Tourette syndrome and tic disorders: A decade of progress

Child Study Center of Yale University, New Haven, CT, USA.
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 6.35). 09/2007; 46(8):947-68. DOI: 10.1097/chi.0b013e318068fbcc
Source: PubMed

ABSTRACT This is a review of progress made in the understanding of Tourette syndrome (TS) during the past decade including models of pathogenesis, state-of-the-art assessment techniques, and treatment.
Computerized literature searches were conducted under the key words "Tourette syndrome," "Tourette disorder," and "tics." Only references from 1996-2006 were included.
Studies have documented the natural history of TS and the finding that tics usually improve by the end of the second decade of life. It has also become clear that TS frequently co-occurs with attention-deficit/hyperactivity disorder), obsessive-compulsive disorder, and a range of other mood and anxiety disorders. These comorbid conditions are often the major source of impairment for the affected child. Advances have also been made in understanding the underlying neurobiology of TS using in vivo neuroimaging and neurophysiology techniques. Progress on the genetic front has been less rapid. Proper diagnosis and education (involving the affected child and his or her parents, teachers, and peers) are essential prerequisites to the successful management of children with TS. When necessary, modestly effective antitic medications are available, although intervening to treat the comorbid attention-deficit/hyperactivity disorder and/or obsessive-compulsive disorder is usually the place to start.
Prospective longitudinal studies and randomized clinical trials have led to the refinement of several models of pathogenesis and advanced our evidence base regarding treatment options. However, fully explanatory models are needed that would allow for more accurate prognosis and the development of targeted and efficacious treatments.

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Available from: James E Swain, Aug 30, 2015
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    • "The onset of TD occurs in childhood and the prevalence is higher in males than in females (4.3: 1) [1,2]. Of school-aged children, 6%–20% experience transient tics and 0.5%–1% suffer from chronic tics or TD [3]. TD usually has a familial component [2]. "
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    • "The pathology is characterized by the presence of tics, which are rapid, stereotyped movements and vocalizations, virtually involving all body segments (Vicario et al., 2010). The neuro-functional profile of childhood TS is characterized by impairment of neural circuits linking the cerebral cortex to the striatum and other sub-cortical regions (Swain et al., 2007; Bush, 2011). "
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    • "Interestingly, these results are consistent with observations that, for instance, activities that require focused attention and fine motor dexterity, such as playing a musical instrument are frequently associated with the momentary disappearance of tics (Swain et al., 2007). "
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