Tourette syndrome, associated conditions and the complexities of treatment

Abstract

Tourette syndrome (TS) is characterized by multiple motor tics plus one or more vocal (phonic) tics, which characteristically wax and wane. It can no longer be considered the rare and bizarre syndrome that it was once thought to be. The concepts surrounding TS, and our understanding of it, are also becoming increasingly complex and, in some individuals, TS is now recognized to be associated with a wide variety of associated behaviours and psychopathologies. It is suggested that TS is heterogeneous from a variety of standpoints including clinical presentation and psychopathology, and thus neuropharmacological responses and possibly even aetiological and genetic mechanisms. In this paper, mention is made of recent findings in epidemiology and genetics, highlighting the complexities of the disorder; these have been chosen because findings in both areas have clinical and management implications. The literature on the clinical manifestations, associated behaviours, psychopathology (and/or comorbid conditions) and management, in particular, is reviewed in detail.

Postural control anomalies in children with Tourette syndrome

“…TS is often associated with various comorbidities such as obsessive-compulsive behavior and hyperactivity (Leckman 2002;Robertson 2000). Several sources of evidence suggest a dysfunction in fronto-striatal systems in TS.…”

Gray’s revised Reinforcement Sensitivity Theory in relation to Attention-Deficit/Hyperactivity and Tourette-like behaviors in the general population

“…The scale comprises two pure TS subscales: TS-phonic (8 items) related to sounds produced through the nose, mouth or throat (e.g., throat clearing, coughing, sniffing), and TS-motor (7 items) related to unintentional physical movements (e.g., blinking, face twitches, random body movements). The questionnaire also includes a subscale for TSrelated obsessive-compulsive behaviors (TS-OCB; 3 items), given that these frequently co-occur with TS (Robertson, 2000). Participants indicate frequency of behavior occurrence on a 5-point scale (0=never to 4=very often).…”

“…Recently, the application of reinforcement learning models has been proposed to further our understanding of the processes involved in complex symptom patterns in psychiatric and neurological disorders (Bijttebier et al, 2009;Maia & Frank, 2011). Although primarily a motor-disorder, the involvement of fronto-striatal dopaminergic pathways and basal ganglia circuitry in the etiology of TS (Robertson, 2000) and the central role of these pathways in reinforcement learning suggests a role for reinforcement sensitivity and motivational inhibitory processes in this disorder (Maia & Frank, 2011 for review). Gray's (1982) original model proposed three neuropsychological systems underpinning approach-avoidance motivation and behavior -the functioning of which was related to personality.…”

A contribuição de Charcot para o estudo da síndrome de Tourette

“…Tourette's syndrome (Ts) is a chronic neuropsychiatric disorder characterized by multiple motor tics associated with the presence of one or more phonic tics, with waxing and waning course and severity 1,2 . The estimated prevalence of the disease ranges from 1 to 10 per 1000 children and adolescents, being associated with various comorbidities such as attention deficit and obsessive-compulsive disorders 1,2 .…”

“…The estimated prevalence of the disease ranges from 1 to 10 per 1000 children and adolescents, being associated with various comorbidities such as attention deficit and obsessive-compulsive disorders 1,2 . These comorbidities have been reported in various series of Brazilian patients in the literature [3][4][5] .…”