Transcript Tourette - neuro - neuropsych

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Neurological disorder
Involuntary body movements and vocal outbursts (tics)
 Needs to be present for at least twelve months
 Can not be caused by medication
 The onset of Tourette Syndrome is prior to age 18
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First case study was completed by Jean-Marc
Itard, a French neurologist in 1825.
In 1855, Georges Albert de la Edouard Brutus
Gilles de la Tourette detailed accounts of many
case studies
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Movement Tics
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Involve head, torso,
and upper or lower limb
movements that the
patient is unable to
control
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Verbal Tics
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Coprolalia
 Uttering obscenities
 Occurs in only about
10% of people
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Various words or
sounds including
 Clicks, grunts, yelps,
barks, sniffs, snorts, and
coughs
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Begin in early childhood
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Between age 3 to 8
Tics gradually worsen in severity and frequency
Adolescence is when they are the most severe
Can be triggered or made worse by stress
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Occurs in 4 to 5 people out of 10,000
Higher incidence rate in boys than girls
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1.5 to 3 times more often
90 percent of individuals with Tourette
experience a remission of symptoms in adulthood
40 percent will become symptom free by age 18
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Obsessive Compulsive Disorder
Learning Disorders
Attention-deficit/hyperactivity Disorder
Distractibility
 Impulsivity
 Hyperactivity
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Basal Ganglia
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Is involved with the control of movement
Has three parts, two of which are thought to be involved with
Tourette
 Caudate and Putamen
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Striate (Primary Visual Cortex)
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Sensitive to orientation and movement
The ventral Striate is related to habits and patterns of movement
Thalamus
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Receives sensory information from sensory systems
Relay sensory information to specific areas in the cerebral cortex
The ventrolateral nucleus of the Thalamus is thought to be
important in Tourette
 It projects information from the cerebellum to the primary motor
cortex
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Motor Cortex
Made of the Motor Association Cortex and the
Primary Motor Cortex
 Involved in planning and executing movements
(Association Cortex)
 Neurons are connected to various parts of the body
(Motor Cortex)
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Broca’s Area
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Contains motor memories needed to articulate sound
Caption: Tourette syndrome and
other tic disorders. Segregated
anatomy of the frontal-sub
cortical circuits: dorsolateral
(blue), lateral orbitofrontal
(green), and anterior cingulate
(red) circuits in the striatum (top),
pallidum (center), and
mediodorsal thalamus (bottom).
Frey, Kirk, A., Albin, Roger, L. (2006). Neuroimaging of tourette
syndrome. Journal of Child Neurology, 21, 672-677
Brain Imaging of control in the first row
Brain Imaging of Tourette patient in middle row
Comparison in bottom row
Looking at the basal ganglia
Neurotransmitters Dopamine and Serotonin
are implicated
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Dopamine is a neurotransmitter involved in many activities
including movement
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Some studies suggest there is a higher pre-synaptic dopamine
function in the caudate nucleus, putamen, and frontal cortex
Other studies suggest there are more Dopamine binding sites in
the caudate nucleus
Dopamine is synthesized in four pathways
 Nigrostriatal: pathway involved with control of movements and
localized in caudate and putamen
 Mesocortical: innervates regions of frontal cortex (motor cortex and
motor association cortex)
 Mesolimbic: deals with the ventral striatum, olfactory tubercle and
parts of the limbic system
 Tuberinfundibular: involved in parts of the brain that deal with
stress
(Collins, J & McCabe, P.)
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Serotonin controls mood, eating, sleeping, and
arousal
Serotonin levels of patients with Tourette is
lower than those without
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Serotonin neurotransmitters bind to receptor cites at a
lower ratio
OCD may be the result of low Serotonin levels in
those with Tourette Syndrome
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Medications do not eliminate symptoms, but can be
used to control them
Medications block the D2 receptors to prevent
Dopamine from binding to the cites
Antagonists for Dopamine are used to treat
Tourette
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Risperidone, Olanzapine, Ziprasidone, Sulpiride, Tiapride
Neuroleptics a the category of medications used to
treat Tourette
Haloperidol, Pimozide, Fluphenazine, Trifluoperazine
 Blocks post-synaptic dopamine sites
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Approximately 40% of students with Tourette also
have a learning disability
Detailed records of behavior is needed to diagnose
Tourette because there is no known test to determine
it
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Stress, excitement and fatigue may make tics worse
Provide information to parents, teachers and the child
with Tourette
 Provide a support system for children with Tourette,
as they may have significant social problems
(Collins, J. & McCabe, P.)
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Black, Kevein, J., , , . Tourette syndrome and other tic disorders. (2007, March
30). Retrieved May 19, 2007, from www.emedicine.com/neuro/topic664.htm
Collins, J. &McCabe, P. (2004, Nov.) Neurochemical bases of tourette
syndrome and implications for school psychologists. NASPCommunique.
Retrieved May 20, 2007 from
www.nasponline.org/publications/cq/mocq333pedsp_tourette.aspx
Retrieved May 2, 2007, from www.faculty.washington.edu
Retrieved May 2, 2007, from www.ninds.nih.gov
Frey, Kirk, A., Albin, Roger, L. (2006). Neuroimaging of tourette syndrome.
Journal of Child Neurology, 21, 672-677.
Gerard, Elizabeth, & Pererson, Bradley, S. (2003). Developmental processes
and brain imaging studies in tourette syndrome. Journal of Psychomatic
Research, 55, 13-22.
Harris, Kendra, & Singer, Harvey, S. (2006). Tic disorders: neural circuits,
neurochemistry, and neuroimmunology. Journal of Child Neurology, 21, 678689.
Marshall, Ed, Paul. Retrieved May 2, 2007, from www.tourettes-disorder.com