Tourette Syndrome in Children: An Updated Review

Abstract

Tourette syndrome (TS) is a common neuropsychiatric disorder in children characterized by multiple motor and vocal tics that fluctuate in severity and lasting for at least 1 year. Boys are more commonly affected than girls. Symptoms usually begin with simple motor or vocal tics which then evolve into more complex motor and vocal tics over time. Premonitory sensory urges are common in children over the age of 8 years, and these urges help distinguish tics from symptoms of other movement disorders. Common comorbidities of TS include attention deficit hyperactivity disorder, obsessive-compulsive disorder and learning difficulties. Several genes have been assessed as candidate genes for TS; environmental factors such as stress and streptococcal infections might also contribute to its etiology. The pathophysiology of TS mainly involves dysfunction of basal ganglia-related circuits and hyperactive dopaminergic innervations. A thorough history assessment and neurological examination are important for the correct diagnosis and differentiation from other movement disorders. Treatment for TS should focus on improving the patient's social functioning, minimizing the impairment from cormobid disorders, and controlling tics, if they are severe. Commonly used medications for TS include a2-adrenergic agonists and atypical neuroleptics. Habit reversal therapy is an effective option for TS, and repetitive transcranial magnetic stimulation may be a promising approach for severe cases.

Targeted ablation of cholinergic interneurons in the dorsolateral striatum produces behavioral manifestations of Tourette syndrome

“…This argues in favor of a direct role for the ChAT deficit in pathophysiology, and against a compensatory or epiphenomenal one. Some aspects of TS, such as the premonitory urges that often precede tics, are difficult or impossible to assess in an animal (3)(4)(5); but behaviors recapitulating aspects of the motor symptomatology are accessible in mice (10). Low-amplitude, stereotyped, repetitive movements that recapitulate aspects of tics can be quantified; these include excessive and fragmentary grooming (35,38) and motor stereotypy (10,39,40).…”

“…The defining symptoms of TS are motor and phonic tics, defined as sudden, repetitive, nonrhythmic, involuntary or semiinvoluntary movements or utterances that involve discrete muscle groups. Tics fluctuate and are exacerbated by stress (3)(4)(5) and by acute challenge with prodopaminergic drugs (6). Individuals with TS also often have deficits in fine motor control (7,8), procedural learning (9), and sensorimotor gating (10,11).…”

Tourette's syndrome and associated disorders: a systematic review

“…The severity of tics in children with TS usually declines over the course of adolescence. 2 TS is the most common cause of tics. 3 According to recent community-based studies, the prevalence of TS in school-aged children ranges from one to eight per 1,000.…”

Tic disorders in the differential diagnosis of chronic cough in children in relation to four cases

“…(10)(11)(12)(13)(14). The most commonly used drugs in clinical practice is dopamin receptor antagonists (antipsychotic agents) (10).…”