Premonitory sensory phenomena and suppressibility of tics in Tourette syndrome: Developmental aspects in children and adolescents

Department of Child and Adolescent Psychiatry, University of Göttingen, Göttingen, Germany.
Developmental Medicine & Child Neurology (Impact Factor: 3.51). 11/2003; 45(10):700-3. DOI: 10.1017/S0012162203001294
Source: PubMed

ABSTRACT Although premonitory sensory phenomena (PSP) and suppressibility of tics (SPT) are important in Tourette syndrome not only when behavioural therapeutic approaches in children are considered, there is a lack of developmental information on these phenomena. Therefore, a cross-sectional survey of these factors in children and adolescents was carried out. Rates of PSP and SPT were gathered using a questionnaire for the assessment of Tourette syndrome. The 254 outpatients (212 males, 42 females) with Tourette syndrome investigated had an age range of 8 to 19 years, normal intelligence, and diagnosis according to DSM-IV-TR/ICD-10. To test for developmental effects, the total group was stratified into three age groups (8 to 10, 11 to 14, and 15 to 19 years). Data were statistically evaluated using chi2 tests. Of the 254 participants, 37% reported PSP, while 64% were able to suppress their tics. Only a subgroup of 119 patients gave unequivocal answers to both questions and only 60% of these experienced both PSP and SPT. Statistically significant stepwise increases were found at two different age levels. One was around 10 years (PSP 'Yes' or 'No' and SPT), the other around age 14 (PSP 'Yes'). There was no influence of tic duration and age at tic onset on PSP/SPT. The reported data suggest that PSP is experienced rarely in younger children with Tourette syndrome and is not a necessary prerequisite for SPT. Increasing PSP with age merely seems to reflect cognitive development rather than intrinsic aspects of Tourette syndrome. In children under 10 years of age, SPT might require more awareness of tics than in older age groups. Developmental aspects of PSP and SPT should be taken into consideration when studies of cognitive behavioural treatment for children and adolescents with Tourette syndrome are planned.

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    • "In this case, TS might involve not only a movement disorder but also a pathologic conscious experience of action. Although this abnormal experience of conscious will does not account for the generation of tics, it could explain why patients with TS are sometimes unable to detect them in advance and thereby fail to suppress the stereotyped movements.31,90,91 Interestingly, reduced awareness of self-initiated movements has been documented in other disorders characterized by hyperdopaminergic states, such as Huntington's disease and levodopa-induced dyskinesias.93,94 "
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    ABSTRACT: Tourette syndrome (TS) is a neuropsychiatric disorder characterized by the chronic presence of multiple motor tics and at least one vocal/phonic tic since childhood. Tics typically change and vary in both intensity and severity over time, with remission and exacerbation common. In the vast majority of patients, tic expression is characteristically accompanied by discomforting bodily sensations, known as sensory phenomena or premonitory urges. We reviewed the existing literature on premonitory urges associated with the sense of voluntariness of action in TS. Although the wish to move is perceived by the patient as involuntary, the decision to release the tic is often perceived by the patient as a voluntary capitulation to the subjective urge. Most patients with TS can exert a degree of control over the urge and constantly try to inhibit the movement. Based on these features, it has been suggested that tics performed in response to an urge to move should be classified as 'unvoluntary', as opposed to voluntary or involuntary acts. However, recent experimental data suggest that the brain areas involved in the generation of the wish to act show considerable overlap between healthy subjects and patients with TS. The simultaneous presence of both voluntary and involuntary aspects in the expression of tic symptoms by patients with TS is consistent with the hypothesis that tics can have the same neurophysiologic substrate as voluntary acts, even though they are misperceived as being involuntary. This reinforces the view of TS as a hyperkinetic movement disorder primarily affecting the conscious experience of action.
    09/2013; 3.
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    • "In both scenarios final motor output is prepared in the primary motor cortex (M1) (Haggard, 2008). Whether or not tics are voluntary has been a matter of debate for a long time (Duggal and Nizamie, 2002; Karp et al., 1996; Obeso et al., 1982) and could probably be resolved only by a multi-modal approach considering the individual perception of premonitory urges before each tic (Banaschewski et al., 2003). It is also unclear whether they are primarily driven internally or externally. "
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    ABSTRACT: Gilles de la Tourette syndrome (GTS) holds a prime position as a disorder transgressing the brittle boundaries of neurology and psychiatry with an entangling web of motor and behavioural problems. With tics as the disorder's hallmark and myriads of related signs such as echo-, pali- and coprophenomena, paralleled by a broad neuropsychiatric spectrum of comorbidities encompassing attention deficit hyperactivity disorder, obsessive-compulsive disorder but also self-injurious behaviour and depression, GTS pathophysiology remains enigmatic. In this review, in the light of GTS phenomenology, we will focus on current theories of tic-emergence related to aberrant activity in the basal ganglia and abnormal basal ganglia - cortex interplay through cortico-striato-thalamocortical loops from an anatomical, neurophysiological and functional-neuroimaging perspective. We will attempt a holistic view to the countless major and minor drawbacks of the GTS brain and comment on future directions of neuroscientific research to elucidate this common and complex neuropsychiatric syndrome, which merits scientific understanding and social acceptance.
    Neuroscience & Biobehavioral Reviews 12/2012; 37(6). DOI:10.1016/j.neubiorev.2012.11.004 · 8.80 Impact Factor
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    • "Predominantly complex tics (Cluster 1) exhibited a unique association with premonitory urges while controlling for age. Although it has been proposed that age is a critical factor in the development of premonitory urges (Banaschewski et al. 2003), the present results are consistent with the notion that tic complexity may also play an important role (Woods et al. 2005). As a consequence, treatment of complex tics may particularly benefit from an emphasis on reducing experience of or habituating to unpleasant premonitory sensations (Himle et al. 2006). "
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    ABSTRACT: Tic disorders are heterogeneous, with symptoms varying widely both within and across patients. Exploration of symptom clusters may aid in the identification of symptom dimensions of empirical and treatment import. This article presents the results of two studies investigating tic symptom clusters using a sample of 99 youth (M age = 10.7, 81% male, 77% Caucasian) diagnosed with a primary tic disorder (Tourette's disorder or chronic tic disorder), across two university-based outpatient clinics specializing in tic and related disorders. In Study 1, a cluster analysis of the Yale Global Tic Severity Scale (YGTSS) identified four symptom dimensions: predominantly complex tics; simple head/face tics; simple body tics; and simple vocal/facial tics. In Study 2, these clusters were shown to be differentially associated with demographic and clinical characteristics. Findings lend support to prior research on tic phenomenology, help to organize treatment goals, and suggest symptom dimensions of tic disorders for further evaluation.
    Journal of Abnormal Child Psychology 04/2010; 38(6):777-88. DOI:10.1007/s10802-010-9410-5 · 3.09 Impact Factor
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