Criteria For Tourette Syndrome Research Articles

The Assessment of Knowledge about Tourette's Syndrome among Medical Students and Primary Physicians in Riyadh, Saudi Arabia: A Cross-Sectional Study.

Background Tourette's syndrome (TS), a chronic, often disabling neuropsychiatric disorder characterized by motor and vocal tics, is frequently misdiagnosed, or patients are delayed in diagnosis. There is severe deficiency of research about Tourette's syndrome (TS) in the Middle East region. Objectives To evaluate the knowledge and attitude of medical students and primary care physicians (PCPs) about TS and tic disorders. Methods IRB approved, cross-sectional study. A total of 316 medical students of King Saud bin Abdulaziz University and 59 primary care physicians of Riyadh participated. Convenient, cluster sampling was used. A validated, self-administered questionnaire was used. Sum of all knowledge questions was calculated. Data were analyzed using SPSS software. Results Survey was completed by 375 students and physicians, of whom 253 (67.5%) were men. Mean general knowledge score was 61.5 (±12.04) out of 100. Majority (66.1%) knew the diagnostic criteria for TS; only 46.1% considered antipsychotics as effective treatment. Only 25.1% had ever heard of habit reversal; 70% wanted to learn more. Only 10% of physicians had treated a patient with TS. There was no difference in knowledge between men and women (p=0.776). Board-certified physicians had a higher knowledge score (p < 0.05). Family physicians demonstrated higher level of knowledge compared to other physicians (p < 0.05). There was no difference between knowledge of students of different years (p=0.859) or between students and physicians (p=0.569). Conclusion There was alarming lack of knowledge about Tourette syndrome at various level of medical training and practice including students and physicians. Those who achieved board certification and practiced as family physicians fared better in knowledge about Tourette's syndrome.

Low-frequent Repetitive Transcranial Magnetic Stimulation (rTMS) inAdolescents with Tourette Syndrome

Objective: The pathophysiology of Tourette syndrome (TS), a chronic motor and vocal tic disorder remains unknown, however abnormalities in basal ganglia-thalamo-cortical circuits presumably play an important role. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive method for modulation of cortical activity, has been applied in different ways in patients with TS. Methods: Open-label pilot study of active rTMS. Four adolescents with TS participated in the pilot study, two females and two males. The patients fulfilled DSM IV criteria for TS, and had tried psychological and/or pharmacological therapy without effects on symptoms. The rTMS treatment consisted of 10 treatment sessions Monday to Friday during a two-week period. Follow-up was done one, three and six months after finishing the treatment with rTMS. Results: There was clinically significant improvement in TS symptoms with benefits lasting up to 6 months in two of the patients. In addition, improvement in ADHD was seen in one patient, and improvement in OCD symptoms in another. There were no side effects. Conclusions: Low-frequency rTMS may be effective in children with TS. Further studies using rTMS in TS are warranted. Careful consideration of target regions and stimulation parameters, longer follow-up, and use of a double-blind, sham-controlled design may allow us to draw founded conclusions in the future.

VISIT-TS version 2: A multimedia tool for population studies on tic disorders.

Population-based assessment of Tourette syndrome (TS) and other tic disorders produces a paradox. On one hand, ideally diagnosis of tic disorders requires expert observation. In fact, diagnostic criteria for TS explicitly require expert assessment of tics for a definite diagnosis. On the other hand, large-scale population surveys with expert assessment of every subject are impracticable. True, several published studies have successfully used expert assessment to find tic prevalence in a representative population (e.g. all students in a school district). However, extending these studies to larger populations is daunting. We created a multimedia tool to demonstrate tics to a lay audience, discuss their defining and common attributes, and address features that differentiate tics from other movements and vocalizations. A first version was modified to improve clarity and to include a more diverse group in terms of age and ethnicity. The result is a tool intended for epidemiological research. It may also provide additional benefits, such as more representative minority recruitment for other TS studies and increased community awareness of TS.

Topiramate in children and adolescents with Tourette syndrome: A case series

The objective of this study is to evaluate the effect of topiramate on tics in patients with Tourette syndrome (TS). TS is a complex neurobehavioral disorder that emerges in childhood with widely varying patterns of intermittent involuntary/semivoluntary movements expressed as motor and vocal tics. Although neuroleptics are effective anti-tic agents, side effects such as tardive dyskinesia, weight gain, and hepatotoxicity can limit their usefulness. Our use of topiramate followed reports of its effectiveness in reducing involuntary movements in patients with essential tremor. Retrospective patient record was audited using a standardized data collection form in a general child neurology practice. Charts for topiramate-treated patients meeting diagnostic criteria for TS were reviewed. Data for tics, behavior disorders, medication history, and topiramate treatment were extracted. The Shapiro tic severity scale was used to quantify change from baseline. Of 39 children/adolescents with TS treated with topiramate, tic severity was reduced at least 50% in 23 (59%) patients, did not change in five (13%) patients and worsened in two (5%) patients. Topiramate was discontinued and not restarted due to side effects in seven (18%) patients. Topiramate appears to be useful in suppressing tics in patients with TS, but double-blind, randomized controlled studies are needed to document its efficacy.

Microstructure assessment of grey matter nuclei in adult tourette patients by diffusion tensor imaging

Tourette syndrome (TS) is a neuropsychiatric disorder with the cardinal symptoms of motor and vocal tics. The onset occurs during childhood; many patients experience a subsequent reduction of tic frequency and severity suggesting that the pathways involved play a significant developmental role. Research has mainly focused on the cortico-striato-thalamo-cortical circuit, but clinical symptoms and recent neuroimaging studies suggest the involvement of limbic structures as well. We acquired diffusion-weighted data at 1.5 T in fifteen adult patients fulfilling the DSM-IV-TR criteria for TS and in a healthy control group. Based on the Harvard–Oxford subcortical structural atlas we investigated the microstructure of grey matter nuclei such as the nucleus accumbens, the amygdala, the putamen, the pallidum and the thalamus. The basal ganglia and the thalamus show in the direct comparison between patients and control subjects no significant differences in the diffusion indices. However, within the Tourette group the correlation coefficients between diffusion parameters and measures of tic severity indicate that the individual microstructure of the basal ganglia has an influence on the individual clinical phenotype. The microstructure assessment of the amygdala and nucleus accumbens in TS revealed a significant difference for the left nucleus accumbens and the right amygdala. Our findings suggest two pathophysiologic patterns in TS. One pattern could indicate altered connectivity based on the correlation between the increased mean and axial diffusivity in the basal ganglia and tic severity. The other pattern is characterized by the increase in radial diffusivity in the amygdala and the correlation between radial diffusivity in the nucleus accumbens and tic measures indicating potentially altered myelination.

White-matter abnormalities in Tourette syndrome extend beyond motor pathways

Tourette syndrome is a neuropsychiatric disorder with the cardinal symptoms of motor and vocal tics. Often tics are accompanied by comorbidities such as obsessive–compulsive disorder, attention-deficit–hyperactivity disorder or depression. Research has mainly focused on the cortico-striato-thalamo circuit, but clinical symptoms and recent neuroimaging studies reporting altered resting network connectivity have suggested abnormalities in Tourette syndrome beyond the major motor circuits.We acquired diffusion-weighted data at 1.5T in nineteen adult patients fulfilling the DSM-IV-TR criteria for Tourette syndrome and in a healthy control group.Diffusion tensor imaging (DTI) analysis in our adult TS sample shows a decrease of FA and increase in radial diffusivity in the corticospinal tract. There are widespread changes (reduced FA and increased radial diffusivity) in the anterior and posterior limb of the internal capsule. Furthermore, it confirms prior findings of altered interhemispheric connectivity as indicated by a FA-decrease in the corpus callosum. In addition, our results indicate that TS is not restricted to motor pathways alone but affects association fibres such as the inferior fronto-occipitalis fascicle, the superior longitudinal fascicle and fascicle uncinatus as well.Tics are the hallmark of Tourette syndrome, so the involvement of the corticospinal tract fits in well with clinical symptoms. Cortical regions as well as limbic structures take part in the modulation of tics. Our findings of alterations in long association fibre tracts and the corpus callosum are a potential source for hindered interhemispheric and transhemispheric interaction. The change in radial diffusivity points toward a deficit in myelination as one pathophysiological factor in Tourette syndrome.

Elevated plasma kynurenine in Tourette syndrome

Fasting plasma kynurenine concentrations were significantly elevated in a group of 7 patients (4 female) conforming to DSM-III-R of the American Psychiatric Association (1987) criteria for Tourette syndrome, in comparison with 10 healthy controls (7 female). Simultaneous normal plasma biopterin and neopterin concentrations indicated that this rise was probably not a consequence of peripheral cellular immune mechanisms.

Neuropsychological correlates of obsessive characteristics in Tourette syndrome

The relationship between obsessive-compulsive (OC) characteristics and performance on a test sensitive to frontal lobe function (Wisconsin Card Sorting Test) was examined in a sample of 100 patients between the ages of 6 and 18 years. All patients met DSM-III-R criteria for Tourette syndrome (TS), confirmed by a neurologist or psychiatrist. Performance on the Wisconsin Card Sorting Test was correlated with ratings of OC characteristics, but not with other TS symptoms. This relationship was maintained even when Full-Scale IQ and the total number of Tourette symptoms were controlled. The effect could not be attributed to medication. These findings were interpreted in the context of models of basal ganglia-cortical associations. It was speculated that different symptoms associated with TS may have different neuroanatomic substrates.