An Introduction to the Clinical Phenomenology of Tourette Syndrome

Centre for Neuroscience and Trauma, Queen Mary University of London, London, United Kingdom
International Review of Neurobiology (Impact Factor: 1.92). 12/2013; 112:1-33. DOI: 10.1016/B978-0-12-411546-0.00001-9
Source: PubMed


Tourette syndrome (TS) is the primary tic disorder that reaches most commonly medical attention and monitoring, with an estimated prevalence close to 1% between 5 and 18 years of age. Motor and phonic tics are the core features of TS. In addition to their well-characterized phenomenology, tics display a peculiar variability over time, which is strongly influenced by a variety of contextual factors. The sensory phenomena of TS are increasingly recognized as another crucial symptom of TS and consist of premonitory urges and somatic hypersensitivity. A relevant proportion of patients with TS display complex, tic-like, repetitive behaviors that include echophenomena, coprophenomena, and nonobscene socially inappropriate behaviors (NOSIBs). The burden of behavioral comorbidities is very important in determining the degree of disability of TS patients. Only a small minority of TS patients presents exclusively with a tic disorder. Obsessive-compulsive symptoms and related disorder (OCD) are common in TS, and the clinical distinction between compulsions and complex tics may be difficult in some cases. Probably, the presence of comorbid attention deficit hyperactivity disorder (ADHD) is the main determinant of cognitive dysfunction in TS patients and influences heavily also the risk of developing disruptive behaviors. Affective disorders, impulse control disorders, autism spectrum disorders, and personality disorders complete the wide psychopathological spectrum of this condition, but have been less investigated than OCD and ADHD. The complexity of the Tourette spectrum has been confirmed by cluster and factor analytical approaches, and is likely to inform the study of the genetic basis of this disorder, as well as future reappraisal of its nosography, with the development of novel clinical subtypes.

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    ABSTRACT: The strong genetic link between obsessive compulsive disorder (OCD) and Tourette syndrome (TS) raises the possibility that obsessions and compulsions may comprise an alternative phenotypic expression of tics. Both of these disorders are characterised by repetitive behaviours (RB) involving recurrent thoughts and/or actions, often linked to dangerous or taboo themes, which present fairly early in life and tend to follow a chronic waxing and waning course. Over time many studies have attempted to disentangle the clinical profiles of these disorders. This article explores the key differences revealed by research over the last few decades, examining the types of RB expressed, patients’ accompanying phenomenological experience (e.g. cognitive and sensory correlates), the proposed neural bases for each condition, and common interventions. Attempts to distinguish between OCD and TS based on the specific types of RB have often met with limitations. However, existing literature pertaining to the phenomenological experience of OCD and TS indicates that a number of factors may help differentiate these commonly associated conditions. Furthermore, differences in the psychological and physiological correlates of RB in TS and OCD are broadly in accordance with neuroimaging data. Study findings could offer insight into the predominance of TS diagnosis in males, age-related changes in diagnoses and the association between more context-dependent tic-like behaviours and OCD in patients with TS. Future studies should explore relationships between the cognitive, emotional and sensory aspects of RB and patients’ demographical characteristics, neuropsychological test performance, and neural profiles.
    Journal of Obsessive-Compulsive and Related Disorders 04/2014; 3(4). DOI:10.1016/j.jocrd.2014.04.003 · 1.18 Impact Factor
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    ABSTRACT: In this update we review our past publications on this topic and add new information on Tourette syndrome (TS) and speech and language disorders. The phenotype for TS is comprised of vocal and motor tics. The vocal tics are expressed as simple and complex, and in nearly all cases share the same neurolinguistic mechanisms of speech and language for insertion into speech and discourse. The tics are typically inserted into ongoing speech at pauses, points of change in inflection, and are typically without meaning. Adherence to segmental, lexical, and suprasegmental rules of linguistics suggest the role of tic selection; expression and elimination of tics involves multiple linguistic mechanisms which are poorly understood. TS increases the risk for clinically significant speech and language disorders.
    12/2014; 1(4). DOI:10.1007/s40474-014-0027-1
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    ABSTRACT: Goal: The aim of this study was to investigate the normalization of the intrinsic functional activity and connectivity of TS adolescents before and after the cranial electrotherapy stimulation (CES) with alpha stim device. Methods: We performed resting-state functional magnetic resonance imaging on eight adolescents before and after CES with mean age of about nine years old who had Tourette's syndrome with moderate to severe tics symptom. Independent component analysis (ICA) with hierarchical partner matching method was used to examine the functional connectivity between regions within cortico-striatothalamo- cortical (CSTC) circuit. Granger causality was used to investigate effective connectivity among these regions detected by ICA. We then performed pattern classification on independent components with significant group differences which served as endophenotype markers to distinguish the adolescents between TS and the normalized ones after CES. Results: Results showed that TS adolescents after CES treatment had stronger functional activity and connectivity in anterior cingulate cortex (ACC), caudate and posterior cingulate cortex while had weaker activity in supplementary motor area within the motor pathway compared with TS before CES. Conclusion: The results suggest that the functional activity and connectivity in motor pathway was suppressed while activities in the control portions within CSTC loop including ACC and caudate were increased in TS adolescents after CES compared with adolescents before CES. Significance: The normalization of the balance between motor and control portions of the CSTC circuit may result in the recovery of TS adolescents.
    IEEE transactions on bio-medical engineering 12/2014; 62(5). DOI:10.1109/TBME.2014.2385151 · 2.35 Impact Factor
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