An international perspective on Tourette syndrome: selected findings from 3500 individuals in 22 countries

Abstract

We have established a multisite, international database of 3,500 individuals diagnosed with Tourette syndrome (TS). The male:female ratio is 4.3:1 for the total sample, with wide variation among sites; the male excess occurs at every site. Anger control problems, sleep difficulties, coprolalia, and self-injurious behavior only reach impressive levels in individuals with comorbidity. Anger control problems are strongly correlated with comorbidity, regardless of site, region, or whether assessed by neurologists or psychiatrists. The mean age at onset of tics is 6.4 years. At all ages, about 12% of individuals with TS have no reported comorbidity. The most common reported comorbidity is attention-deficit-hyperactivity disorder. Males are more likely to have comorbid disorders than females. The earlier the age at onset, the greater the likelihood of a positive family history of tics. An understanding of the factors producing these and other variations might assist in better subtyping of TS. Because behavioral problems are associated with comorbidity, their presence should dictate a high index of suspicion of the latter, whose treatment may be at least as important as tic reduction. The established database can be used as the entry point for further research when large samples are studied and generalizability of results is important.

Stereotypic movement disorder: easily missed

“…However, there were two unexpected findings. First, frequency of OCD and OCB was low, two and three individuals respectively (similar to the frequencies of 5% OCD and 5% OCB in Mahone et al 1 ), which is in contrast to Tourette syndrome, where OCD ⁄ OCB is common (48% in the Tourette syndrome international database 22 ). This rate in SMD is low, even when compared with children with Tourette syndrome of the same age.…”

“…For Tourette syndrome in our clinic (n=828), the corresponding figures are 5 years 10 months (SD 2y 4mo) and range 21 years (1-22y) in the Tourette syndrome international database. 22 Severity of tics tends to increase until early adolescence, 24 whereas in this study SMD gradually improved during child- hood. SMD is much more likely to occur in flurries or prolonged bouts that are much longer than tics (the latter are usually brief, jerk-like, and randomly occurring) and may be rhythmical.…”

Síndrome de Gilles de la Tourette: estudo clínico de 58 casos

“…A análise da distribuição por sexo dos pacientes mostra relação de 1,6 pacientes do sexo masculino para um do sexo feminino, portanto abaixo da encontrada na maioria das casuísticas relatadas na literatura 2,[11][12][13][14][15] . Porém, essa proporção é semelhante à encontrada por Apter et al 16 , que estudaram jovens de 18 anos, recrutados para o serviço militar obrigatório em Israel.…”

“….reeman et al 11 , em recente estudo multicên-trico envolvendo 22 países e agrupando 3500 casos da SGT (parte dos casos deste estudo integram essa gigantesca série), observaram que, quanto mais precoce a instalação dessa afecção, maior era a positividade de história familiar para tiques.…”

Intragenic deletions affecting two alternative transcripts of the IMMP2L gene in patients with Tourette syndrome

“…1 TS is a complex disorder where several environmental and genetic components are likely to be involved in the disease etiology. About 88% of TS patients are diagnosed with comorbidities such as attention-deficit hyperactivitydisorder (ADHD), obsessive compulsive disorder/behavior (OCD/ OCB), rage attacks, sleep difficulties, autism spectrum disorders (ASD) and affective disorders 2,3 suggesting a shared background between these disorders. 4 This notion is strengthened by finding of genes, such as CHRNA7, CNTNAP2 and NLGN4, which are implicated in a wide variety of neurodevelopmental disorders, including TS and ASD.…”