Clinical assessment of Tourette syndrome and tic disorders

Abstract

Tourette Syndrome (TS) is a neuropsychiatric disorder involving multiple motor and phonic tics. Tics, which usually begin between the ages of 6 and 8, are sudden, rapid, stereotyped, and apparently purposeless movements or sounds that involve discrete muscle groups. Individuals with TS experience a variety of different sensory phenomena, including premonitory urges prior to tics and somatic hypersensitivity due to impaired sensorimotor gating. In addition to other conditions, stress, anxiety, fatigue, or other heightened emotional states tend to exacerbate tics, while relaxation, playing sports, and focused concentration on a specific task tend to alleviate tic symptoms. Ninety percent of children with TS also have comorbid conditions, such as Attention deficit hyperactivity disorder (ADHD), Obsessive-compulsive disorder (OCD), or an impulse control disorder. These disorders often cause more problems for the child both at home and at school than tics do alone. Proper diagnosis and treatment of TS involves appropriate evaluation and recognition, not only of tics, but also of these associated conditions.

Tactile processing in children and adolescents with obsessive–compulsive disorder

“…Because of the high OCD comorbidity, patients diagnosed with Tourette's syndrome may also offer additional ideas about the pathophysiology of OCD (Cohen et al 2013). As a matter of fact, similar results have been reported in the literature regarding sensorimotor gating in Tourette's syndrome (Smith and Lees 1989;Swerdlow et al 1993Swerdlow et al , 2001Castellanos et al 1996;Ziemann et al 1997;Greenberg et al 2000).…”

Inhibition, Disinhibition, and the Control of Action in Tourette Syndrome

“…TS is a childhood-onset hyperkinetic condition affecting approximately 1% of school-age children [1]. It is characterized by an evolving repertoire of chronic motor tics and one or more phonic tics.…”

“…TS first presents during early childhood and the severity of tics follows a remitting pattern with increasing age. Tic severity is often maximal between 11 and 14 years, with tics decreasing by early adulthood [1]. It has been proposed that Trends Tourette syndrome (TS) has been linked to impairment of inhibitory function.…”

“…A substantial minority ($20-30%) of individuals will continue to exhibit debilitating tics into adulthood, in some cases with symptoms becoming more severe and resistant to treatment, resulting in considerable impairment in social functioning and quality of life [1]. Currently we do not understand why some individuals gain control over their tics while others do not.…”

“…TS most often follows a developmental timecourse characterized by a reduction in the frequency and intensity of tics during adolescence [1]. It has been proposed that individuals gain control over their tics through the development of compensatory mechanisms that lead to enhanced control over motor outputs (e.g., [4,5,42]).…”