Tourette Syndrome Symptoms Research Articles

Fixational eye movements in Tourette syndrome.

Studies of saccadic eye movements in subjects with Tourette syndrome (TS) have provided additional evidence that there is a link between TS symptoms and deficits in fronto-striato-thalamic networks. These studies revealed impaired timing and inhibition of saccades. We compared fixational eye movements, such as microsaccades and ocular drifts, in subjects with TS and healthy controls.We measured horizontal and vertical eye positions with video-oculography in 14 subjects with Tourette syndrome. We found reduced microsaccade amplitude but increased time between adjacent microsaccades (intersaccadic interval). Hence, the rate of microsaccades was reduced in subjects with TS compared to controls. Measure of ocular stability during intersaccadic intervals revealed increased drift velocity and increased variance in eye position. We hypothesize that increased activity of the direct fronto-striatal pathway and the resulting reduction in basal ganglia outflow targeting the superior colliculus fixation zone affect the rate and amplitude of microsaccades in subjects with TS. The resulting impairment in frontal eye field fixation leads to increased drifts during intersaccadic interval in subjects with TS. Possible clinical implication for these results is that fixational eye movements can be objective biological markers of TS.

17 Depressive symptoms in tourette syndrome: a controlled study

<h3>Objective</h3> Affective symptoms are frequently reported by patients with tic disorders and Tourette syndrome in particular. Depression in the context of Tourette syndrome is likely to be aetiologically multifactorial and phenotypically heterogeneous. Despite the known impact of depression on health-related quality of life of patients with neuropsychiatric disorders, little research has been conducted on the clinical aspects of affective symptoms associated with Tourette syndrome. We set out to assess the clinical phenomenology and severity of depressive symptoms in adult patients with Tourette syndrome compared to adult patients with major depression and healthy controls. <h3>Method</h3> The Beck Depression Inventory (BDI) was used to collect self-report ratings of depressive symptoms from 65 patients with Tourette syndrome (BDI-II), 293 healthy controls (BDI-IA) and 696 patients with a lifetime diagnosis of recurrent major depressive disorder (BDI-IA). All clinical diagnoses were validated by DSM criteria and direct comparisons were possible for 14 out of the 21 BDI items. Patients with Tourette syndrome were recruited at a specialist tertiary referral clinic, whereas patients with a primary diagnosis of depression and healthy controls were extracted from a large multicentre research database developed for the investigation of genetic and non-genetic determinants of affective disorders. <h3>Results</h3> Patients with Tourette syndrome reported significantly higher total BDI scores than healthy controls <h3>Conclusion</h3> Depression is confirmed as a major clinical issue in patients with Tourette syndrome. Self-report ratings of overall depression severity in this patient population are similar to those reported by patients with a primary diagnosis of recurrent major depressive disorder. There are however specific differences in the clinical phenomenology of depressive symptoms, as irritability is a more prominent feature in patients with Tourette syndrome. Routine screening for affective symptoms with particular focus on the assessment of irritability symptoms is warranted in order to implement effective treatment strategies as appropriate. Future research is needed to better understand the relationship between tic symptoms, irritability and depression in Tourette syndrome.

Allopregnanolone mediates the exacerbation of Tourette-like responses by acute stress in mouse models

Tourette syndrome (TS) is a neuropsychiatric disorder characterized by multiple tics and sensorimotor abnormalities, the severity of which is typically increased by stress. The neurobiological underpinnings of this exacerbation, however, remain elusive. We recently reported that spatial confinement (SC), a moderate environmental stressor, increases tic-like responses and elicits TS-like sensorimotor gating deficits in the D1CT-7 mouse, one of the best-validated models of TS. Here, we hypothesized that these adverse effects may be mediated by neurosteroids, given their well-documented role in stress-response orchestration. Indeed, SC increased the levels of progesterone, as well as its derivatives 5α-dihydroprogesterone and allopregnanolone, in the prefrontal cortex (PFC) of D1CT-7 mice. Among these steroids, however, only allopregnanolone (5–15 mg/kg, IP) dose-dependently exacerbated TS-like manifestations in D1CT-7, but not wild-type littermates; these effects were countered by the benchmark anti-tic therapy haloperidol (0.3 mg/kg, IP). Furthermore, the phenotypic effects of spatial confinement in D1CT-7 mice were suppressed by finasteride (25–50 mg/kg, IP), an inhibitor of the main rate-limiting enzyme in allopregnanolone synthesis. These findings collectively suggest that stress may exacerbate TS symptoms by promoting allopregnanolone synthesis in the PFC, and corroborate previous clinical results pointing to finasteride as a novel therapeutic avenue to curb symptom fluctuations in TS.

Systematic review of severity scales and screening instruments for tics: Critique and recommendations.

Several clinician, informant, and self-report instruments for tics and associated phenomena have been developed that differ in construct, comprehensiveness, and ease of administration. A Movement Disorders Society subcommittee aimed to rate psychometric quality of severity and screening instruments for tics and related sensory phenomena. Following the methodology adopted by previous Movement Disorders Society subcommittee papers, a review of severity and screening instruments for tics was completed, applying a classification as "recommended," "suggested," or "listed" to each instrument. A total of 5 severity scales (Yale Global Tic Severity Scale, Tourette Syndrome Clinical Global Impression, Tourette's Disorder Scale, Shapiro Tourette syndrome Severity Scale, Premonitory Urges for Tics Scale) were "recommended," and 6 (Rush Video-Based Tic Rating Scale, Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey, Tourette Syndrome Global Scale, Global Tic Rating Scale, Parent Tic Questionnaire, Tourette Syndrome Symptom List) were "suggested." A total of 2 screening instruments (Motor tic, Obsession and compulsions, Vocal tic Evaluation Survey and Autism-Tics, Attention Deficit/Hyperactivity Disorder and Other Comorbidities Inventory) were "recommended," whereas 2 others (Apter 4-questions screening and Proxy Report Questionnaire for Parents and Teachers) were "suggested." Our review does not support the need for developing new tic severity or screening instruments. Potential objectives of future research include developing a rating instrument targeting the full spectrum of tic-related abnormal behaviors, assessing/screening malignant forms of tic disorders, and developing patient-reported outcome measures. © 2017 International Parkinson and Movement Disorder Society.

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.

A Family's Guide to Tourette Syndrome

This well-written and easy-to-read text is designed for patients, parents, educators, and medical professionals who are impacted by Tourette syndrome (TS). The book provides not only a historical perspective but also a summary of current knowledge, available resources, and future directions for research and study in nontechnical language that is accessible to all readers. This book was released by the National Tourette Syndrome Association, Inc. (TSA) which describes itself as “the most notable advocate for people touched by this disorder and is perhaps the leading supporter of Tourette syndrome research and education around the world.” The opening chapter provides an overview for the contents of the book, including the definition, diagnosis, and treatment of TS, as well as the genetic basis and possible environmental triggers of the syndrome. One particularly memorable chapter is written by a physician who has spent her life working with patients with TS, and she illustrates how the psychosocial aspects of TS can impact the individual's perception of his or her disorder. Another chapter is written by a mother of three children with TS who, herself, also suffers from TS. This chapter provides an intimate and personal description of living with TS and parenting children with TS. The authors of each chapter represent a diverse array of experience with the disorder and each lends a unique perspective based on their role as a clinician, researcher, or parent. The final chapter contains 50 “Frequently Asked Questions” with brief responses and is an excellent resource for people looking for a quick answer. Throughout the book, multiple figures, graphs, and illustrative case examples help to make more of the complex concepts or multiple treatment strategies easier to understand and interpret. Several chapters address treatment. One section is devoted to drug treatments used to target the symptoms of TS and the multiple disorders known to be comorbid with TS, including attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, anxiety, and depression. The chapter begins by defining how scientific studies into drug efficacy are conducted, followed by a description and chart of medications which includes the generic drug names, brand drug names, mechanism of action, FDA approval status, and side effects. Later chapters discuss behavioral therapies including Comprehensive Behavioral Intervention for Tics (CBIT), a form of cognitive behavioral therapy that is focused on first “awareness training” of when a tic is about to occur, followed by “competing response training” where the patient then identifies a physical response that he or she can use when feeling the urge to tic. This form of therapy emphasizes the importance of social support and encouragement for the person practicing the CBIT techniques. In addition to discussing the history and well-defined knowledge related to TS, the book also explores more controversial areas including pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), complementary and alternative medicine (CAM) therapies, medication use during pregnancy and breastfeeding, and deep brain stimulation (DBS) as a treatment for some with TS. However, an updated version reflecting more recent discussions regarding these topics and using the language of the Diagnostic and Statistical Manual–Fifth Edition would make this section more practical and applicable. While the language of this text is aimed toward parents and caregivers, interested clinicians may find this an accurate and easy-to-read resource to refresh their knowledge of this disorder. However, this book is not meant to be a clinical reference, and interested parties seeking peer-reviewed material would need to look elsewhere. Overall, A Family's Guide to Tourette Syndrome offers concise and easily understandable information in a manner that is accessible to all readers. This book will be of special interest to parents, teachers, patients, or any person interested in an overview of how TS is defined, what treatments are available, and what research is ongoing.

Impact of co-morbid attention-deficit and hyperactivity disorder on cognitive function in male children with Tourette syndrome: A controlled study

Tourette syndrome (TS) and attention-deficit and hyperactivity disorder (ADHD) are co-morbid neurodevelopmental conditions affecting more commonly male patients. We set out to determine the impact of co-morbid ADHD on cognitive function in male children with TS by conducting a controlled study. Participants included four matched groups of unmedicated children (age range 6–15 years): TS (n=13), TS+ADHD (n=8), ADHD (n=39), healthy controls (n=66). Following clinical assessment, each participant completed a battery of tests from the Wechsler Intelligence Scale for Children-III, the Italian Battery for ADHD, the Tower of London test, the Corsi test, and the Digit Span test. All patient groups reported significantly lower scores than healthy controls across the neuropsychological tests involving executive functions. The TS+ADHD group was the most severely affected, followed by the ADHD group and the TS group, particularly in the tests assessing planning ability, inhibitory function, working memory and visual attention, but not auditory attention. Problems in executive functions are more common in patients with neurodevelopmental disorders than controls. Deficits in planning ability, inhibitory function, working memory and visual attention reported by children with TS appear to be more strongly related to the presence of co-morbid ADHD symptoms than core TS symptoms.

Comorbidities, Social Impact, and Quality of Life in Tourette Syndrome.

Tourette syndrome (TS) is more than having motor and vocal tics, and this review will examine the varied comorbidities as well as the social impact and quality of life (QoL) in individuals with TS. The relationship between any individual and his/her environment is complex, and this is further exaggerated in the case of a person with TS. For example, tics may play a significant role in shaping the person’s experiences, perceptions, and interactions with the environment. Furthermore, associated clinical features, comorbidities, and coexisting psychopathologies may compound or alter this relationship. In this regard, the common comorbidities include attention-deficit hyperactivity disorder and disruptive behaviors, obsessive compulsive disorder, and autism spectrum disorder, and coexistent problems include anxiety, depression, and low self-esteem, which can all lead to poorer psychosocial functioning and QoL. Thus, the symptoms of TS and the associated comorbid conditions may interact to result in a vicious cycle or a downward spiraling of negative experiences and poor QoL. The stigma and social maladjustment in TS and the social exclusion, bullying, and discrimination are considered to be caused in large part by misperceptions of the disorder by teachers, peers, and the wider community. Improved community and professional awareness about TS and related comorbidities and other psychopathologies as well as the provision of multidisciplinary services to meet the complex needs of this clinical population are critical. Future research to inform the risk and resilience factors for successful long-term outcomes is also warranted.

Contribution of therapeutic strategies for understanding the Tourette syndrome

Motion is a behavior involving a motor act programmed and executed in a particular cognitive and emotional context. Deep structures of the brain, including the basal ganglia, appear to play a crucial role in the integration of these three kinds of cortex information (motion, cognition, emotion). Through its organization, the basal ganglia system enables learning and memorization of behavioral sequences, which can then be executed as routines. Their dysfunctions seem to be associated with many psychopathological situations. Thus, tics in Tourette's syndrome (TS) can be seen as a control routines defect that may result from wiring anomaly between the cortex and the basal ganglia. By precisely targeting deep brain circuits implicated in psychiatric disorders, deep brain stimulation (DBS) offers hope for the alleviation of severe illnesses resistant to drug therapies and provides a novel tool to investigate the neuroanatomic and physiological bases of certain disorders, including Obsessive-Compulsive Disorder (OCD) and TS, for which early results indicate positive therapeutic outcomes, even during the long-term follow-up. The pathophysiologies of OCD and of TS share dysfunctions of the associative and limbic circuits running between cortical and sub-cortical structures. Recent pathophysiological hypotheses suggest that TS symptoms result from a dysfunction of the basal ganglia circuitry, notably of the ventral striatum. These data are consistent with the supposed function of cortico-basal ganglia circuits in habit learning and routine performance of habits. Based on early reports indicating that high-frequency stimulation of structures along the cortico-basal ganglia axis might be effective in alleviating TS symptoms, DBS is being tested across the world at several nodes of this circuit, including the pallidum, and thalamus. Increasing our knowledge of the functional organization of the cortico-basal ganglia circuits and of their dysfunction in pathological repetitive behaviors would certainly contribute to better define the surgical therapeutic targets, thereby improving available treatments.

Fits, Tantrums, and Rages in TS and Related Disorders

Tourette syndrome (TS) is a neuropsychiatric disorder of childhood onset characterized by motor and phonic tics. In the majority of cases, psychiatric comorbidity complicates TS, manifesting with a wide range of affective and behavioral disturbances. Aggressive symptoms are relatively common in TS and have adverse impacts on family functioning and quality of life. The etiology of such symptoms may reflect a complex interplay among neurobiological, genetic, and environment factors. This paper provides an update on aggressive symptoms in TS with focus on explosive outbursts or “rages” and self-injurious behaviors. Recent studies highlight the association between aggression and common psychiatric comorbidities as well as the role of psychosocial influences. Aggressive symptoms in TS appear associated with tic severity and certain psychiatric comorbid disorders including attention deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder (OCD), and mood disorders. Although still limited, pharmacological and non-pharmacological evidence-based treatments are emerging.

The effectiveness and safety of plum-blossom needle therapy for Tourette syndrome: study protocol for a randomized controlled trial.

BackgroundPrevious studies have indicated that acupuncture can alleviate the symptoms of Tourette syndrome (TS), but the evidence is insufficient. So far, there have been no reports on plum-blossom needle therapy for TS. Here we present a protocol for a randomized controlled trial using plum-blossom needle therapy to treat TS.Methods/designSixty patients will be randomly allocated into either the plum-blossom needle therapy group or the habit reversal training (HRT) group. All patients in each group will be given 12 weeks of treatment, with follow-up at the 24th week. The primary outcome measure will be the mean change from baseline in the total tic score on the Yale Global Tic Severity Scale (YGTSS) at the 12th week. Secondary outcome measures will include the scores on the TS Clinical Global Impression Scale (CGI) and the mean changes from baseline in the YGTSS score and the Children and Adolescents’ Quality of Life Scale (CAQOL) at other time points. Safety will also be evaluated.DiscussionThis trial will evaluate the effectiveness and safety of plum-blossom needle therapy for TS compared with HRT. A limitation of this trial is that patients and acupuncturists cannot be blinded.Trial registrationClinicalTrials.gov Identifier: NCT02403258 (Date of registration: March 31, 2015).

Tourette syndrome, co-morbidities and quality of life.

Tourette syndrome is often associated with attention deficit hyperactivity disorder, obsessive compulsive disorder and other co-morbidities, the presence of which can reduce health-related quality of life. The relationship between the number and type of co-morbidities and tic severity upon health-related quality of life has been insufficiently examined in Tourette syndrome populations and not at all in the Australian context. We hypothesised that an increased number of co-morbid diagnoses would be inversely related to health-related quality of life and that the presence of attention deficit hyperactivity disorder and obsessive compulsive disorder in particular would negatively impact health-related quality of life. In all, 83 people with a previously established diagnosis of Tourette syndrome, who responded to a letter of invitation sent to the Tourette Syndrome Association of Australia past-member database, formed the study sample. Participants completed the Gilles de la Tourette Syndrome-Quality of Life Scale and a short form of the National Hospital Interview Schedule to assess tics and related behaviours. Participants with pure-Tourette syndrome had significantly better health-related quality of life than those with Tourette syndrome and three or more co-morbid diagnoses. Few differences were observed between the pure-Tourette syndrome and Tourette syndrome and one or two co-morbid diagnoses groups. Analysis of the impact of individual co-morbid disorders and Tourette syndrome symptoms on health-related quality of life indicated that attention deficit hyperactivity disorder exerted a significant negative effect, as did the presence of complex tics, especially coprolalia and copropraxia. When these variables were examined in multiple regression analysis, number of co-morbidities and the presence of coprophenomena emerged as significant predictors of health-related quality of life. While tics are the defining feature of Tourette syndrome, it appears to be the presence of co-morbidities, attention deficit hyperactivity disorder, in particular, and coprophenomena that have the greater impact on health-related quality of life. This has implications for symptom-targeting in the treatment of Tourette syndrome since all available treatments are symptomatic and not disease modifying.

Targeted ablation of cholinergic interneurons in the dorsolateral striatum produces behavioral manifestations of Tourette syndrome

Gilles de la Tourette syndrome (TS) is characterized by tics, which are transiently worsened by stress, acute administration of dopaminergic drugs, and by subtle deficits in motor coordination and sensorimotor gating. It represents the most severe end of a spectrum of tic disorders that, in aggregate, affect ∼ 5% of the population. Available treatments are frequently inadequate, and the pathophysiology is poorly understood. Postmortem studies have revealed a reduction in specific striatal interneurons, including the large cholinergic interneurons, in severe disease. We tested the hypothesis that this deficit is sufficient to produce aspects of the phenomenology of TS, using a strategy for targeted, specific cell ablation in mice. We achieved ∼ 50% ablation of the cholinergic interneurons of the striatum, recapitulating the deficit observed in patients postmortem, without any effect on GABAergic markers or on parvalbumin-expressing fast-spiking interneurons. Interneuron ablation in the dorsolateral striatum (DLS), corresponding roughly to the human putamen, led to tic-like stereotypies after either acute stress or d-amphetamine challenge; ablation in the dorsomedial striatum, in contrast, did not. DLS interneuron ablation also led to a deficit in coordination on the rotorod, but not to any abnormalities in prepulse inhibition, a measure of sensorimotor gating. These results support the causal sufficiency of cholinergic interneuron deficits in the DLS to produce some, but not all, of the characteristic symptoms of TS.

Predictors of Experiences and Attitudes at a Summer Camp for Children and Adolescents With Tourette Syndrome

The current study aimed to examine factors predicting camp experiences and attitudes towards having Tourette syndrome (TS). Twenty-eight campers with TS and their caregivers completed measures before and after camp. Higher depressive symptoms before camp significantly predicted poorer camp experiences and attitudes towards having TS at the end of camp. Neither externalizing symptoms nor TS symptoms emerged as significant predictors of camp experiences or attitudes towards having TS. Identification and treatment of symptoms related to depression may benefit children with TS who attend camp.

Therapeutic effect of atomoxetine hydrochloride for attention deficit hyperactivity disorder comorbid Tourette syndrome

Objective To evaluate the therapeutic efficacy of atomoxetine hydrochloride for attention deficit hyperactivity disorder (ADHD) combined with Tourette syndrome (TS). Methods Twenty-six cases of children with ADHD combined with TS were firstly diagnosed American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-Ⅳ) of ADHD and TS were treated with atomoxetine.The symptoms were improved and conditions were assessed based on the fourth version of ADHD parent rating scale and the severity of Yale comprehensive pumping quantity during pre-treatment, the 2nd, 4th, 6th and the 8th week of therapeutic courses, respectively.The adverse reaction was observed. Results 1.Compared with pre-treatment, attention deficit scores after treatment were statistically different(t=8.41, 9.97, all P 0.05). But at the fourth week of assessment, and the rates of curative effect were respectively 19.23% and 46.15%.It had statistical significance (χ2=3.923, P 0.05).3.During the treatment, no severe adverse reaction had appeared. Conclusions Atomoxetine in ADHD comorbid TS had exact curative effect and no obvious adverse reactions.In the treatment of ADHD, hyperactivity / impulsivity effect is better than the attention deficit.In the treatment of TS, vocal tics onset is better than the motor tics.In comparison of ADHD with TS, TS symptoms improve faster than ADHD in the onset, but the final effect is quite. Key words: Attention deficit hyperactivity disorder; Tourette syndrome; Comorbid; Atomoxetine hydrochloride

Sensory Phenomena in Tourette Syndrome: Their Role in Symptom Formation and Treatment.

The primary symptoms of Tourette Syndrome (TS) are motor and vocal tics, but increasingly, researchers have examined the role of sensory phenomena in biobehavioral models of the disorder. These sensory phenomena involve tic-related premonitory urge sensations as well as potential abnormalities in the perceptual and behavioral experiences associated with external sensory input. As such, dysfunctional sensorimotor integration might represent a key facet of TS pathology. The current paper reviews the literature on sensory phenomena in tic disorders and highlights possible connections to TS symptoms and directions for future research.

Impaired activation of the innate immune response to bacterial challenge in Tourette syndrome

Objectives. Infections resulting in immune activation have been proposed to play an etiological role in a subgroup of patients with Tourette syndrome (TS). Methods. In order to further characterize the interaction between pathogens and the innate immune system the toll-like receptor (TLR) 4 on CD14 + monocytes and soluble CD14 (sCD14) levels were analyzed in the serum of 33 Tourette patients and 31 healthy controls. Moreover, collected blood samples were stimulated with lipopolysaccharide (LPS) mimicking a bacterial infection. TLR4 was analysed by flow cytometry, sCD14 was analysed by enzyme-linked immunosorbent assay. Results. Patients had a lower receptor expression of TLR4 after stimulation with LPS (P = 0.045) and higher levels of sCD14 (unstimulated P = 0.014, after LPS P = 0.045). The increase in TLR4 expression after stimulation with LPS was significantly higher in the control group (P = 0.041). Conclusions. Higher levels of sCD14, lower levels of TLR4 expression after stimulation and a diminished up-regulation of TLR4 expression after LPS stimulation in patients might represent an impaired activation of the innate immune response in TS, especially in regard to bacterial infection. The impaired response to pathogens could eventually lead to a higher susceptibility for infections. Recurring infections and a chronic inflammation could trigger and maintain the symptoms of TS.

Histidine Decarboxylase Deficiency Causes Tourette Syndrome: Parallel Findings in Humans and Mice

Tourette syndrome (TS) is characterized by tics, sensorimotor gating deficiencies, and abnormalities of cortico-basal ganglia circuits. A mutation in histidine decarboxylase (Hdc), the key enzyme for the biosynthesis of histamine (HA), has been implicated as a rare genetic cause. Hdc knockout mice exhibited potentiated tic-like stereotypies, recapitulating core phenomenology of TS; these were mitigated by the dopamine (DA) D2 antagonist haloperidol, a proven pharmacotherapy, and by HA infusion into the brain. Prepulse inhibition was impaired in both mice and humans carrying Hdc mutations. HA infusion reduced striatal DA levels; in Hdc knockout mice, striatal DA was increased and the DA-regulated immediate early gene Fos was upregulated. DA D2/D3 receptor binding was altered both in mice and in humans carrying the Hdc mutation. These data confirm histidine decarboxylase deficiency as a rare cause of TS and identify HA-DA interactions in the basal ganglia as an important locus of pathology.

Efficacy of Herbal Drugs in Human Diseases and Disorders

According to a ballpark figure by World Health Organization, more than three-quarters of population of the developing nations exploit herbal medicine for their primary health care. Herbal drugs and their constituents have advantageous effects on long-term fitness and can be used to efficiently treat human diseases or disorders. In veracity, herbs frequently include various active ingredients that imaginably have drug allying commotion in the body. Bringing into play, herbs are often more affordable than procuring expensive contemporary pharmaceuticals to take care of ailments. A large number of herbs have proved their usefulness in managing various illnesses. Latest advances in biology and medicine have introduced new technologies to study the biological significance of herbal drugs in various human diseases and disorders. Hence it is important to understand the mechanism(s) of herbal drug action for the knowledge and development of successful therapies. The current special issue brings together several exciting papers defining the efficacy of herbal drugs in an assortment of human diseases and disorders. J. Li et al. have tested the effects and mechanism of Bufei Yishen formula (BYF) in a rat chronic obstructive pulmonary disease (COPD) model and provided the basis for mechanisms of BYF on COPD and new therapeutic drug targets. X. Yu et al. have reported the treatment of Si-Jun-Zi decoction, a famous Chinese medicine that promotes the restoration of intestinal function after obstruction by regulating intestinal homeostasis. Tong xinluo (TXL), a Chinese herbal compound, has been used in China with traditional therapeutic efficacy in patients with diabetic nephropathy (DN). N. Zhang et al. demonstrated that TXL successfully inhibits TGF-β1-induced epithelial-to-mesenchymal transition in DN, which may account for the therapeutic efficacy in TXL-mediated renal protection. W. Zhang et al. explored the effects of Jian-Pi-Zhi-Dong decoction (JPZDD) on Tourette syndrome (TS) by investigating the expression of gamma-aminobutyric acid (GABA) and its type A receptor (GABAAR) in the striatum of a TS mice model induced by 3,3′-iminodipropionitrile (IDPN) treatment. It was revealed that JPZDD alleviates TS symptoms which may be associated with GABAAR expression downregulation in striatum thereby controlling GABA metabolism. TZQ-F has been traditionally used as a traditional Chinese medicine formula for the treatment of diabetes. H. Yuhong et al. compared the pharmacologic effects and gastrointestinal adverse events between TZQ-F and acarbose in Chinese healthy volunteers. T. Numata et al. reported the treatment of posttraumatic stress disorder (PTSD) using the traditional Japanese herbal medicine Saikokeishikankyoto in survivors of the great east Japan earthquake and tsunami. The traditional medicine may be a valid choice for the treatment of psychological and physical symptoms in PTSD patients. Y. Ewnetu et al. evaluated the synergetic antimicrobial effect of Ethiopian honey and ginger powder extract mixtures on standard and resistant clinical isolates of Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae. The combination has the potential to serve as cheap source of antibacterial agents especially for the drug resistant strains. Herbs are now gaining much attention as the main source of effective drugs for lowering serum lipids and lipid peroxidation. M. Rafieian-kopaei et al. assessed the impact of Ferulago angulata on serum lipid profiles and on levels of lipid peroxidation in male Wistar rats. Administration of a hydroalcoholic extract reduces the serum levels of total cholesterol, triglycerides, and LDL comparable to atorvastatin (a standard lipid lowering drug). A-J. Lee et al. investigated the absolute counts and percentages of peripheral blood (PB) lymphocyte subtypes in end-stage cancer patients before and after localized radiotherapy (RT) and after oral administration of Bojungikki-tang water extract (BJITE) and to evaluate the changes mediated by RT and BJITE. It was observed that immune deterioration occurs after RT and administration of BJITE was found effective in its restoration. T. Shimizu provides a good overview of efficacy of Kampo medicine (KM) in treating atopic dermatitis (AD). KM is a traditional herbal medicine in Japan and has a long history and plays an important role in the prevention and treatment of various diseases including AD. Y. Ma et al. explored the efficacy of herb-partitioned moxibustion in patients with diarrhoea-predominant irritable bowel syndrome (DPIBS) and suggest it as a promising, efficacious, and well-tolerated treatment for patients. Melinjo (Gnetum gnemon L.) seed extract containing transresveratrol (3,5,4′-trihydroxy-trans-stilbene) and other derivatives exerts diverse beneficial effects. H. Konno et al. reported melinjo seed extract decreases serum uric acid levels in nonobese Japanese males regardless of insulin resistance and may improve lipid metabolism by increasing HDL cholesterol. We anticipate that readers and scientific fraternity working in the area of herbal drugs will find not only the updated review on the subject but also a compilation of precise data on the efficacy of herbal drugs in some lifestyle diseases and disorders with their suggested mechanism of action. Suaib Luqman Syed Ibrahim Rizvi Andre-Michael Beer Sunil Kumar Khare Pinar Atukeren

Effect of "jian-pi-zhi-dong decoction" on gamma-aminobutyric Acid in a mouse model of tourette syndrome.

The purpose of this study was to explore the positive effects of Jian-Pi-Zhi-Dong Decoction (JPZDD) on Tourette syndrome (TS) by investigating the expression of gamma-aminobutyric acid (GABA) and its type A receptor (GABAAR) in the striatum of a TS mice model. The model was induced by 3,3′-iminodipropionitrile (IDPN) treatment; then mice were divided into 4 groups (n=22, each); control and IDPN groups were gavaged with saline and the remaining 2 groups were gavaged with tiapride and JPZDD. We recorded the stereotypic behaviors of TS mice and measured the content of GABA in striatum by HPLC and GABAAR expression by immunohistochemistry and real-time PCR. Our results showed that JPZDD inhibited the abnormal behaviors of TS model mice and decreased GABA levels and GABAAR protein and mRNA expression in the striatum of TS model mice. In brief, the mechanism by which JPZDD alleviates TS symptoms may be associated with GABAAR expression downregulation in striatum which may regulate GABA metabolism.