New Insights into Clinical Characteristics of Gilles de la Tourette Syndrome: Findings in 1032 Patients from a Single German Center.

Tanvi Sambrani,Kirsten R Müller-Vahl,Ewgeni Jakubovski

doi:10.3389/fnins.2016.00415

Tanvi Sambrani, Kirsten R Müller-Vahl + Show 1 more

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https://doi.org/10.3389/fnins.2016.00415

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Abstract

Background: Gilles de la Tourette syndrome (TS) is a complex neuropsychiatric disorder defined by the presence of motor and phonic tics, but often associated with psychiatric comorbidities. The main objective of this study was to explore the clinical presentation and comorbidities of TS.Method: We analyzed clinical data obtained from a large sample (n = 1032; 529 children and 503 adults) of patients with tic disorders from one single German TS center assessed by one investigator. Data was collected with the help of an expert-reviewed semi-structured interview, designed to assess tic severity and certain comorbidities. Group comparisons were carried out via independent sample t-tests and chi-square tests.Results: The main findings of the study are: (1) tic severity is associated with the presence of premonitory urges (PU), copro-, echo-, and paliphenomena and the number of comorbidities, but not age at tic onset; it is higher in patients with comorbid obsessive-compulsive disorder (OCD) than in patients with comorbid attention deficit/hyperactivity disorder (ADHD). (2) PU were found to be highly associated with “not just right experiences” and to emerge much earlier than previously thought alongside with the ability to suppress tics (PU in >60% and suppressibility in >75% at age 8–10 years). (3) Self-injurious behavior (SIB) is highly associated with complex motor tics and coprophenomena, but not with OCD/obsessive-compulsive behavior (OCB). While comorbid ADHD is associated with a lower ability to suppress tics, comorbid depression is associated with sleeping problems.Discussion: Our results demonstrate that tic severity is not influenced by age at onset. From our data, it is suggested that PU represent a specific type of “not just right experience” that is not a prerequisite for tic suppression. Comorbid ADHD reduces patients' ability of successful tic suppression. Our data suggest that SIB belongs to the coprophenomena spectrum and hence should be conceptualized as a complex tic rather than a compulsion. Finally, this study strongly supports the hypothesis that TS+OCD is a more severe form of TS and that comorbid OCD/OCB, depression, and anxiety belong to the TS spectrum, while ADHD should be better conceptualized as a separate problem.

Highlights

A part of the broad spectrum of tic disorders—including provisional tic disorder and persistent tic disorder— Gilles de la Tourette syndrome (TS) is a neuropsychiatric disorder with an onset in childhood
We aim to extend our knowledge of possible differences in the clinical presentation and nature of TS-related phenomena/various tic symptoms based on gender, age groups, and single comorbidity subgroups of TS, and thereby achieve a better understanding of the factors producing variations in order to engage in better subtyping of TS
We found that almost half the total number of patients diagnosed with rage attacks did not have either hyperactivity or inattention, which is consistent with the finding that rage attacks, as compared to hyperactivity and inattention, is highly common and represents one symptom of the typical spectrum of disinhibited behaviors in TS that occurs in a substantial number of patients independently from the presence of attention deficit/hyperactivity disorder (ADHD) (Frank et al, 2011)

Summary

Introduction

A part of the broad spectrum of tic disorders—including provisional tic disorder and persistent (chronic) tic disorder— Gilles de la Tourette syndrome (TS) is a neuropsychiatric disorder with an onset in childhood. This developmental disorder is characterized by the presence of multiple motor tics and at least one phonic tic for a minimum period of 1 year, beginning before 18 years of age and occurring in bouts (American Psychiatric Association, 2013). Gilles de la Tourette syndrome (TS) is a complex neuropsychiatric disorder defined by the presence of motor and phonic tics, but often associated with psychiatric comorbidities. The main objective of this study was to explore the clinical presentation and comorbidities of TS

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