Tic Symptom Severity Research Articles

The Severity and Neural Correlates of Premonitory Urge in Tourette Syndrome: A Systematic Review and Meta-Analysis.

Premonitory urge (PU) is an aversive bodily sensation that signals the onset of tic disorder.To our knowledge, PU typically precedes the appearance of tic symptoms, and both age and tic severity are correlated with PU. However, inconsistent findings have also been reported. Hence, we conducted a meta-analysis to examine the relationship among premonitory symptoms, patient age and the severity of tic symptoms, as well as to summarize the research on the neural underpinnings of PU in Tourette syndrome (TS). We conducted a literature search of relevant studies published between December 2005 and April 2022 using databases such as PubMed, Elsevier, PsycINFO, and Web of Science. Our analysis was carried out using R software with the assistance of the "meta" and "metafor" packages. Our meta-analysis included 22 studies with a total of 1236 tic disorder patients. The mean Premonitory Urge for Tics Scale (PUTS) score was 20.17, with a 95% confidence interval of [18.14, 21.68]. Through meta-regression, we found that age and tic severity play important moderating roles in PU severity (p < 0.0001). Neuroimaging studies suggest that PU is related to the insula, prefrontal cortex (PFC), anterior cingulate cortex (ACC), and supplementary motor area (SMA), regardless of the structural or functional level. Our meta-analysis confirmed the positive relationship between the severity of tics and PU and identified age as a significant factor influencing PU. The neural mechanisms underlying PU remain largely unknown, but evidence suggests that the insula, PFC, ACC, and SMA are related regions.

The Roles of Lifetime Enacted Stigma in Tic Symptoms among Young Adults with Tourette Syndrome.

Although rarely framed as enacted stigma, adults with Tourette syndrome (ATS) have long suffered from discrimination associated with their tic symptoms. Given the high stress levels of enacted stigma that ATS experience, it is expected that their tic symptoms are profoundly impacted. However, the evidence linking enacted stigma to ATS's tic symptoms remains limited. This study used a secondary data-analysis approach to reanalyze the data from the follow-up phase of a multi-centered, randomized controlled trial in which a behavioral intervention was tested for its efficacy in managing tic symptoms. This study first conducted psychometric testing on a list of 16 enacted stigma events across five life stages and identified the underlying factor structure. The Yale Global Tic Severity Scale (YGTSS) was used to assess severity and impairment of current tic symptoms, whereas the Clinical Global Impression of Severity scale (CGI) was used to obtain the gestalt of clinical judgment on tic severity. A series of multivariate linear models were then fitted to test the relationships between different types of lifetime enacted stigma and current tic symptoms. The analytic sample included 73 young ATS (average age of 23.2 [standard deviation = 2.5] years). The factor analysis identified three types of enacted stigmas: "traumatic events," "confrontations," and "subtle mistreatments." In multivariate models, traumatic events significantly associated with YGTSS-severity, whereas subtle mistreatments provided additional explanations for CGI. Enacted stigma may play important roles in shaping ATS's current tics symptom severity and, therefore, should be carefully considered in future intervention development.

Moderating Role of Depression on the Association of Tic Severity With Functional Impairment in Children

BackgroundChronic tic disorders (CTDs) commonly co-occur with other psychiatric disorders. CTDs have been linked to functional impairment and reduction in quality of life. Insufficient research is available on depressive symptoms in patients with CTD, especially children and adolescents, yielding conflicting findings. To investigate the presence of depressive symptoms in a cohort of children and young adolescents with CTD and to test whether they moderate the link between tic severity and functional impairment. MethodsThe sample consisted of 85 children and adolescents (six to 18 years) with a CTD who were treated in a large referral center. Participants were evaluated using gold-standard self- and clinician-reporting instruments to measure tic symptom severity and tic-related functional impairment (Yale Global Tic Severity Scale), depression (Child Depression Inventory), and obsessive-compulsive symptoms (Children Yale Brown Obsessive Compulsive Scale). ResultsDepressive symptoms (mild to severe) were exhibited by 21% of our sample. Study participants with CTD and comorbid obsessive-compulsive disorder (OCD) and/or attention-deficit/hyperactivity disorder had higher rates of depressive symptoms compared with those without comorbidities. Significant correlations were found within and among all tic-related and OCD-related measures, yet depressive symptoms only correlated to tic-related functional impairment. Depression significantly and positively moderated the correlation between tic severity and tic-related functional impairment. ConclusionsFindings suggest that depression plays an important part as a moderator in the link between tic severity and functional impairment in children and adolescents. Our study highlights the importance of screening for and treating depression in patients with CTD.

Comparative efficacy, tolerability, and acceptability of pharmacological interventions for the treatment of children, adolescents, and young adults with Tourette's syndrome: a systematic review and network meta-analysis

In clinical practice guidelines there is no consensus about the medications that should be initially offered to children and young people with Tourette's syndrome. To provide a rigorous evidence base that could help guide decision making and guideline development, we aimed to compare the efficacy, tolerability, and acceptability of pharmacological interventions for Tourette's syndrome. For this systematic review and network meta-analysis, we searched the Cochrane Central Register of Controlled Trials, Embase, PsycINFO, PubMed, Web of Science, the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov, for published and unpublished studies from database inception to Nov 19, 2021. We included double-blind randomised controlled trials of any medication administered as a monotherapy for at least 1 week against another medication or placebo in children and adolescents (aged ≥4 years and ≤18 years), adults (>18 years), or both, diagnosed with Tourette's syndrome according to standardised criteria. We excluded studies that exclusively recruited participants with comorbid attention-deficit hyperactivity disorder or obsessive-compulsive disorder. The primary outcome was change in severity of tic symptoms (efficacy). Secondary outcomes were treatment discontinuations due to adverse events (tolerability) and for any reason (acceptability). Pharmacological interventions were examined considering medication categories and medications individually in separate analyses. Summary data were extracted and pooled with a random-effects network meta-analysis to calculate standardised mean differences for efficacy and odds ratios for tolerability and acceptability, with 95% CIs. The Confidence in Network Meta-Analysis (CINeMA) framework was used to assess the certainty of evidence. The protocol was pre-registered in PROSPERO (CRD42022296975). Of the 12 088 records identified through the database search, 88 records representing 39 randomised controlled trials were included in the network meta-analysis; these 39 randomised controlled trials comprised 4578 participants (mean age 11·8 [SD 4·5] years; 3676 [80·8%] male participants) and evaluated 23 individual medications distributed across six medication categories. When considering medication categories, first-generation (standardised mean difference [SMD] -0·65 [95% CI -0·79 to -0·51]; low certainty of evidence) and second-generation (-0·71 [-0·88 to -0·54]; moderate certainty of evidence) antipsychotic drugs, as well as α-2 agonists (-0·21 [-0·39 to -0·03]; moderate certainty of evidence), were more efficacious than placebo. First-generation and second-generation antipsychotic drugs did not differ from each other (SMD 0·06 [95% CI -0·14 to 0·25]; low certainty of evidence). However, both first-generation (SMD 0·44 [95% CI 0·21 to 0·66]) and second-generation (0·49 [0·25 to 0·74]) antipsychotic drugs outperformed α-2 agonists, with moderate certainty of evidence. Similar findings were observed when individual medications were considered: aripiprazole (SMD -0·60 [95% CI -0·83 to -0·38]), haloperidol (-0·51 [-0·88 to -0·14]), olanzapine (-0·83 [-1·49 to -0·18]), pimozide (-0·48 [-0·84 to -0·12]), risperidone (-0·66 [-0·98 to -0·34]), and clonidine (-0·20 [-0·37 to -0·02]) all outperformed placebo, with moderate certainty of evidence. Antipsychotic medications did not differ from each other, but there was low to very low certainty of evidence for these comparisons. However, aripiprazole (SMD -0·40 [95% CI -0·69 to -0·12]) and risperidone (-0·46 [-0·82 to -0·11]) outperformed clonidine, with moderate certainty of evidence. Heterogeneity or inconsistency only emerged for a few comparisons. In terms of tolerability and acceptability, there were no relevant findings for any of the efficacious medication categories or individual medications against each other or placebo, but there was low to very low certainty of evidence associated with these comparisons. Our analyses show that antipsychotic drugs are the most efficacious intervention for Tourette's syndrome, while α-2 agonists are also more efficacious than placebo and could be chosen by those who elect not to take antipsychotic drugs. Shared decision making about the degree of tic-related severity and distress or impairment, the trade-offs of efficacy and safety between antipsychotic drugs and α-2 agonists, and other highly relevant individual factors that could not be addressed in the present analysis, should guide the choice of medication for children and young people with Tourette's syndrome. None.

Protocol of a randomized controlled trial to investigate the efficacy and neural correlates of mindfulness-based habit reversal training in children with Tourette syndrome.

Tourette syndrome (TS) is a developmental neuropsychiatric disorder. Behavior therapy, especially habit reversal training (HRT), has gradually become regarded as one of the core therapies for TS. Mindfulness approaches can improve psychological adjustment and reduce stress and anxiety, suggesting potential benefits when incorporated into behavior therapy. To improve the efficacy of HRT, we combined it with mindfulness, an approach named mindfulness-based habitual reversal training (MHRT). The aim of this protocol is to investigate the efficacy and neural mechanisms of MHRT for TS. We will perform a randomized control trial (RCT) to evaluate the efficacy and neural mechanisms of MHRT. The sample will include 160 participants (including 120 patients with TS and 40 healthy controls). The patient sample will be randomly divided into three groups exposed to three different types of training: MHRT, HRT, and psychoeducation and supportive therapy (PST). Participants will be assessed and undergo resting-state fMRI scans at baseline and at the end of the 12-week training. The Yale Global Tic Severity Scale (YGTSS) and Premonitory Urge for Tic Scale (PUTS) will be used to assess the severity of tic symptoms and premonitory urges. The primary outcomes are change scores on the YGTSS and other assessments from baseline and the end of the training. The secondary outcomes are the neural correlates of these trainings among these groups based on graph theory, which is used to characterize brain functional connectivity networks. The default mode network (DMN) and the salience network (SN) will be assessed (which have been associated with mindfulness as well as the generation of tic symptoms) by network parameters, including clustering coefficients and shortest path lengths. Changes in these network parameters will be regarded as the neural correlates of the behavioral training. MHRT was newly developed for the treatment of TS. MHRT may lead to greater reductions in tic severity than traditional HRT. Changes in the network parameters of the DMN and SN may show associations with the efficacy of MHRT. http://www.chictr.org.cn, ChiCTR2100053077, China.

0646 Sleep Disorders and Sleep Medication Use in Youth with Persistent Tic Disorders

Abstract Introduction Sleep disturbance is present in 80% of youth with persistent tic disorders (PTD). However, studies examining rates of sleep disorders in youth with PTD are limited, and reports on sleep medication use in this population are lacking. Such knowledge would inform understanding of assessment and treatment needs of youth with PTD. Therefore, the present study examined rates of sleep disorders and sleep medication use among youth with PTD, and their associations with tic severity and ADHD symptoms. Methods Participants were 52 parents of youth with PTD who responded to an internet survey evaluating sleep-wake patterns. Youth were predominantly male (n = 37, 72.5%); and 88.5% (n = 46) were reported to have Tourette’s disorder and 11.5% (n = 6) were reported to have persistent motor tic disorder. Parents provided demographics and medical history, including lifetime sleep disorder diagnosis by a health professional and current prescription or over-the-counter sleep medication use. Parents rated youth tic severity (Parent Tic Questionnaire) and ADHD symptom severity (Swanson, Nolan, and Pelham-IV Parent Rating Scale). Results Descriptive statistics and independent samples t-tests were performed. Per parent report, 39.2% (n = 20) of youth with PTD had one or more lifetime sleep disorders. Insomnia (n = 9, 17.3%), nightmares (n = 9, 15.7%), sleep walking (n = 5, 10.0%), bruxism (n = 5, 10.0%), and restless leg syndrome (n = 5, 10.0%) were most commonly endorsed. Fifty percent of parents of youth with PTD endorsed youth sleep medication use. The most commonly endorsed sleep medications were melatonin (n = 23, 44.2%), valerian (n = 6, 11.5%), and diphenhydramine (n = 5, 9.6%). There were no significant group differences in tic severity or ADHD symptom severity. Conclusion Findings highlight the presence of disorders of sleep initiation and maintenance, parasomnias, and sleep-related movement disorders in youth with PTD. Results indicate that sleep medication use, particularly melatonin, is common in this population. Future research is needed to test the efficacy of melatonin use for addressing sleep problems in youth with PTDs. Support (If Any) NIMH K23 MH113884 funding to Dr. Ricketts.

Use of Nutritional Supplements Based on L-Theanine and Vitamin B6 in Children with Tourette Syndrome, with Anxiety Disorders: A Pilot Study.

Background: Tourette syndrome (TS) is a neurodevelopmental disorder characterized by tics and co-occurring disorders. It has been suggested that anxiety occurs in 2–45% patients affected by Tourette syndrome. Despite dietary and nutritional factors have been found to affect a range of neurological conditions, no more studies have investigated the relationship between nutritional supplements and tics. Objective: To evaluate the effectiveness of supplementation of both L-Theanine and Vitamin B6 in reducing tics and co-occurring disorders in a sample of youth with chronic tic disorder (CTD) or Tourette syndrome with anxiety symptoms. Design: A open-label trial. Patients affected by Tourette syndrome were randomized to receive nutritional supplements based on L-Theanine and vitamin B6, or psychoeducation (PE). Participants: 34 children (30 boys and 4 girls) aged between 4 and 17 years affected by Tourette syndrome or chronic tic disorder, associated with anxiety symptoms. Results: Patients in both groups showed a reduction in the severity of tic and anxiety symptoms. Supplementation with L-Theanine and vitamin B6 was significantly more effective than psychoeducation in reducing tics and co-occurring disorders, as measured by neuropsychological findings. Conclusions: Supplementation of both L-Theanine and Vitamin B6 may help in the treatment of tic disorders associated with anxious symptoms. Between-group differences in clinician-rated severity did reach statistical significance only for tics. Despite this finding, further placebo-controlled trials are needed.

Depicting the composition of gut microbiota in children with tic disorders: an exploratory study.

Symptom improvement in children with tic disorder (TD) following fecal microbiota transplantation led us to investigate the gut microbiota in TD. This exploratory study aims to depict the gut microbial profile in patients with TD and explore the impact of dopamine receptor antagonist (DRA) drugs on the composition and metabolic function of the gut microbiota. The gut microbiota were profiled in fecal samples of 49 children with TD and 50 matched healthy controls (HC) using shotgun metagenomic sequencing. A random forest (RF) model was constructed using the gut bacterial species to distinguish TD from HC. Associations between clinical metadata and microbial abundance or function were analyzed using MaAsLin2 and Spearman correlation. The gut microbiota in children with TD was featured by higher abundances of Bacteroides plebeius and Ruminococcus lactaris (a potential pro-inflammatory taxon) and lower abundances of Prevotella stercorea and Streptococcus lutetiensis compared to HC. The constructed RF model accurately distinguished TD from HC based on the gut microbiota profile, resulting in an AUC of 0.884. Significant correlations were observed between tic symptom severity and the abundances of multiple bacterial species and gut microbiota metabolic functions. Multivariate analysis identified an upregulation of 4-aminobutanoate (GABA) degradation in the gut microbiota associated with TD status. The gut microbiota of DRA-treated TD children showed a distinct gut microbiota compared to the treatment-naïve group, represented by an increase in some potential enteric pathogens such as Escherichia coli, a decline in several species including Akkermansia muciniphila, and alterations in various metabolic functions. Bacterial species promoting inflammatory responses and those modulating neurotransmitters such as GABA may be involved in the pathogenesis of TD. The use of DRA drugs is likely to induce overgrowth of some enteric pathogens and alter the gut microbiota metabolism.

Association of Group A Streptococcus Exposure and Exacerbations of Chronic Tic Disorders: A Multinational Prospective Cohort Study.

To examine prospectively the association between group A Streptococcus (GAS) pharyngeal exposures and exacerbations of tics in a large multicenter population of youth with chronic tic disorders (CTD) across Europe. We followed up 715 children with CTD (age 10.7 ± 2.8 years, 76.8% boys), recruited by 16 specialist clinics from 9 countries, and followed up for 16 months on average. Tic, obsessive-compulsive symptom (OCS), and attention-deficit/hyperactivity disorder (ADHD) severity was assessed during 4-monthly study visits and telephone interviews. GAS exposures were analyzed using 4 possible combinations of measures based on pharyngeal swab and serologic testing. The associations between GAS exposures and tic exacerbations or changes of tic, OC, and ADHD symptom severity were measured, respectively, using multivariate logistic regression plus multiple failure time analyses and mixed effects linear regression. A total of 405 exacerbations occurred in 308 of 715 (43%) participants. The proportion of exacerbations temporally associated with GAS exposure ranged from 5.5% to 12.9%, depending on GAS exposure definition. We did not detect any significant association of any of the 4 GAS exposure definitions with tic exacerbations (odds ratios ranging between 1.006 and 1.235, all p values >0.3). GAS exposures were associated with longitudinal changes of hyperactivity-impulsivity symptom severity ranging from 17% to 21%, depending on GAS exposure definition. This study does not support GAS exposures as contributing factors for tic exacerbations in children with CTD. Specific workup or active management of GAS infections is unlikely to help modify the course of tics in CTD and is therefore not recommended.

Application of 18-fluorodeoxyglucose as an indicator of symptom severity in a rat model of tic disorder following treatment with traditional Chinese medicine.

Quantitative evaluation of tic disorders (TDs) is challenging as there are few objective indicators that can be used for the assessment of treatment outcomes. 18F-Fluorodeoxyglucose (FDG) is a radioactive tracer that is able to cross the blood-brain barrier and can be detected by positron emission tomography/CT (PET/CT). In the present study, it was hypothesized that FDG PET/CT scan can be applied to reflect the severity of tic symptoms in a rat TD model, where signals detected in the brain striatum can be used to evaluate the efficacy of tic treatment with traditional Chinese medicine (TCM). A rat model of TD was established by treatment with iminodipropionitrile. Rats were divided into the following four groups (n=10 each): i) Control; ii) TCM; iii) haloperidol; and iv) model only. Observations of stereotypic behavior in rats were subsequently scored and micro-PET/CT was used to evaluate the rate of FDG uptake. Stereotypy scores were found to be significantly higher (P<0.05) in the TD rat model (P<0.05) compared with those in control rats. Both stereotypy scores (P<0.05) and standardized FDG uptake values (SUV; P<0.05) were revealed to be significantly reduced in the TD model rats after treatment with TCM or haloperidol. SUV correlated positively with stereotypy score (R=0.926; P<0.05) and the SUV scores were found to be significantly different among control group, TCM group, haloperidol group and model only group (P<0.05). These data suggest that the application of FDG in the striatum can be used to evaluate the effectiveness of TCM treatment for TDs.

Discrimination of Tourette Syndrome Based on the Spatial Patterns of the Resting-State EEG Network.

Tourette syndrome (TS) is a neuropsychiatric disorder with childhood onset characterized by chronic motor and vocal tics; however, the current diagnosis of TS patients is subjective, as it is mainly assessed based on the parents' description alongside specific evaluations. The early and accurate diagnosis of TS based on its potential symptoms in children would be of benefit in their future therapy, but reliable diagnoses are difficult due to the lack of objective knowledge of the etiology and pathogenesis of TS. In this study, resting-state electroencephalograms were first collected from 36 patients and 21 healthy controls (HCs); the corresponding resting-state functional networks were then constructed, and the potential differences in network topology between the two groups were extracted by using the topology of the spatial pattern of the network (SPN). Compared to the HCs, the TS patients exhibited decreased frontotemporal/occipital/parietal connectivity. When classifying the two groups, compared to the network properties, the derived SPN features achieved a much higher accuracy of 92.31%. The intrinsic long-range connectivity between the frontal and the temporal/occipital/parietal lobes was damaged in the patient group, and this dysfunctional network pattern might serve as a reliable biomarker to differentiate TS patients from HCs as well as to assess the severity of tic symptoms.

What is the effect of pharmacological treatment for attention-deficit/hyperactivity disorder in children with comorbid tic disorders? A Cochrane Review summary with commentary.

Objective: The Covid-19 related pandemic has negatively impacted NHS service provision We investigated its effect on specialist paediatric neuro-rehabilitation services in England and Wales Methods: A questionnaire was sent to UK National Neuro-rehabilitation network members by survey monkey app Questions explored: (1) centre details;(2) Covid-19 impact;(3) mitigation strategies;(4) recovery planning Results: 19 centres responded, including 17 Regional Neuroscience Centres;one stand-alone neurorehabilitation unit;one community-based specialist unit 18 reported Covid-19 had had a significant impact on service provision Six reported the impact was wholly negative;9 mainly negative, with some positive aspects;3 mainly positive, with some negative aspects;one was unsure 16 reported having fewer neurorehabilitation beds than pre-Covid-19;in 2, >80% were closed;2, 61-80%;3, 41-60%;7, 21-40% and 2, <20% Six indicated they were unable to accept internal or external referrals;3 only in exceptional circumstances 7 centres offer full rehabilitation to existing inpatients;11 only restricted rehabilitation 14 had discharged inpatients early;8 provided outpatient therapy post-discharge, 6 could not Two-thirds of centres transferred patients out at the start of the crisis, 9 to another neurorehabilitation unit and 3 to district hospitals Outpatient services were closed in 5 centres;operating fully (2);on a limited basis (8);on an increased basis due to reduced inpatient work (2) No community teams were offering normal services 9 centres were concerned about service restoration in the short term;12 in the medium term;10 in the long term Only 5 reported having a neurorehabilitation recovery plan Conclusion: Results highlight importance of developing robust neurorehabilitation service recovery plans to prevent children with acquired disability being further disadvantaged

The severity of obsessive-compulsive symptoms in Tourette syndrome and its relationship with premonitory urges: a meta-analysis

ABSTRACT Objectives Nearly half of the patients with Tourette Syndrome (TS) present with comorbid Obsessive-Compulsive Symptoms (OCS) and premonitory urges (PUs). However, inconsistent results have been found in the correlation between PUs and OCS in patients with TS. Methods A meta-analysis was applied to identify the severity of OCS and its correlation with PUs in TS patients. Subgroup and meta-regression analyses were used to identify potential heterogeneity. Results A total of 13 studies, including 576 patients, were enrolled in this study. The pooled correlation coefficient (r) was 0.29 (95% confidence interval: 0.18, 0.38) and heterogeneity (I2) of pooled r was 40% based on a fixed-effect model. The mean level of OCS based on the assessment of Children’s Yale-Brown Obsessive-Compulsive Symptom Scale/Yale-Brown Obsessive-Compulsive Symptom Scale was 14.99 (95% CI: 11.41, 18.57) by a random effect model. Results of meta-regression analysis demonstrated that the severity of tic symptoms based on the assessment of the Yale Global Tic Severity Scale was the predictor of severity of OCS (p = 0.018). Conclusion There was a mild positive correlation between the PUs and OCS in patients with TS. The severity of OCS in TS patients was mild to moderate and positively predicted by the severity of tic symptoms.

Hippocampal Volume in Provisional Tic Disorder Predicts Tic Severity at 12-Month Follow-up.

Previous studies have investigated differences in the volumes of subcortical structures (e.g., caudate nucleus, putamen, thalamus, amygdala, and hippocampus) between individuals with and without Tourette syndrome (TS), as well as the relationships between these volumes and tic symptom severity. These volumes may also predict clinical outcome in Provisional Tic Disorder (PTD), but that hypothesis has never been tested. This study aimed to examine whether the volumes of subcortical structures measured shortly after tic onset can predict tic symptom severity at one-year post-tic onset, when TS can first be diagnosed. We obtained T1-weighted structural MRI scans from 41 children with PTD (25 with prospective motion correction (vNavs)) whose tics had begun less than 9 months (mean 4.04 months) prior to the first study visit (baseline). We re-examined them at the 12-month anniversary of their first tic (follow-up), assessing tic severity using the Yale Global Tic Severity Scale. We quantified the volumes of subcortical structures using volBrain software. Baseline hippocampal volume was correlated with tic severity at the 12-month follow-up, with a larger hippocampus at baseline predicting worse tic severity at follow-up. The volumes of other subcortical structures did not significantly predict tic severity at follow-up. Hippocampal volume may be an important marker in predicting prognosis in Provisional Tic Disorder.

Correlation between premonitory urges and tic symptoms in a Chinese population with tic disorders.

ABSTRACTImportanceTics usually start around 4–6 years old and affect about 1% of school‐age children. Premonitory urges (PUs) are sensory phenomena that precede tics and are often described as unpleasant feelings. Recent evidence supports a relationship between PUs and tic severity, but reports are conflicting. In addition, there is no report of PUs in the Chinese population.ObjectiveTo investigate the correlation between PUs and tic symptoms in the Chinese population with tic disorders.MethodsWe recruited 252 Chinese individuals with chronic tic disorders (age 5–16 years). The Yale Global Tic Severity Scale (YGTSS) was used to assess tic symptoms, and the Premonitory Urge for Tics Scale (PUTS) was used to assess PUs. We calculated Spearman correlations between PUTS and YGTSS scores, and constructed a linear regression model to predict the tic symptom severity by PUs.ResultsThere was a significant positive correlation between PU severity (PUTS scores) and motor tic severity, total tic severity, tic‐caused impairment (YGTSS scores) (P < 0.05). PU severity was a significant positive predictor of tic symptom severity (standardized beta coefficient = 0.174, t = 2.786, P = 0.006).InterpretationWe provide evidence for a correlation between PUs and tic symptoms. PU severity predicts tic symptom severity. Further research on PUs is needed to clarify the shared brain mechanism with tics, and their role in tic expression. A suitable tool to assess PUs in younger children is also needed.

Effectiveness and Safety of a Clonidine Adhesive Patch for Children With Tic Disorders: Study in a Real-World Practice.

Background: Real-world evidence includes data from retrospective/prospective observational studies and observational registries, and provides insights beyond those addressed by randomized controlled trials. This study aimed to evaluate the effectiveness and safety of a clonidine adhesive patch (CAP) for children with tic disorder (TD) in a real-world setting (RWS).Methods: This was an open-label, non-interventional, post-marketing, observational study in a RWS. Children diagnosed with TDs were enrolled from a pediatric neurology clinic in China, and the change in tic symptom severity following 6 weeks pharmacologic treatments was investigated using Yale Global Tic Severity Scale (YGTSS) during visits at weeks 0, 4, 8, and 12.Results: Of 150 patients, 76% (114/150) were male (age range, 3.03–14.24 years; mean, 8.11 ± 2.48 years). Patients were divided into three groups: tiapride (n = 94), CAP (n = 14), and CAP + tiapride (n = 42). The mean YGTSS improved 11.02, 15.14, 11.13 points from baseline to posttreatment for tiapride, CAP, and CAP + tiapride, respectively, but variance analysis showed there was no significant difference in YGTSS related to different pharmacologic intervention during subsequent visits at weeks 4, 8, and 12. Repeated measure analysis showed there was no significant difference between different medication types for reducing the YGTSS score (F = 0.553, P = 0.576). No serious adverse events (AEs) occurred, and there was no significant difference in the prevalence of AEs between the three groups.Conclusion: The CAP is effective and safe for TD management in a RWS, because of the limitation of sample size and the period of follow up, observational studies with longer-term outcomes, and larger sample size are needed.

Sex and psychiatric comorbidity correlates of the premonitory urge for tic scale in youth with persistent tic disorders.

The premonitory urge for tics scale (PUTS) is a common self-report measure of premonitory sensations preceding tics. The present study aimed to examine the internal consistency and concurrent validity of the PUTS by sex and psychiatric comorbidity status; and explored interactions between sex and psychiatric comorbidity in predicting premonitory urge and tic symptom severity. Seventy-four youth and young adults with persistent tic disorders completed the PUTS, while their parents completed the parent tic questionnaire (PTQ) and a demographic measure. Independent samples t-tests revealed no significant sex differences in PUTS items or total score. The PUTS total score also did not significantly differ between participants with and without attention-deficit hyperactivity disorder (ADHD) and/or obsessive-compulsive disorder (OCD) comorbidity. Internal consistency did not significantly differ between females (α = 0.85) and males (α = 0.75), and those with comorbid ADHD and/or OCD (α = 0.83) relative to those without (α = 0.69). With respect to concurrent validity, the PUTS total was significantly correlated with PTQ tic frequency, intensity, number, and severity for males but not for females. Among those with ADHD and/or OCD, the PUTS total score was correlated significantly and strongly with tic number and moderately with tic intensity. Interactions between sex and psychiatric comorbidity performed using 2 × 2 analysis of variance did not significantly predict the PUTS total or PTQ subscale scores. Findings suggest sex and comorbidity status may influence premonitory urge expression. Results have implications for understanding and measurement of the premonitory urge.

Relationships among Tic Symptoms, Expressed Emotions, and Quality of Life in Tic Disorder Patients

Tic disorder is a chronic disease seen in children and adolescents that considerably affects quality of life. Of the many factors affecting quality of life in tic disorder patients, their families’ emotional relatedness and responses are important determinants; we used “expressed emotions” to identify this. A total of 56 patients aged 8–23 were enrolled. We used the Yale Global Tic Severity Scale (YGTSS) to assess tic symptoms, as well as the Family Questionnaire and the KIDSCREEN-52 to respectively evaluate expressed emotions in pediatric tic patients’ families and quality of life in tic patients. Children’s Depression Inventory (CDI) and State-Trait Anxiety Inventory for children (STAIC) were used for assessing severities of depression and anxiety. We then analyzed the correlations between these elements. Levels of depression and anxiety, and severity of tic symptoms negatively affected quality of life in patients with tic disorder (CDI: r = −0.806, SAIC: r = −0.783, TAIC: r = −0.705). Expressed emotions also showed negative correlations with quality of life (r = −0.333). Considering each subscale of KIDSCREEN-52, we found that expressed emotions had negative correlations with subscale of moods and emotions (r = −0.426), autonomy (r = −0.288), social support and peers (r = −0.301), and school environment (r = −0.274). Quality of life in children and adolescents with tic disorder could be improved further by focusing on and treating emotional distress and difficulties within their families.

Effects of comorbidity on Tourette's tic severity and quality of life.

ObjectiveThe aim of this study is to gain more insight in the differential contributions of anxiety, depression and obsessive‐compulsive (OC) symptom severity to quality of life (QoL) and tic severity in adults with Tourette Disorder (TD).MethodsSelf‐reported OC symptom, anxiety and depression severity measures were used to investigate their predictive value on QoL and Tic severity in adult TD patients (N = 187), using correlation, regression, and mediation analyses.ResultsTic severity has no effect on QoL. Depression severity directly reduces QoL, whereas anxiety and OC symptom severity have an indirect effect on QoL, mediated by depression severity. OC symptom severity directly affects tic severity, whereas depression and anxiety severity do not have a direct effect on tic or OC severity. Finally, anxiety severity indirectly impacts tic severity, with OC symptom severity functioning as a mediator.ConclusionIn line with and extending previous studies, these findings indicate that OC symptom severity directly influences tic symptom severity whereas depression severity directly influences QoL in TD. Results imply that to improve QoL in TD patients, treatment should primarily focus on diminishing OC and depressive symptom severity rather than focusing on tic reduction.

Clinical improvement following vitamin D3 supplementation in children with chronic tic disorders.

PurposeVitamin D deficiency has been found in children with chronic tic disorders (CTDs). Our previous data showed that serum 25-hydroxyvitamin D [25(OH)D] level in children with CTDs was lower than that of the healthy controls and lower serum 25(OH)D level was associated with increased severity of the tic disorder. Thus, we intend to further verify this phenomenon and examine the effect of vitamin D3 on CTDs.Patients and methodsIn total, 120 children with CTDs and 140 normal controls were enrolled in this study, with 36/120 of those in the CTD group receiving vitamin D3 treatment for 3 months. The Yale Global Tic Severity Scale (YGTSS) and Clinical Global Impression of Severity of Illness (CGI-SI) were, respectively, used to evaluate the tic severity. High-performance liquid chromatography and tandem mass spectrometry were used to measure serum 25(OH)D level.ResultsThose children with CTDs exhibited significantly lower 25(OH)D levels than did healthy controls, and these reduced 25(OH)D levels were linked to increasing severity of tic symptoms. After treatment with supplemental vitamin D3, serum 25(OH)D level and scores of YGTSS total, motor tics, phonic tics, total tic, impairment, and CGI-SI improved significantly in children with CTDs without any adverse reactions.ConclusionSupplementation vitamin D3, given its low cost and excellent safety, may be an effective means of improving symptoms in certain children with CTDs.