Transcript Fetal Alcohol Spectrum Disorder (FASD)

Tourette Syndrome (TS)
• TS is a neurodevelopmental disorder that is
characterized by involuntary motor movements and
vocalizations called Tics1
• Tics are rapid, repetitive, and stereotyped movements or
vocalizations
– The quantity and complexity of the tics fluctuate over time
• TS is a chronic condition that is frequently associated
with difficulties in self-esteem, school performance,
social acceptance, and family life.
• TS is chronic and usually emerges between ages 2 to 15
(~50% affected by age 7) 1-2
• TS is more common in males than females by a ratio of
about 5 to 1. 1-2
• TS is not a rare disorder, with the number of children
affected estimated to be 7 in 1000. 1-2
Other Characteristics of TS
• Other symptoms associated with TS: 3-4
– speech and conduct problems
– mood instability, anxiety, obsessive-compulsive symptoms
– impulsivity, distractibility, motor hyperactivity,
– learning problems
• Common Co-morbidities:
– ADHD (55%)5
– Obsessive-Compulsive Disorder (OCD) (20-60%)6-8
– Referred to as ‘TS-plus’
– More severe tics, higher the psychiatric co-morbidity
• Neuropsychological deficits9
Causes of TS
• Serotonogic & dopaminergic neurotransmitter systems1
– Tics and comorbidities improve with use of SSRIs and
dopamine-receptor blockers
• TS has been linked to disruption of brain areas:1,10,11
– Frontal areas
– basal ganglia
– Caudate
• Genetics plays a role1
– Relatives have higher rates of Tics, OCD, and ADHD
– High concordance rate in monozygotic twins
Prognosis
• Tics peak between 8 and 12 years12
• Most Tics are gone by adulthood (only 20% still have
significant Tics in adulthood)12
• Treatment:1
– Medications
– Behavior Therapy
– Counseling
– Cognitive therapy
– Relaxation theory
– Awareness and assertiveness training
– Habit reversal training
References
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Lekman J, Yeh C, Lombroso P. Neurobiology of tic disorders, including Tourette's Syndrome. Pediatric
Psychopharmacology: Oxford University Press. 2003;164-174.
Shapiro A, Shapiro E, Young J, Feinberg T, eds. Gilles de la Tourette Syndrome, 2nd ed. New York: Raven
Press;1988.
Freeman R. Tic disorders and ADHD: Answers from a world-wide clinical dataset on Tourette Syndrome. Eur
Child Adolesc Psychiatry. 2007;16(Suppl 1):15-23.
Apter A, Pauls D, Bleich A, et al. An epidemiologic study of Gilles de la Tourette's Syndrome in Israel. Arch
Gen Psychiatry. 1993;50:734-738.
Cath D, Spinhoven P, van Woerkom T, et al. Gilles de la Tourette's Syndrome with and without obsessivecompulsive disorder compared with obsessive-compulsive disorder without tics: Which symptoms
discriminate? J Nerv Ment Dis. 2001;189:219-228.
Pitman R, Green R, Jenike M, Mesulam M. Clinical comparison of Tourette's disorder and obsessivecompulsive disorder. Am J Psychiatry. 1987;144:1166-1171.
Bornstein R, King G, Carroll A. Neuropsychological abnormalities in Gilles de la Tourette's Syndrome. J Nerv
Ment Dis. 1983;171:497-502.
Robertson M. Tourette Syndrome, associated conditions and the complexities of treatment. Brain. 2000;123(Pt
3):425-462.
Mink JW. Neurobiology of basal ganglia circuits in Tourette Syndrome: Faulty inhibition of unwanted motor
patterns? Adv Neurol. 2001;85:113-122.
Leckman, JF., Bloch, M., Scahill, L., & King, R. (2006). Tourette Syndrome: The self under siege, Journal of
Child Neurology, 21.