Chapter 34 - Tics and Gilles de la Tourette Syndrome

Abstract

Publisher Summary This chapter provides a practical approach for understanding, evaluating, and treating tic disorders. Tic disorders are paroxysmal movement abnormalities that begin in childhood, are frequently associated with various comorbid problems, are capable of causing psychosocial difficulties, and may persist into adulthood. The diagnosis of a tic disorder is based on historical features and a clinical examination confirming their presence. The formal descriptions of tics include involuntary, sudden, rapid, abrupt, repetitive, nonrhythmic, simple, or complex motor movements or vocalizations. Gilles de la Tourette syndrome (TS) actually represents only one entity in a spectrum of disorders that have tics as their cardinal feature, ranging from a mild transient form to TS. Tic disorders are divided into two major categories based on their duration: transient and chronic. The possible effects of genomic imprinting, bilineal transmission, and gene–environment interactions complicate the understanding of TS genetics. Convincing direct and indirect evidence indicates that corticostriatothalamocortical pathways are involved in the expression of TS and its accompanying neuropsychiatric problems. The presence of dopaminergic, glutamatergic neurons that produce gamma-aminobutyric acid (GABA) as their output (GABAergic), serotoninergic, cholinergic, noradrenergic, and opioid systems within corticostriatothalamocortical circuits raises the possibility that various transmitters may be involved in the pathobiology of TS. The diagnosis and treatment of tic disorders include these steps: evaluation and identification of all individual problems, determination of the degree of impairment and need for treatment for each concern, education of the patient and family about tic disorders (e.g., outcome, comorbidities, etiology, pathophysiology, and treatment), selection of an appropriate treatment program, and establishment of a comprehensive multidisciplinary treatment approach.