Premonitory urge to tic in tourette's is associated with interoceptive awareness

Ganos, Christos; Garrido, Alícia; Navalpotro‐Gómez, Irene; Ricciardi, Lucia; Martino, Davide; Edwards, Mark J.; Tsakiris, Manos; Haggard, Patrick; Bhatia, Kailash P.

doi:10.1002/mds.26228

Cited by 117 publications

(105 citation statements)

References 33 publications

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“…This brings into sharp focus the dynamics of tic expression and elucidates the ongoing debate about whether tics should be classified as voluntary, involuntary, or unvoluntary/nonvoluntary (Singer 2005; Ganos et al 2015b). Although the symptomatology of GTS is conventionally characterized as the involuntary expression of tics, it is the premonitory urges—which occur in over 80 % of patients—that are unequivocally involuntary (Leckman et al 1993; Fahn et al 2011; Cohen et al 2013).…”

Section: Tic Expressionmentioning

confidence: 89%

“…The confounding factor is that the large majority of sufferers (>90 %) report that they partly or wholly respond to these involuntary premonitory urges with voluntary tics (Leckman et al 1993; Woods et al 2005; Doyon et al 2009). In fact, subjects report voluntary ticcing regardless of tic severity, although a higher incidence of premonitory urges has been correlated with an increase in both tic severity and tic complexity (Ganos et al 2015b). Thus, the conundrum becomes clear: is a voluntary response to an involuntary sensation truly voluntary when the urge is irresistible?…”

Section: Tic Expressionmentioning

confidence: 99%

“…Ganos et al show a correlation between increased interoceptive awareness and the intensity of bodily sensations referred to as premonitory urges in GTS (Ganos et al 2015b). One interpretation of this is that the perception of a premonitory sensation would be oversensitivity to an internal somatosensory signal.…”

Section: Tic Expressionmentioning

confidence: 99%

“…One interpretation of this is that the perception of a premonitory sensation would be oversensitivity to an internal somatosensory signal. Given the theory that the discernment of voluntary action depends on a perceptual discrimination in relation to a given threshold level, internal signals unrelated to volition could be misconstrued as voluntary movements if the internal somatosensory signal is above said threshold (Ganos et al 2015a, b). Premonitory phenomena have been associated with maturation and an increased awareness of interoceptive sensation (Rajagopal and Cavanna 2013; Ganos et al 2015b).…”

Section: Tic Expressionmentioning

confidence: 99%

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Putting the Pieces Together in Gilles de la Tourette Syndrome: Exploring the Link Between Clinical Observations and the Biological Basis of Dysfunction

2016

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Gilles de la Tourette syndrome is a complex, idiopathic neuropsychiatric disorder whose pathophysiological mechanisms have yet to be elucidated. It is phenotypically heterogeneous and manifests more often than not with both motor and behavioral impairment, although tics are its clinical hallmark. Tics themselves present with a complex profile as they characteristically wax and wane and are often preceded by premonitory somatosensory sensations to which it is said a tic is the response. Highly comorbid with obsessive–compulsive disorder and attention deficit-hyperactivity disorder, it is purported to be an epigenetic, neurodevelopmental spectrum disorder with a complex genetic profile. It has a childhood onset, occurs disproportionately in males, and shows spontaneous symptomatic attenuation by adulthood in the majority of those afflicted. Although not fully understood, its neurobiological basis is linked to dysfunction in the cortico-basal ganglia–thalamo–cortical network. Treatment modalities for Tourette syndrome include behavioral, pharmacological and surgical interventions, but there is presently no cure for the disorder. For those severely affected, deep brain stimulation (DBS) has recently become a viable therapeutic option. A key factor to attaining optimal results from this surgery is target selection, a topic still under debate due to the complex clinical profile presented by GTS patients. Depending on its phenotypic expression and the most problematic aspect of the disorder for the individual, one of three brain regions is most commonly chosen for stimulation: the thalamus, globus pallidus, or nucleus accumbens. Neurophysiological analyses of intra- and post-operative human electrophysiological recordings from clinical DBS studies suggest a link between tic behavior and activity in both the thalamus and globus pallidus. In particular, chronic recordings from the thalamus have shown a correlation between symptomatology and (1) spectral activity in gamma band power and (2) theta/gamma cross frequency coherence. These results suggest gamma oscillations and theta/gamma cross correlation dynamics may serve as biomarkers for dysfunction. While acute and chronic recordings from human subjects undergoing DBS have provided better insight into tic genesis and the neuropathophysiological mechanisms underlying Tourette syndrome, these studies are still sparse and the field would greatly benefit from further investigations. This review reports data and discoveries of scientific and clinical relevance from a wide variety of methods and provides up-to-date information about our current understanding of the pathomechanisms underlying Tourette syndrome. It gives a comprehensive overview of the current state of knowledge and addresses open questions in the field.

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Section: Tic Expressionmentioning

confidence: 89%

Section: Tic Expressionmentioning

confidence: 99%

Section: Tic Expressionmentioning

confidence: 99%

Section: Tic Expressionmentioning

confidence: 99%

See 2 more Smart Citations

Putting the Pieces Together in Gilles de la Tourette Syndrome: Exploring the Link Between Clinical Observations and the Biological Basis of Dysfunction

2016

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“…Conversely, the difference between results of the clinician-rated and self-report urge scale may more likely be attributed to the broad assessment window shared by the PUTS, SCARED, and DTS. Indeed, experimental evidence has linked interoceptive awareness with premonitory urges (Ganos et al 2015), suggesting that these relationships are not likely happenstance and attributable to conflated ratings. Given the importance of urge phenomena in TD, future research should investigate the causality of the relationship between premonitory urges and both distress tolerance and anxiety severity in a multiple time point study that includes both broad and time-specific measures.…”

Section: Discussionmentioning

confidence: 99%

The premonitory urge revisited: An individualized premonitory urge for tics scale

McGuire

McBride

Piacentini

et al. 2016

Journal of Psychiatric Research

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Background Premonitory urge ratings have advanced our understanding of urge phenomenology among individuals with tic disorders (TD). However, these ratings have been limited by their reliance on a single global dimension of urge severity. This study examined the psychometric properties of a novel scale called the Individualized Premonitory Urge for Tics Scale (I-PUTS) that assesses urge severity across multiple dimensions (number, frequency, and intensity). Method Seventy-five youth with a TD and their parents participated. Clinicians assessed youth’s tic severity, depression severity, rages, and premonitory urges. Parents completed ratings of youth’s anxiety, affect lability, and general psychopathology. Youth completed self-report ratings of anxiety, urge severity, and distress tolerance. Results The I-PUTS identified that youth experienced an average of three distinct urges, but had an average of seven tics over the past week. Urges were primarily localized in the head/face, neck/throat, and arm regions. All I-PUTS dimensions exhibited excellent inter-rater reliability. The I-PUTS dimensions exhibited good convergent validity with global urge ratings and tic severity, and appropriate divergent validity from other clinical constructs. Youth who exhibited discrepant reports between clinician-administered and self-report urge ratings had less anxiety and tic severity, and greater inattention and externalizing problems compared to youth who exhibited good agreement. Conclusions The I-PUTS is a reliable and valid assessment of urge phenomena, which provides additional and complementary information to existing urge scales. It highlights the existence of multiple dimensions of urge severity, and presents particular utility when assessing urges in youth with TD who have inattention and externalizing problems.

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Tics in the Pediatric Population: Pragmatic Management

Ganos

Martino

Pringsheim

2016

Movement Disord Clin Pract

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BackgroundPrimary tic disorders, notably Tourette syndrome, are very common movement disorders in childhood. However, the management of such patients still poses great therapeutic challenges to medical professionals.MethodsBased on a synthesis of the available guidelines published in Europe, Canada, and the United States, coupled with more recent therapeutic developments, the authors provide a pragmatic guide to aid clinicians in deciding when and how to treat patients who have primary tic disorders.ResultsAfter a systematic assessment of tics and common neuropsychiatric comorbidities (primarily attention‐deficit hyperactivity disorder [ADHD] and obsessive‐compulsive disorder [OCD]), the first step in treatment is a comprehensive psychoeducation of patients and families that addresses the protean phenomenology of tics and associated behaviors, coping mechanisms, prognosis, and treatment options. When more active intervention beyond watchful monitoring is indicated, hierarchical evaluation of treatment targets (i.e., tics vs. comorbid behavioral symptoms) is crucial. Behavioral treatments for tics are restricted to older children and are not readily available to all centers, mainly due to the paucity of well‐trained therapists. Pharmacological treatments, such as antipsychotics for tics, stimulants and atomoxetine for ADHD, and α2A‐agonists for children with tics plus ADHD, represent widely available and effective treatment options, but safety monitoring must be provided. Combined polypharmacological and behavioral/pharmacological approaches, as well as neuromodulation strategies, remain under‐investigated in this population of patients.ConclusionsThe treatment of children with tics and Tourette syndrome is multifaceted. Multidisciplinary teams with expertise in neurology, psychiatry, psychology, and pediatrics may be helpful to address the complex needs of these children.

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Premonitory urge to tic in tourette's is associated with interoceptive awareness

Abstract: The observed relationship between severity of premonitory urges and interoceptive awareness suggests that interoception might be involved in self-reported premonitory urges in GTS. High levels of interoceptive awareness might reflect a self-attentive capacity to perceive urges.

Cited by 117 publications

References 33 publications

Putting the Pieces Together in Gilles de la Tourette Syndrome: Exploring the Link Between Clinical Observations and the Biological Basis of Dysfunction

Putting the Pieces Together in Gilles de la Tourette Syndrome: Exploring the Link Between Clinical Observations and the Biological Basis of Dysfunction

The premonitory urge revisited: An individualized premonitory urge for tics scale

Tics in the Pediatric Population: Pragmatic Management

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