Article

Caudate volumes in childhood predict symtom severity in adults with Tourette syndrome

Yale University, New Haven, Connecticut, United States
Neurology (Impact Factor: 8.29). 11/2005; 65(8):1253-8. DOI: 10.1212/01.wnl.0000180957.98702.69
Source: PubMed

ABSTRACT

Most children with Tourette syndrome (TS) experience a marked decline in the severity of tic symptoms during adolescence. Currently no clinical measures can predict whose tic symptoms will persist into adulthood. Previous cross-sectional imaging studies have identified reduced caudate nucleus volumes in subjects with TS.
To evaluate whether caudate nucleus volumes in childhood can predict the severity of tic or obsessive-compulsive symptoms at follow-up in early adulthood.
In a prospective longitudinal study, clinical status and basal ganglia volumes of 43 children with TS were measured on high-resolution magnetic resonance images before age 14 years. Follow-up clinical assessments were conducted after age 16 years, an average of 7.5 years later. Linear regression and Tobit regression analyses were used to assess the association of basal ganglia volumes measured in childhood with the severity of tic and obsessive-compulsive disorder (OCD) symptoms at the time of childhood MRI and at follow-up in early adulthood.
Volumes of the caudate nucleus correlated significantly and inversely with the severity of tic and OCD symptoms in early adulthood. Caudate volumes did not correlate with the severity of symptoms at the time of the MRI scan.
Caudate volumes in children with Tourette syndrome predict the severity of tic and obsessive-compulsive symptoms in early adulthood. This study provides compelling evidence that morphologic disturbances of the caudate nucleus within cortico-striatal-thalamo-cortical circuits are central to the persistence of both tics and obsessive-compulsive symptoms into adulthood.

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    • "It is of note that the exact etiology of GTS remains unknown. Volumetric MRI in GTS provided evidence for correlations between tic severities and volume of specific structures [e.g., caudate, see Ref. (47)] and also for abnormal gray matter volumes in prefrontal cortex in children and adults [see Ref. (48, 49), and for review see Ref. (50, 51)]. Functional neuroimaging techniques, such as single-photon emission computed tomography (SPECT), PET, and fMRI have provided some evidence for the underlying pathological mechanisms in GTS that enabled new hypotheses on its pathophysiology to be formulated (50, 51). "
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    • "Tics may result from defective striatal inhibition of undesired motor patterns via loss of inhibition of motor cortical neurons (Mink, 2001; Wang et al., 2011). Decreased volume of the caudate nucleus, cortical thinning of primary sensory and motor cortices, and age-related slowing of fronto-striatal and fronto-parietal pathway maturation support the network scale of TS pathophysiology (Bloch et al., 2005; Worbe et al., 2012a). Nuclear imaging studies showed that these network abnormalities are associated with an increased dopaminergic tone, as well as abnormal GABAergic and other monoaminergic (noradrenaline, histamine , serotonine) transmission within striatal, thalamic, insular and cerebellar regions (Buse et al., 2013). "
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    • " continue to have difficulty, and who belongs in the transient tic category would be most helpful to families and clinicians. Similarly, being able to understand who will experience a relief of tic burden with age, and who will continue to experience lifelong difficulties with TS would be of enormous importance to our understanding of the disorder. Bloch et al. (2005) provide one illustration of how a longitudinal study design may go a long way towards understanding and predicting TS burden by tracking how child anatomical measurements correlate to TS symptoms in those same participants in adulthood. CBIT is a clearly effective, but sorely underutilized (due to the dearth of clinicians with the exper"
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