Gilles De La Tourette Research Articles

Long-term efficacy, prognostic factors, and safety of deep brain stimulation in patients with refractory Tourette syndrome: A single center, single target, retrospective study

BackgroundTo evaluate the long-term efficacy, prognostic factors, and safety of posteroventral globus pallidus internus deep brain stimulation (DBS) in patients with refractory Tourette syndrome (RTS). MethodsThis retrospective study recruited 61 patients with RTS who underwent posteroventral globus pallidus internus (GPi) DBS from January 2010 to December 2020 at the Chinese People's Liberation Army General Hospital. The Yale Global Tic Severity Scale (YGTSS), Yale-Brown Obsessive-Compulsive Scale (YBOCS), Beck Depression Inventory (BDI), Gilles de la Tourette Syndrome Quality-of-Life Scale (GTS-QOL) were used to evaluate the preoperative and postoperative clinical condition in all patients. Prognostic factors and adverse events following surgery were analyzed. ResultsPatient follow up was conducted for an average of 73.33 ± 28.44 months. The final postoperative YGTSS (32.39 ± 22.34 vs 76.61 ± 17.07), YBOCS (11.26 ± 5.57 vs 18.31 ± 8.55), BDI (14.36 ± 8.16 vs 24.79 ± 11.03) and GTS-QOL (39.69 ± 18.29 vs 78.08 ± 14.52) scores at the end of the follow-up period were significantly lower than those before the surgery (p < 0.05). While age and the duration of follow-up were closely related to prognosis, the disease duration and gender were not. No serious adverse events were observed and only one patient exhibited symptomatic deterioration. ConclusionsPosteroventral-GPI DBS provides long-term effectiveness, acceptable safety and can improve the quality of life in RTS patients. Moreover, DBS is more successful among younger patients and with longer treatment duration.

Comprehensive behavioural intervention for tics: a neurophysiological intervention.

Gilles de la Tourette Syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterised by motor and vocal tics. While Comprehensive Behavioural Intervention for Tics (CBIT) is an effective, non-pharmacological treatment for patients with GTS, the underlying neurophysiological basis of this intervention has not been investigated. To investigate the clinical effectiveness of CBIT in reducing tic severity in young people with GTS and explore neurophysiological mechanisms associated with clinical change. There was a significant overall improvement in tic severity of large effect size. The Cortical Silent Period (CSP) to motor evoked potential (MEP) ratio (CSP/MEP ratio) increased after the intervention with a small effect size. Other neurophysiological measures of inhibition were not significantly related to the change in tic severity. Alongside significant clinical improvements, these results suggest a role for motor cortical Gamma-aminobutyric acid (GABA)-ergic inhibitory circuitry in the neurophysiological changes underlying CBIT treatment. These findings need to be replicated in larger studies using control samples.

Heat induced reduction of tics for Gilles de la Tourette Syndrome

Heat induced reduction of tics for Gilles de la Tourette Syndrome

Medical Cannabis for Gilles de la Tourette Syndrome: An Open-Label Prospective Study.

Objectives Assessing the effectiveness and tolerability of medical cannabis (MC) treatment on Gilles de la Tourette syndrome (GTS) patients. Methods We report on an open-label, prospective study on the effect of MC on adult GTS patients. MC mode of use was decided by the treating neurologist and the patient. Δ9-Tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) content within MC product and monthly dose were titrated during the study. Following treatment initiation, patients were assessed after 4 and 12 weeks for efficacy, tolerability, and side effects. Results Eighteen patients entered the study. Baseline Yale Global Tic Severity Scale- (YGTSS) Total (range 0-100) was 60.3 ± 17.1. Three patients did not reach the end of follow-up period. The most common mode of administration was smoking (80%). Following twelve weeks of treatment, a significant 38% average reduction (p = 0.002) of YGTSS-Total and a 20% reduction (p = 0.043) of Premonitory Urge for Tic Scale (PUTS) were observed. Common side effects were dry mouth (66.7%), fatigue (53.3%), and dizziness (46.7%). Three patients suffered from psychiatric side effects including worsening of obsessive compulsive disorder (stopped treatment), panic attack, and anxiety (resolved with treatment modification). Six patients (40%) reported cognitive side effects regarding time perception, visuospatial disorientation, confusion, slow processing speed, and attention. Conclusions MC treatment demonstrates good efficacy and tolerability in adult GTS patients. Predilection for smoking rather than using oil drops requires further comparative studies to evaluate the efficacy of each. Cognitive and psychiatric side effects have to be monitored and addressed.

Cannabis-based medicine in treatment of patients with Gilles de la Tourette syndrome.

Gilles de la Tourette syndrome (GTS) is a childhood onset disorder characterised by the presence of motor and vocal tics. The guidelines of both the American Academy of Neurology (AAN) as well as the European Society for the Study of Tourette Syndrome (ESSTS) recommend behavioural therapy and pharmacotherapy, mainly with antipsychotics, as first line treatments for tics. In spite of these well-established therapeutic approaches, a significant number of patients are dissatisfied because of insufficient tic reduction or intolerable side effects. Previous studies have suggested that cannabis-based medicine (CBM) might be an alternative treatment in these patients. Two reviewers (KS, NS) searched the electronic database of PubMed on 1 July, 2021 for relevant studies using the search terms: ('Tourette syndrome' [MeSH Terms] OR 'Gilles de la Tourette syndrome' [MeSH Terms] OR 'tic disorders' [MeSH Terms] OR 'tics' [MeSH Terms] OR 'tic disorders'[Title/Abstract]) AND ('cannabis-based medicine' [Title/Abstract] OR 'cannabis' [Title/Abstract] OR 'dronabinol' [Title/Abstract] OR 'nabiximols' [Title/Abstract] OR 'tetrahydrocannabinol' [Title/Abstract] OR 'THC' [Title/Abstract] OR 'cannabidiol' [Title/Abstract], limit: 'humans'. These studies were further reviewed for additional relevant citations. The titles and abstracts of the studies obtained through this search were examined by two reviewers (KS, NS) in order to determine article inclusion. Discrepancies were addressed by the reviewers through discussion and eventually conversation with the senior reviewer (KMV). Although the amount of evidence supporting the use of CBM in GTS is growing, the majority of studies are still limited to case reports, case series, and open uncontrolled studies. To date, only two small randomised controlled trials (RCTs) using tetrahydrocannabinol (THC, dronabinol) have been published demonstrating the safety and efficacy of this intervention in the treatment of tics in patients with GTS. On the other hand, another RCT with Lu AG06466 (formerly known as ABX-1431), a modulator of endocannabinoid neurotransmission, has failed to prove effective in the therapy of GTS. Accordingly, under the guidelines of both the ESSTS and the AAN, treatment with CBM is categorised as an experimental intervention that should be applied to patients who are otherwise treatment-resistant. Increasing evidence suggests that CBM is efficacious in the treatment of tics and psychiatric comorbidities in patients with GTS. The results of ongoing larger RCTs, such as CANNA-TICS (ClinicalTrials.gov Identifier: NCT03087201), will further clarify the role of CBM in the treatment of patients with GTS.

The Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL): A Validation in Japanese Patients.

Background: Though Gilles de la Tourette's syndrome (GTS) has significant impact on the quality of life of its patients, measures of health-related quality of life (HR-QOL) specific to adolescents and adults with GTS were not developed until recently. The present study provides evidence on the validity of the Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL), the first disease-specific HR-QOL instrument for GTS patients, for the first time in an East Asian sample.Methods: One hundred and two Japanese individuals aged 13 and above with GTS were included in our study. Internal consistency was evaluated using Cronbach's alpha. The 4-factor structure of the GTS-QOL was assessed using confirmatory factor analysis, using goodness of fit indices, factor loadings of each questionnaire item, and covariances between factors. Validity was assessed using interscale correlations. Convergent and discriminate construct validity was evaluated using correlations with other scales such as the 28-item General Health Questionnaire, the Yale Global Tic Severity Scale, and the short version of the Padua Inventory.Results: Scaling assumptions were met. Internal consistency reliability was high, with a Cronbach's alpha of 0.96. Confirmatory factor analysis revealed sufficient factor loadings and goodness of fit. All measures of goodness of fit corroborated the fit of the 4-factor model. Standardized covariances between factors in the confirmatory factor analysis were >0.8. There were significant correlations with other well-validated scales, and thus convergent and discriminate construct validity was sufficient.Conclusion: The GTS-QOL is a valid and reliable instrument to measure disease-specific HR-QOL of GTS patients in Japan.

Management of Psychosis Accompanying Tourette Syndrome with Quetiapine

Gilles de la Tourette (or briefly Tourette) syndrome (TS) is a neurobehavioral disorder that often begins in childhood and is characterized by motor and vocal tics. Many psychiatric disorders may accompany TS, attention-deficit hyperactivity disorder, and obsessive–compulsive disorder being the most frequent. However, literature regarding the association between TS and psychosis is controversial. We present a patient who has comorbid TS and psychosis and is treated successfully with quetiapine.

The Imitation Game in Children With Tourette Syndrome: A Lack of Impulse Control to Mirror Environmental Stimuli.

The learning process in humans requires continuous contacts with environmental stimuli, especially during neurodevelopmental growth. These functions are assisted by the coding potential of mirror neurons to serve social interactions. This ability to learn imitating the observed behavior is no longer necessary during adulthood, and control mechanisms prevent automatic mirroring. However, children with Gilles de la Tourette syndrome could encounter coding errors at the level of the mirror neurons system as these cortical regions are themselves the ones affected in the syndrome. Combined with impulsivity, the resulting sign would be a manifest echopraxia that persists throughout adulthood, averting these individuals from the appraisal of a spot-on motor control.

The Prevalence of Tourette Syndrome and Other Tic Disorders in Saudi Arabia

Background: Tic disorders (TD), including Tourette syndrome, are considered as one of the prevalent neurological conditions across the world which affects pediatric population. Tourette syndrome (TS), also called Gilles de la Tourette syndrome or Tourette disorder, a clinical subtype of TD with the most severe and persistent symptoms, is a complex multifaceted neurodevelopmental disorder characterized by multiple motor and at least one phonic tic starting before the age of 18 and lasting for at least 1 year.&#x0D; Objectives: Our study is designed to assess the prevalence of Tourette syndrome and other tic disorders among Saudi population and examine the sociodemographic factors including age, sex, education, and birthplace.&#x0D; Methods: A cross-sectional survey study conducted in Saudi population. An online questionnaire utilized to collect information from the population via various social media applications. The required minimum sample size is determined to be 384 participants. For statistical analyzation, the Statistical Package of Social Science Software (SPSS) program, version 20 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) was used.&#x0D; Results: The study sample consisted of 2793 participants, 73% of them were females and 27% were males. 43.6% aged between 20- 30 years old and 33.4% aged less than 20 years old. 9.7% of participants suffer from Tourette syndrome while 5.7% of participants have a child who suffer from Tourette syndrome. Regarding co-morbid diseases, 23.7% suffer from anxiety disorder, 16.7% have sleeping disorder, 16.2% have depression, 10.8% eating disorder and 9.9% have obsessive-compulsive disorder. As for children with Tourette syndrome, 20.3% suffer from anxiety disorder, 19.5% have sleeping disorder, 18% have attention deficit hyperactivity disorder, 13.5% eating disorder and 7.9% have obsessive-compulsive disorder.&#x0D; Conclusion: Prevalence of TS among adults and children is higher than reported in previous figures. TS is associated with psychological and neurological diseases especially among children. TS should no longer be considered merely a motor disorder and, most importantly, that TS is no longer a unitary condition, as it was previously thought. Clinical assessment of children with chronic tic disorders warrants examination of other problems such as ADHD, disruptive behavior and anxiety.

50 years of intelligence gone

Gilles de la Tourette (1857–1904) was a French neurologist and personal secretary to Jean Martin Charcot in 1886–87, before becoming his clinical co-director at the Pitié Salpêtrière Hospital (Paris, France) between 1887 and 1888.1 His name remains attached to an eponym, Tourette's Syndrome, which was attributed to him by Charcot following his description, for the first time, of a new nervous disease in nine patients, in January 1885.2

Concordance and comorbidities among monozygotic twins with tic disorders

Gilles de la Tourette Syndrome (GTS) is a multifactorial neurodevelopmental disorder characterized by tics and multiple comorbidities. The pathophysiology is not yet fully understood, but both environmental and genetic risk factors seem to be involved. Twin studies provide important knowledge on genetic factors. We assessed the concordance of GTS and chronic tic disorders (CTD) in monozygotic (MZ) twins, and examined tic severity, symptoms of obsessive-compulsive disorder (OCD), attention deficit/hyperactivity disorder and autism spectrum disorder. Twin pairs, where at least one twin was diagnosed with any tic disorder, were identified through Danish Twin Registry, Psychiatric Central Registry, Danish National Patient Registry and National Tourette Clinic, Copenhagen University Hospital, Herlev. Zygosity was tested with single-nucleotide polymorphism (SNP) genotyping and clinical assessment was done with validated tools. 14 MZ twin pairs were included: five were discordant. Seven twin pairs were concordant for GTS, and for two pairs one twin had GTS and the other CTD. Among the twins with CTD or GTS, 50% had at least one comorbidity, which is higher than in background populations. The GTS + OCD-phenotype was significantly more frequent among GTS-concordant than among discordant twins. No statistically significant differences were found between the GTS-concordant and discordant twin pairs regarding tic severity or comorbidities. Thorough clinical assessment and SNP-based genotyping are important when conducting clinical twin studies. We found high concordance of GTS and CTD, which supports the notion that both disorders have common genetic risk factors. Further studies with larger cohorts including dizygotic twins are warranted for more conclusive results.

Efficacy and Safety of Fixed-Dose Deutetrabenazine in Children and Adolescents for Tics Associated With Tourette Syndrome

Tourette syndrome is a neurodevelopmental disorder characterized by childhood onset of motor and phonic tics, often accompanied by behavioral and psychiatric comorbidities. Deutetrabenazine is a vesicular monoamine transporter 2 inhibitor approved in the US for the treatment of chorea associated with Huntington disease and tardive dyskinesia. To report results of the ARTISTS 2 (Alternatives for Reducing Tics in Tourette Syndrome 2) study examining deutetrabenazine for treatment of Tourette syndrome. This phase 3, randomized, double-blind, placebo-controlled, parallel-group, fixed-dose study was conducted over 8 weeks with a 1-week follow-up (June 21, 2018, to December 9, 2019). Children and adolescents aged 6 to 16 years with a diagnosis of Tourette syndrome and active tics causing distress or impairment were enrolled in the study. Children were recruited from 52 sites in 10 countries. Data were analyzed from February 4 to April 22, 2020. Participants were randomized (1:1:1) to low-dose deutetrabenazine (up to 36 mg/d), high-dose deutetrabenazine (up to 48 mg/d), or a matching placebo, which were titrated over 4 weeks to the target dose followed by a 4-week maintenance period. The primary efficacy end point was change from baseline to week 8 in the Yale Global Tic Severity Scale-Total Tic Score (YGTSS-TTS) for high-dose deutetrabenazine. Key secondary end points included changes in YGTSS-TTS for low-dose deutetrabenazine, Tourette Syndrome Clinical Global Impression score, Tourette Syndrome Patient Global Impression of Impact score, and Child and Adolescent Gilles de la Tourette Syndrome-Quality of Life Activities of Daily Living subscale score. Safety assessments included incidence of treatment-emergent adverse events, laboratory parameters, vital signs, and questionnaires. The study included 158 children and adolescents (mean [SD] age, 11.7 [2.6] years). A total of 119 participants (75%) were boys; 7 (4%), Asian; 1 (1%), Black; 32 (20%), Hispanic; 4 (3%), Native American; 135 (85%), White; 2 (1%), multiracial; 9 (6%), other race; and 1 (0.6%), of unknown ethnic origin. Fifty-two participants were randomized to the high-dose deutetrabenazine group, 54 to the low-dose deutetrabenazine group, and 52 to the placebo group. Baseline characteristics for participants were similar between groups. Of the total 158 participants, 64 (41%) were aged 6 to 11 years, and 94 (59%) were aged 12 to 16 years at baseline. Mean time since Tourette syndrome diagnosis was 3.3 (2.8) years, and mean baseline YGTSS-TTS was 33.8 (6.6) points. At week 8, the difference in YGTSS-TTS was not significant between the high-dose deutetrabenazine and placebo groups (least-squares mean difference, -0.8 points; 95% CI, -3.9 to 2.3 points; P = .60; Cohen d, -0.11). There were no nominally significant differences between groups for key secondary end points. Treatment-emergent adverse events were reported for 34 participants (65%) treated with high-dose deutetrabenazine, 24 (44%) treated with low-dose deutetrabenazine, and 25 (49%) treated with placebo and were generally mild or moderate. In this fixed-dose randomized clinical trial of deutetrabenazine in children and adolescents with Tourette syndrome, the primary efficacy end point was not met. No new safety signals were identified. ClinicalTrials.gov Identifier: NCT03571256.

Reduced Axon Calibre in the Associative Striatum of the Sapap3 Knockout Mouse.

Pathological repetitive behaviours are a common feature of various neuropsychiatric disorders, including compulsions in obsessive–compulsive disorder or tics in Gilles de la Tourette syndrome. Clinical research suggests that compulsive-like symptoms are related to associative cortico-striatal dysfunctions, and tic-like symptoms to sensorimotor cortico-striatal dysfunctions. The Sapap3 knockout mouse (Sapap3-KO), the current reference model to study such repetitive behaviours, presents both associative as well as sensorimotor cortico-striatal dysfunctions. Previous findings point to deficits in both macro-, as well as micro-circuitry, both of which can be affected by neuronal structural changes. However, to date, structural connectivity has not been analysed. Hence, in the present study, we conducted a comprehensive structural characterisation of both associative and sensorimotor striatum as well as major cortical areas connecting onto these regions. Besides a thorough immunofluorescence study on oligodendrocytes, we applied AxonDeepSeg, an open source software, to automatically segment and characterise myelin thickness and axon area. We found that axon calibre, the main contributor to changes in conduction speed, is specifically reduced in the associative striatum of the Sapap3-KO mouse; myelination per se seems unaffected in associative and sensorimotor cortico-striatal circuits.

Safety and Efficacy of Flexible-Dose Deutetrabenazine in Children and Adolescents With Tourette Syndrome

Tourette syndrome is a neurodevelopmental disorder characterized by childhood onset of motor and phonic tics; treatments for tics are associated with safety concerns. Deutetrabenazine is a selective vesicular monoamine transporter 2 inhibitor approved for the treatment of chorea associated with Huntington disease and tardive dyskinesia in adults. To examine whether deutetrabenazine is effective and safe for the treatment of Tourette syndrome in children and adolescents. This phase 2/3, randomized, double-masked, placebo-controlled, parallel-group, dose-titration study included children and adolescents (aged 6-16 years) with Tourette syndrome with active tics causing distress or impairment (ie, Yale Global Tic Severity Scale-Total Tic Score [YGTSS-TTS] ≥20). The trial was conducted over 12 weeks, with 1 week of follow-up from February 2018 to November 2019 at 36 centers in the United States, Canada, Denmark, Russia, Serbia, and Spain. Data analysis was conducted from January 31 to April 22, 2020. Patients were randomized (1:1) to receive deutetrabenazine or placebo, titrated during 7 weeks to an optimal level, followed by a 5-week maintenance period. The maximum total daily deutetrabenazine dose was 48 mg/d. The primary efficacy end point was change from baseline to week 12 in YGTSS-TTS. Key secondary end points included changes in Tourette Syndrome-Clinical Global Impression, Tourette Syndrome-Patient Global Impression of Impact, and Child and Adolescent Gilles de la Tourette Syndrome-Quality of Life Activities of Daily Living subscale score. Safety was assessed based on treatment-emergent adverse events, vital signs, questionnaires, and laboratory parameters. A total of 119 participants were randomized to deutetrabenazine (59 participants; mean [SD] age, 11.5 [2.5] years; 53 [90%] boys; 49 [83%] White; 3 [5%] Black) and placebo (60 participants; mean [SD] age, 11.5 [2.6] years; 51 [85%] boys; 53 [88%] White; 3 [5%] Black). At week 12, the difference in YGTSS-TTS score was not significant between deutetrabenazine and placebo (least squares mean difference, -0.7; 95% CI, -4.1 to 2.8; P = .69; Cohen d, -0.07). There were no nominally significant differences between groups for key secondary end points. Treatment-emergent adverse events were reported for 38 patients (66%) and 33 patients (56%) receiving deutetrabenazine and placebo, respectively, and were generally mild or moderate. In this study of deutetrabenazine in children and adolescents with Tourette syndrome, the primary efficacy end point was not met. No new safety signals were identified. These results may be informative for future studies of treatments for tics in Tourette syndrome. ClinicalTrials.gov Identifier: NCT03452943.

Deep brain stimulation for psychiatric disorders: role of imaging in identifying/confirming DBS targets, predicting, and optimizing outcome and unravelling mechanisms of action.

Following the established application of deep brain stimulation (DBS) in the treatment of movement disorders, new non-neurological indications have emerged, such as for obsessive-compulsive disorders, major depressive disorder, dementia, Gilles de la Tourette Syndrome, anorexia nervosa, and addictions. As DBS is a network modulation surgical treatment, the development of DBS for both neurological and psychiatric disorders has been partly driven by advances in neuroimaging, which has helped explain the brain networks implicated. Advances in magnetic resonance imaging connectivity and electrophysiology have led to the development of the concept of modulating widely distributed, complex brain networks. Moreover, the increasing number of targets for treating psychiatric disorders have indicated that there may be a convergence of the effect of stimulating different targets for the same disorder, and the effect of stimulating the same target for different disorders. The aim of this paper is to review the imaging studies of DBS for psychiatric disorders. Imaging, and particularly connectivity analysis, offers exceptional opportunities to better understand and even predict the clinical outcomes of DBS, especially where there is a lack of objective biomarkers that are essential to properly guide DBS pre- and post-operatively. In future, imaging might also prove useful to individualize DBS treatment. Finally, one of the most important aspects of imaging in DBS is that it allows us to better understand the brain through observing the changes of the functional connectome under neuromodulation, which may in turn help explain the mechanisms of action of DBS that remain elusive.

EWAS of Monozygotic Twins Implicate a Role of mTOR Pathway in Pathogenesis of Tic Spectrum Disorder.

Tic spectrum disorder (TSD) is an umbrella term which includes Gilles de la Tourette syndrome (GTS) and chronic tic disorder (CTD). They are considered highly heritable, yet the genetic components remain largely unknown. In this study we aimed to investigate disease-associated DNA methylation differences to identify genes and pathways which may be implicated in TSD aetiology. For this purpose, we performed an exploratory analysis of the genome-wide DNA methylation patterns in whole blood samples of 16 monozygotic twin pairs, of which eight were discordant and six concordant for TSD, while two pairs were asymptomatic. Although no sites reached genome-wide significance, we identified several sites and regions with a suggestive significance, which were located within or in the vicinity of genes with biological functions associated with neuropsychiatric disorders. The two top genes identified (TSC1 and CRYZ/TYW3) and the enriched pathways and components (phosphoinosides and PTEN pathways, and insulin receptor substrate binding) are related to, or have been associated with, the PI3K/AKT/mTOR pathway. Genes in this pathway have previously been associated with GTS, and mTOR signalling has been implicated in a range of neuropsychiatric disorders. It is thus possible that altered mTOR signalling plays a role in the complex pathogenesis of TSD.

Candidate Genes and Pathways Associated with Gilles de la Tourette Syndrome-Where Are We?

Gilles de la Tourette syndrome (GTS) is a childhood-onset neurodevelopmental and -psychiatric tic-disorder of complex etiology which is often comorbid with obsessive-compulsive disorder (OCD) and/or attention deficit hyperactivity disorder (ADHD). Twin and family studies of GTS individuals have shown a high level of heritability suggesting, that genetic risk factors play an important role in disease etiology. However, the identification of major GTS susceptibility genes has been challenging, presumably due to the complex interplay between several genetic factors and environmental influences, low penetrance of each individual factor, genetic diversity in populations, and the presence of comorbid disorders. To understand the genetic components of GTS etiopathology, we conducted an extensive review of the literature, compiling the candidate susceptibility genes identified through various genetic approaches. Even though several strong candidate genes have hitherto been identified, none of these have turned out to be major susceptibility genes yet.

Les biographies de psychiatres

The biographies of psychiatrists have been in the 19th century panegyrics, pronounced during the funeral or necrologies evoking the career and the publications of the deceased. The successive secretaries of the medico-psychological society, Auguste Motet and then Antoine Ritti, have written many texts with accurate information on the life and works of the first French alienists. They have been gathered in books, published in 1894 and in 1913–1914. The specialist of the psychiatric biography at the beginning of the 20th century is René Sémelaigne (1855–1934), descendant of the Pinel family by his mother. He has written a reference book during half a century: The pioneers of the French psychiatry before and after Pinel (2 tomes, 1930 and 1932), including notices about 97 personalities from the 16th to the 20th century (22 before Pinel, 75 after). They were physicians, alienists or specialists of internal medicine having contributed to the clinic of neurosis. A detailed bibliography (books and articles), almost exhaustive, of each author is presented in annex of his notice. The chapters are rather hagiographic. The texts are based on the quest for forerunners and the positivist illusion of uninterrupted progress. Psychiatric journals have published in 1950 and in 1973 some issues with articles on the life and works of famous alienists. After Michel Foucault's Histoire de la Folie (1961), the biographies are more critical. The suicides of Clérambault and more recently of Marcé are clearly related. The Biographic Dictionary of Pierre Morel (1984) include about 270 notices (350 in the edition of 1996) of French and foreign personalities, not only physicians, but also psychoanalysts, philanthropists and patients. For the first time, women are present in a psychiatric dictionary. Like Kraepelin, some psychiatrists have written theirs memoirs at the end of the 20th century (Baruk, Debray-Ritzen). Others have answered in the journal International Psychiatry (1993) to the questionnaire: why have you chosen the psychiatry? In the 1990s, several books have been written on the life of alienists and psychiatrists that have marked their time, either by physicians (Marcé, Dide, Heuyer, Ey), or by historians (Pinel, Toulouse, Clérambault). For others, it is a collective book by several contributors (Esquirol, Moreau de Tours, Minkowski, Delay). Personalities belonging to neurology and psychiatry have also inspired biographies (Bourneville, Alzheimer, Gilles de la Tourette). Since 2004, a Biographical dictionary, initiated by Joseph Biéder, is published in the issues of the Annales Médico-Psychologiques, the most ancient French psychiatric journal, created in 1843. In 2020, it includes 86 notices, written by 16 contributors. The personalities are alienists, psychiatrists, neuropsychiatrics and physicians interested by the psychiatry during the 19th and the 20th centuries. The evolution of the biography from the panegyric to the critical contribution, for example in the case of Clérambault, question about its function and about the relationship between the works of an author and his life.

Successful nutrition-based approach in Gilles de la Tourette syndrome heralding drug side effects: A case report and short review

Gilles de la Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by tics that frequently hide complex spectra with behavioral disorders. Medical intervention should rely on multimodal strategies including nutritional assessment and dietetic support as patients can suffer from impulsive eating and the medications often cause metabolic side effects. We present for the first time the case and treatment of a boy suffering from a severe phenotype of TS who experienced hyperphagia, weight gain, gastrointestinal disturbances, and nutritional delusions. Brief annotations about both differential nutritional assessment and underlying drug-related implications are also offered. The parents were educated on healthy eating, drug-food interactions, and hunger delay techniques. After the symptom-driven personalization of drug therapy, the start of cognitive behavioral therapy, and the escalation of the dietetic plan, the boy managed to lose weight and maintain healthy eating habits at the three-year follow-up. We reaffirm the importance of not only including a nutritionist in the management team of patients with TS, but also of assuring that the nutritional protocol perfectly integrates a comprehensive strategy in order to obtain long-term results.

Lower-level associations in Gilles de la Tourette syndrome: Convergence between hyperbinding of stimulus and response features and procedural hyperfunctioning theories.

Gilles de la Tourette syndrome (GTS) can be characterized by enhanced cognitive functions related to creating, modifying and maintaining connections between stimuli and responses (S-R links). Specifically, two areas, procedural sequence learning and, as a novel finding, also event file binding, show converging evidence of hyperfunctioning in GTS. In this review, we describe how these two enhanced functions can be considered as cognitive mechanisms behind habitual behaviour, such as tics in GTS. Moreover, the presence of both procedural sequence learning and event file binding hyperfunctioning in the same disorder can be treated as evidence for their functional connections, even beyond GTS. Importantly though, we argue that hyperfunctioning of event file binding and procedural learning are not interchangeable: they have different time scales, different sensitivities to potential impairment in action sequencing and distinguishable contributions to the cognitive profile of GTS. An integrated theoretical account of hyperbinding and hyperlearning in GTS allows to formulate predictions for the emergence, activation and long-term persistence of tics in GTS.