Temporal Course of the Tourette Syndrome Clinical Triad

David R. Shprecher,Keenan Gannon,Lindsay A. Rubenstein,Samuel A. Frank,Roger Kurlan

doi:10.5334/tohm.195

Abstract

Background: Tourette syndrome (TS) is a disorder characterized by childhood onset of motor and phonic tics, often with improvement of tic symptoms by young adult years. The temporal course of tics and commonly comorbid behavioral symptoms is still not well characterized. Methods: In order to clarify the time course of tics and comorbid attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD) in TS, we administered a brief survey regarding the course of symptoms at a single point in time to 53 TS patients aged 13–31 years. Results: Mean age (¡SD) at symptom onset was 7.9 (±3.6) years for tics, 7.9 (±3.5) for ADHD, and 9.2 (±5.0) for OCD. Age at peak symptom severity was 12.3 (±4.6) years for tics, 10.8 (±3.8) for ADHD, and 12.6 (±5.5) for OCD. Tics, ADHD, and OCD were reported to be no longer present in 32.0%, 22.8%, and 21.0% of subjects, respectively. Decline in symptom severity began at age 14.7 (±3.7) years for tics, 13.9 (±2.9) for ADHD, and 15.1 (±5.0) for OCD. Remission of symptoms occurred at age 17.4 (±3.8) years for tics, 17.4 (±1.3) for ADHD, and 15.6 (±2.3) for OCD. Discussion: Our data confirm and expand previously reported TS spectrum symptom milestones and may guide design of future research aimed at improving the course of TS.

Highlights

Tourette syndrome (TS) is defined by childhood onset of multiple motor and vocal tics lasting more than one year.[1]
A peak in tic severity has been reported to occur between the ages of 10 and 13 years;[4,5] significant reduction in tic severity has been reported to begin at a mean age of 16 years, and between 26% and 50% of patients have been described as being essentially free of tics by early adulthood.[4,6,7]
Age at peak symptom severity was 12.3 (¡4.6) for tics, 10.8 (¡3.8) for attention deficit hyperactivity disorder (ADHD), and 12.6 (¡5.5) years for obsessive compulsive disorder (OCD); 83.0% reported that their tics had lessened over time, and tics were reported to have stopped in 32.0%

Summary

Introduction

Tourette syndrome (TS) is defined by childhood onset of multiple motor and vocal tics lasting more than one year.[1]. A peak in tic severity has been reported to occur between the ages of 10 and 13 years;[4,5] significant reduction in tic severity has been reported to begin at a mean age of 16 years, and between 26% and 50% of patients have been described as being essentially free of tics by early adulthood.[4,6,7] While substantial reductions in tic severity have been called ‘‘tic remissions,’’ many TS patients who report that their tics are in remission still have tics that are appreciated by an expert[8] or recur during times of psychosocial stress.[9] There are reports of tics observed in individuals older than age 60, even after being reportedly absent for more than 40 years.[10,11] Little information is available regarding the natural course of the other components of the TS triad, comorbid ADHD, and OCD. In order to guide development of therapies aimed at hastening or increasing the likelihood of remission, we conducted a patient survey to gather more information on the temporal course of the full TS triad

Methods

Results

Conclusion