Motor, Behavioral and Pharmacologic Findings in Tourette's Syndrome

Abstract

ABSTRACT:We studied 112 patients with Tourette's syndrome (TS); the male-to-female ratio was 3.8, the mean age of onset was 7.3 years, and the average duration of symptoms prior to the initial evaluation was 15.2 years. Seventy-nine percent of the patients had at least one family member with motor or vocal tics, and an additional 10 percent had a family member with marked obsessive-compulsive behavior. Simple motor tics occurred as the presenting symptom in about one-third of patients; one-third had multiple motor tics at the onset, and another third started with vocal tics. During the course of the illness all patients developed multifocal motor tics and 86 percent had vocal tics. Verbal and mental coprolalia was present in 44 percent of the patients. Copropraxia was seen in 19 percent of patients, and both coprolalia and copropraxia were more frequent among the males than expected. Attentional deficit disorder was diagnosed in 36 percent of the patients and 32 percent had obsessive-compulsive personality. Sleep disturbances were reported by 62 percent of the patients and polysomnography in 34 patients showed motor and vocal tics during all stages of sleep, sleep apnea, abnormal arousal pattern, and other sleep disturbances. Patients with mild symptoms improved with clonidine or clonazepam, but those with more advanced disorder required fluphenazine, pimozide, haloperidol or tetrabenazine.

Tetrabenazine in the treatment of hyperkinetic movement disorders

“…In 1971, TBZ was approved for the treatment of chorea in the UK. Besides chorea, TBZ has also been studied as a treatment for other hyperkinetic movement disorders including tics [21][22][23][24][25], tardive dyskinesia (TD) [26][27][28], dystonia [29,30], myoclonus [16,[31][32][33] and tremor (TABLE 1) [34,35]. Several European countries, Canada and others also approved the use of TBZ, but the drug is still not available in the USA except to selected physicians through the notice of claimed investigational exemption for a new drug (IND).…”

Sleep Problems in Children of Affectively Ill Mothers

“…In a study based on an objective measure of sleep (Sadeh et al, 1995), high correlations were found between sleep quality and self-report scales of depression, hopelessness, and self-esteem. Sleep problems are also a symptom of children's manic episodes (Carlson, 1990;Varanka, Weller, Weller, & Fristad, 1988), attention deficit disorder with hyperactivity (Morrison et al, 1993;Simeon, 1984), Tourette's syndrome (Jankovic & Rohaidy, 1987), anxiety disorders (^Puig-Antich et al, 1982), mental handicap (Quine, 1991), and autism, psychosis, or severe personality disorders (Simeon, 1984).…”

Is Tourette syndrome a cause of sudden infant death syndrome and childhood obstructive sleep apnea?

“…COMMENT eses [Perrin et al, 19841. Administration of tetrabenazine, a dopamine antagonist, to two TS patients resulted in amelioration of tics and elimination of abnormal sleep patterns and sleep apnea and marked reduction of &O0 during sleep [Jankovic et al, 19841 and neuroleptics reversed the depressant effect of intravenously infused dopamine on ventilatory responses to hypoxia in humans [Olson et al, 19821. Regarding OSAS, the clinical manifestations reported to be present in some children [Guilleminault, et al, 1981,19821 are also seen in TS children or children who show evidence of being TS gene carriers [Comings and Comings, 1991;Jankovic and Rohaidy, 1987;Sverd, 19911. These symptoms include reduced REM sleep, disturbed sleep, hyperactive and antisocial behaviors, stereotypic behaviors, bizarre behaviors, possible hallucinations, learning problems, introversion, and enuresis.…”