (Review). 51 (5): 255–64. doi:10.1016/S1875-9572(10)60050-2. PMID 20951354.
  53. ^ a b c Bloch M, State M, Pittenger C (April 2011). "Recent advances in Tourette syndrome". Curr. Opin. Neurol. (Review). 24 (2): 119–25. doi:10.1097/WCO.0b013e328344648c. PMC 4065550. PMID 21386676.
  54. ^ O'Rourke JA, Scharf JM, Yu D, Pauls DL (December 2009). "The genetics of Tourette syndrome: a review". J Psychosom Res (Review). 67 (6): 533–45. doi:10.1016/j.jpsychores.2009.06.006. PMC 2778609. PMID 19913658.
  55. ^ a b c Mejia NI, Jankovic J (March 2005). "Secondary tics and tourettism" (PDF). Braz J Psychiatry. 27 (1): 11–17. doi:10.1590/s1516-44462005000100006. PMID 15867978.
  56. ^ van de Wetering BJ, Heutink P (May 1993). "The genetics of the Gilles de la Tourette syndrome: a review". J. Lab. Clin. Med. (Review). 121 (5): 638–45. PMID 8478592.
  57. ^ "Living with Tourette and tic disorders" (PDF). Tourette Association of America. Retrieved January 19, 2020.
  58. ^ "PANDAS". National Institutes of Health. Archived from the original on February 12, 2012. Retrieved November 25, 2006.
  59. ^ Frick L, Pittenger C (2016). "Microglial dysregulation in OCD, Tourette syndrome, and PANDAS". J Immunol Res (Review). doi:10.1155/2016/8606057. PMC 5174185. PMID 28053994.
  60. ^ a b Walkup, Mink & Hollenback (2006), p. xv.
  61. ^ a b c d Sukhodolsky, et al (2017), p. 246.
  62. ^ Rapanelli M, Pittenger C (July 2016). "Histamine and histamine receptors in Tourette syndrome and other neuropsychiatric conditions". Neuropharmacology (Review). 106: 85–90. doi:10.1016/j.neuropharm.2015.08.019. PMID 26282120.
  63. ^ Rapanelli M (February 2017). "The magnificent two: histamine and the H3 receptor as key modulators of striatal circuitry". Prog. Neuropsychopharmacol. Biol. Psychiatry (Review). 73: 36–40. doi:10.1016/j.pnpbp.2016.10.002. PMID 27773554.
  64. ^ Bolam JP, Ellender TJ (July 2016). "Histamine and the striatum". Neuropharmacology (Review). 106: 74–84. doi:10.1016/j.neuropharm.2015.08.013. PMC 4917894. PMID 26275849.
  65. ^ Sadek B, Saad A, Sadeq A, Jalal F, Stark H (October 2016). "Histamine H3 receptor as a potential target for cognitive symptoms in neuropsychiatric diseases". Behav. Brain Res. (Review). 312: 415–30. doi:10.1016/j.bbr.2016.06.051. PMID 27363923.
  66. ^ a b Walkup JT, Ferrão Y, Leckman JF, Stein DJ, Singer H (June 2010). "Tic disorders: some key issues for DSM-V" (PDF). Depress Anxiety (Review). 27 (6): 600–10. doi:10.1002/da.20711. PMID 20533370.
  67. ^ a b "Summary of Practice: Relevant changes to DSM-IV-TR". American Psychiatric Association. Retrieved December 29, 2011.
  68. ^ a b "What is DSM-IV-TR?". Psychnet-UK. Retrieved October 28, 2006.
  69. ^ a b c "What is Tourette syndrome?" (PDF). Tourette Association of America. Retrieved January 19, 2020.
  70. ^ a b c d e f Bagheri MM, Kerbeshian J, Burd L (April 1999). "Recognition and management of Tourette's syndrome and tic disorders". Am Fam Physician (Review). 59 (8): 2263–72, 2274. PMID 10221310.
  71. ^ a b c d e f g Scahill L, Erenberg G, Berlin CM, et al. (April 2006). "Contemporary assessment and pharmacotherapy of Tourette syndrome". NeuroRx (Review). 3 (2): 192–206. doi:10.1016/j.nurx.2006.01.009. PMC 3593444. PMID 16554257.
  72. ^ Ringman JM, Jankovic J (June 2000). "Occurrence of tics in Asperger's syndrome and autistic disorder". J. Child Neurol. (Case report). 15 (6): 394–400. doi:10.1177/088307380001500608. PMID 10868783.
  73. ^ Jankovic J, Mejia NI (2006). "Tics associated with other disorders". Adv Neurol (Review). 99: 61–8. PMID 16536352.
  74. ^ Freeman RD. "Tourette's syndrome: minimizing confusion". Roger Freeman, MD, blog. Archived from the original on April 11, 2006. Retrieved February 8, 2006.
  75. ^ a b Robertson MM (November 2008). "The prevalence and epidemiology of Gilles de la Tourette syndrome. Part 2: tentative explanations for differing prevalence figures in GTS, including the possible effects of psychopathology, aetiology, cultural differences, and differing phenotypes". J Psychosom Res (Comparative study). 65 (5): 473–86. doi:10.1016/j.jpsychores.2008.03.007. PMID 18940378.
  76. ^ a b c Singer HS (March 2005). "Tourette's syndrome: from behaviour to biology". Lancet Neurol (Review). 4 (3): 149–59. doi:10.1016/S1474-4422(05)01012-4. PMID 15721825.
  77. ^ Spencer T, Biederman J, Harding M, et al. (October 1998). "Disentangling the overlap between Tourette's disorder and ADHD". J Child Psychol Psychiatry (Comparative study). 39 (7): 1037–44. doi:10.1111/1469-7610.00406. PMID 9804036.
  78. ^ a b Sukhodolsky, et al (2017), p. 247
  79. ^ a b c Sukhodolsky, et al (2017), p. 248.
  80. ^ Martino D, Pringsheim TM, Cavanna AE, et al. (March 2017). "Systematic review of severity scales and screening instruments for tics: Critique and recommendations". Mov. Disord. (Review). 32 (3): 467–473. doi:10.1002/mds.26891. PMC 5482361. PMID 28071825.
  81. ^ Robertson MM (March 2000). "Tourette syndrome, associated conditions and the complexities of treatment" (PDF). Brain (Review). 123 (Pt 3): 425–62. doi:10.1093/brain/123.3.425. PMID 10686169.
  82. ^ a b Stern JS, Burza S, Robertson MM (January 2005). "Gilles de la Tourette's syndrome and its impact in the UK". Postgrad Med J (Review). 81 (951): 12–19. doi:10.1136/pgmj.2004.023614. PMC 1743178. PMID 15640424.
  83. ^ a b c d e Fründt O, Woods D, Ganos C (April 2017). "Behavioral therapy for Tourette syndrome and chronic tic disorders". Neurol Clin Pract (Review). 7 (2): 148–56. doi:10.1212/CPJ.0000000000000348. PMC 5669407. PMID 29185535.
  84. ^ Ganos C, Martino D, Pringsheim T (2017). "Tics in the Pediatric Population: Pragmatic Management". Mov Disord Clin Pract (Review). 4 (2): 160–172. doi:10.1002/mdc3.12428. PMC 5396140. PMID 28451624.
  85. ^ Sudhodolsky, et al (2017), p. 250.
  86. ^ a b Bloch MH, Leckman JF (December 2009). "Clinical course of Tourette syndrome". J Psychosom Res (Review). 67 (6): 497–501. doi:10.1016/j.jpsychores.2009.09.002. PMC 3974606. PMID 19913654.
  87. ^ Woods DW, Himle MB, Conelea CA (2006). "Behavior therapy: other interventions for tic disorders". Adv Neurol (Review). 99: 234–40. PMID 16536371.
  88. ^ Schapiro NA (2002). ""Dude, you don't have Tourette's:" Tourette's syndrome, beyond the tics". Pediatr Nurs (Review). 28 (3): 243–46, 249–53. PMID 12087644. See also Bloch, State, Pittenger (2011), PMID 21386676
  89. ^ Zinner SH (August 2004). "Tourette syndrome—much more than tics". Contemporary Pediatrics. 21 (8): 22–49. Archived September 30, 2007, at the Wayback Machine Archived September 30, 2007, at the Wayback Machine
  90. ^ Kumar A, Duda L, Mainali G, Asghar S, Byler D (2018). "A comprehensive review of Tourette syndrome and complementary alternative medicine". Curr Dev Disord Rep (Review). 5 (2): 95–100. doi:10.1007/s40474-018-0137-2. PMC 5932093. PMID 29755921.
  91. ^ a b c Fraint A, Pal G (2015). "Deep brain stimulation in Tourette's syndrome". Front Neurol (Review). 6: 170. doi:10.3389/fneur.2015.00170. PMC 4523794. PMID 26300844.
  92. ^ Viswanathan A, Jimenez-Shahed J, Baizabal Carvallo JF, Jankovic J (2012). "Deep brain stimulation for Tourette syndrome: target selection". Stereotact Funct Neurosurg (Review). 90 (4): 213–24. doi:10.1159/000337776. PMID 22699684.
  93. ^ Baxter, Kevin (October 5, 2019). "Column: Tim Howard, whose career is likely to end Sunday, will retire as the best U.S. goalkeeper ever". Los Angeles Times. Retrieved December 28, 2019.
  94. ^ a b Howard T (December 6, 2014). "Tim Howard: Growing up with Tourette syndrome and my love of football". The Guardian. Archived from the original on November 15, 2016. Retrieved March 21, 2015.
  95. ^ a b Knight T, Steeves T, Day L, Lowerison M, Jette N, Pringsheim T (August 2012). "Prevalence of tic disorders: a systematic review and meta-analysis". Pediatr. Neurol. (Review). 47 (2): 77–90. doi:10.1016/j.pediatrneurol.2012.05.002. PMID 22759682.
  96. ^ Burd L, Kerbeshian PJ, Barth A, Klug MG, Avery PK, Benz B (June 2001). "Long-term follow-up of an epidemiologically defined cohort of patients with Tourette syndrome". J. Child Neurol. 16 (6): 431–37. doi:10.1177/088307380101600609. PMID 11417610.
  97. ^ Pappert EJ, Goetz CG, Louis ED, Blasucci L, Leurgans S (October 2003). "Objective assessments of longitudinal outcome in Gilles de la Tourette's syndrome". Neurology. 61 (7): 936–40. doi:10.1212/01.wnl.0000086370.10186.7c. PMID 14557563.
  98. ^ a b c d Evans J, Seri S, Cavanna AE (September 2016). "The effects of Gilles de la Tourette syndrome and other chronic tic disorders on quality of life across the lifespan: a systematic review". Eur Child Adolesc Psychiatry (Review). 25 (9): 939–48. doi:10.1007/s00787-016-0823-8. PMC 4990617. PMID 26880181.
  99. ^ Leckman & Cohen (1999), p. 37. "For example, individuals who were misunderstood and punished at home and at school for their tics or who were teased mercilessly by peers and stigmatized by their communities will fare worse than a child whose interpersonal environment was more understanding and supportive."
  100. ^ Cohen DJ, Leckman JF, Pauls D (1997). "Neuropsychiatric disorders of childhood: Tourette's syndrome as a model". Acta Paediatr Suppl. Scandinavian University Press. 422: 106–11. The individuals with TS who do the best, we believe, are: those who have been able to feel relatively good about themselves and remain close to their families; those who have the capacity for humor and for friendship; those who are less burdened by troubles with attention and behavior, particularly aggression; and those who have not had development derailed by medication.
  101. ^ Cohen, Jankovic & Goetz (2001), p. xviii.
  102. ^ Abuzzahab FE, Anderson FO (June 1973). "Gilles de la Tourette's syndrome; international registry". Minn Med. 56 (6): 492–96. PMID 4514275.
  103. ^ a b c Scahill L. "Epidemiology of tic disorders" (PDF). Medical letter: 2004 retrospective summary of TS literature. Tourette Syndrome Association. Retrieved June 11, 2007.
  104. ^ Bloch, State, Pittenger 2011. See also Zohar AH, Apter A, King RA, et al (1999). "Epidemiological studies" in Leckman & Cohen (1999), pp. 177–92.
  105. ^ Bloch, State, Pittenger 2011. See also Schapiro 2002 and Coffey BJ, Park KS (May 1997). "Behavioral and emotional aspects of Tourette syndrome". Neurol Clin (Review). 15 (2): 277–89. doi:10.1016/s0733-8619(05)70312-1. PMID 9115461.
  106. ^ Hawley JS (June 23, 2008). "Tourette syndrome". eMedicine. Retrieved August 10, 2009.
  107. ^ Leckman JF (November 2002). "Tourette's syndrome". Lancet (Review). 360 (9345): 1577–86. doi:10.1016/S0140-6736(02)11526-1. PMID 12443611.
  108. ^ Teive HA, Chien HF, Munhoz RP, Barbosa ER (December 2008). "Charcot's contribution to the study of Tourette's syndrome". Arq Neuropsiquiatr (Historical biography). 66 (4): 918–21. doi:10.1590/s0004-282x2008000600035. PMID 19099145. As reported in Finger S (1994). "Some movement disorders." Origins of neuroscience: the history of explorations into brain function. New York: Oxford University Press. pp. 220–39.
  109. ^ Germiniani FM, Miranda AP, Ferenczy P, Munhoz RP, Teive HA (July 2012). "Tourette's syndrome: from demonic possession and psychoanalysis to the discovery of gene". Arq Neuropsiquiatr (Historical review). 70 (7): 547–49. doi:10.1590/s0004-282x2012000700014. PMID 22836463.
  110. ^ Itard J (1825). "Mémoire sur quelques functions involontaires des appareils de la locomotion, de la préhension et de la voix". Arch Gen Med. 8: 385–407. As cited in Newman S (2006). "Study of several involuntary functions of the apparatus of movement, gripping, and voice by Jean-Marc Gaspard Itard (1825)". History of Psychiatry. 17: 333–39. doi:10.1177/0957154X06067668.
  111. ^ "What is Tourette syndrome?". Tourette Syndrome Association. Retrieved January 14, 2012.
  112. ^ Gilles de la Tourette G, Goetz CG, Llawans HL (1982). "Étude sur une affection nerveuse caractérisée par de l'incoordination motrice accompagnée d'echolalie et de coprolalie". Advances in Neurology: Gilles de la Tourette Syndrome. 35: 1–16.. As discussed at Black KJ (March 30, 2007). "Tourette syndrome and other tic disorders". eMedicine. Retrieved August 10, 2009. Also Original text (in French). Archived January 19, 2012, at the Wayback Machine Retrieved on August 10, 2009.
  113. ^ Robertson MM, Reinstein DZ (1991). "Convulsive tic disorder: Georges Gilles de la Tourette, Guinon and Grasset on the phenomenology and psychopathology of Gilles de la Tourette syndrome". Behavioural Neurology. 4 (1): 29–56.
  114. ^ Enersen OD. Georges Albert Édouard Brutus Gilles de la Tourette. Archived March 9, 2005, at the Wayback Machine WhoNamedIt.com Retrieved on May 14, 2007.
  115. ^ a b Blue T (2002). Tourette syndrome. Essortment, Pagewise Inc. Retrieved on August 10, 2009.
  116. ^ Rickards H, Hartley N, Robertson MM (September 1997). "Seignot's paper on the treatment of Tourette's syndrome with haloperidol. Classic Text No. 31". Hist Psychiatry (Historical biography). 8 (31 Pt 3): 433–36. doi:10.1177/0957154X9700803109. PMID 11619589.
  117. ^ Gadow KD, Sverd J (2006). "Attention deficit hyperactivity disorder, chronic tic disorder, and methylphenidate". Adv Neurol (Review). 99: 197–207. PMID 16536367.
  118. ^ Brody JE (May 29, 1975). "Bizarre outbursts of Tourette's disease victims linked to chemical disorder in brain". The New York Times. Retrieved January 19, 2020.
  119. ^ Walkup, Mink & Hollenback (2006), pp. xvi–xviii.
  120. ^ Sacks O (1985). The Man Who Mistook His Wife for a Hat. Harper and Row, New York. pp. 92–100. ISBN 0-684-85394-9
  121. ^ Leckman & Cohen (1999), p. 408.
  122. ^ Leckman & Cohen (1999), pp. 18–19, 148–51, 408.
  123. ^ Portraits of adults with TS. Tourette Syndrome Association. Retrieved from July 16, 2011 archive.org version on December 21, 2011.
  124. ^ Samuel Johnson. Tourette Syndrome Association. Retrieved from April 7, 2005 archive.org version on December 30, 2011.
  125. ^ Pearce JM (July 1994). "Doctor Samuel Johnson: 'the great convulsionary' a victim of Gilles de la Tourette's syndrome". J R Soc Med (Historical biography). 87 (7): 396–9. PMC 1294650. PMID 8046726.
  126. ^ Keilman J (January 22, 2015). "Reviews: The Game of Our Lives by David Goldblatt, The Keeper by Tim Howard". Chicago Tribune. Archived from the original on April 2, 2015. Retrieved March 21, 2015.
  127. ^ Tim Howard receives first-ever Champion of Hope Award from the National Tourette Syndrome Association. Archived March 30, 2015, at the Wayback Machine Tourette Syndrome Association. October 14, 2014. Retrieved on March 21, 2015.
  128. ^ Simkin B (1992). "Mozart's scatological disorder". BMJ (Historical biography). 305 (6868): 1563–67. doi:10.1136/bmj.305.6868.1563. PMC 1884718. PMID 1286388. Also see: Simkin, Benjamin. Medical and musical byways of Mozartiana. Fithian Press. 2001. ISBN 1-56474-349-7 Review Archived December 7, 2005, at the Wayback Machine, Retrieved on May 14, 2007.
  129. ^ a b Did Mozart really have TS? Tourette Syndrome Association. Retrieved from April 7, 2005 archive.org version on December 30, 2011.
  130. ^ Mozart:
  131. ^ Voss H (October 2012). "The representation of movement disorders in fictional literature". J. Neurol. Neurosurg. Psychiatry (Review). 83 (10): 994–9. doi:10.1136/jnnp-2012-302716. PMID 22752692.
  132. ^ Calder-Sprackman S, Sutherland S, Doja A (March 2014). "Tourette syndrome in film and television" (PDF). The Canadian Journal of Neurological Sciences, Ind. 41 (2): 226–32.
  133. ^ Lim Fat MJ, Sell E, Barrowman N, Doja A (2012). "Public perception of Tourette syndrome on YouTube". Journal of Child Neurology. 27 (8): 1011–16.
  134. ^ Holtgren B (January 11, 2006). "Truth about Tourette's not what you think". Cincinnati Enquirer. As medical problems go, Tourette's is, except in the most severe cases, about the most minor imaginable thing to have. ... the freak-show image, unfortunately, still prevails overwhelmingly. The blame for the warped perceptions lies overwhelmingly with the video media—the Internet, movies and TV. If you search for 'Tourette' on Google or YouTube, you'll get a gazillion hits that almost invariably show the most outrageously extreme examples of motor and vocal tics. Television, with notable exceptions such as Oprah, has sensationalized Tourette's so badly, for so long, that it seems beyond hope that most people will ever know the more prosaic truth.
  135. ^ US media:
  136. ^ UK media:
  137. ^ Swerdlow NR (September 2005). "Tourette syndrome: current controversies and the battlefield landscape". Curr Neurol Neurosci Rep. 5 (5): 329–31. doi:10.1007/s11910-005-0054-8. PMID 16131414.
  138. ^ Georgitsi M, Willsey AJ, Mathews CA, State M, Scharf JM, Paschou P (2016). "The genetic etiology of Tourette syndrome: large-scale collaborative efforts on the precipice of discovery". Front Neurosci. 10: 351. doi:10.3389/fnins.2016.00351. PMC 4971013. PMID 27536211.

Book sources

  • Cohen DJ, Jankovic J, Goetz CG, eds (2001). Advances in Neurology, Tourette Syndrome. 85. Philadelphia, PA: Lippincott, Williams & Wilkins. ISBN 0-7817-2405-8
  • Jankovic J (2014). Movement Disorders, An Issue of Neurologic Clinics. 33-1. The Clinics: Radiology: Elsevier. ISBN 978-0323354462
  • Leckman JF, Cohen DJ (1999). Tourette's Syndrome—Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care. John Wiley & Sons, Inc., New York. ISBN 0-471-16037-7
  • Sukhodolsky DG, Gladstone TR, Kaushal SA, Piasecka JB, Leckman JF (2017). "Tics and Tourette Syndrome". In Matson JL (ed.). Handbook of Childhood Psychopathology and Developmental Disabilities Treatment. Autism and Child Psychopathology Series. Springer. pp. 241–56. doi:10.1007/978-3-319-71210-9_14.
  • Walkup JT, Mink JW, Hollenback PJ, eds (2006). Advances in Neurology, Tourette Syndrome. 99. Philadelphia, PA: Lippincott, Williams & Wilkins. ISBN 0-7817-9970-8.

Further reading

External links

Classification
External resources