An update on Tourette syndrome

Severe motor and vocal tics controlled with Sativex®

OBJECTIVES

A single case report on cannabinoid treatment for treatment-resistant Tourette syndrome (TS).

METHOD

Our subject received 10.8 mg Tetrahydocannabinol and 10 mg cannabidiol daily, in the form of two oro-mucosal sprays of 'Sativex^®', twice daily. Assessment was pre-treatment and at week one, two, and four during treatment. He completed the Yale Global Tic Severity Scale as a subjective measure, and was videoed at each stage. The videos were objectively rated by two assessors, blind to the stage of treatment, using the Original Rush Videotape Rating Scale.

RESULTS

Both subjective and objective measures demonstrated marked improvement in the frequency and severity of motor and vocal tics post-treatment. There was good interrater reliability of results.

CONCLUSIONS

Our results support previous research suggesting that cannabinoids are a safe and effective treatment for TS and should be considered in treatment-resistant cases. Further studies are needed to substantiate our findings.

Clinical observation on treatment of Tourette syndrome in Chinese children by clonidine adhesive patch

OBJECTIVE

To evaluate the therapeutic effectiveness and safety of clonidine adhesive patch in treating Tourette syndrome (TS).

METHODS

From July 2010 to July 2014,a total of 261 children, who met the Chinese Classification of Mental Disorders (third edition) diagnostic criteria for TS, aged 5-12 years, were referred to the department of Pediatrics, Shaanxi Provincial People's Hospital. The patients were divided randomly into a treatment group (clonidine adhesive patch, n = 128) and a control group (haloperidol, n = 116), 17cases dropped out. The clinical effectiveness was assessed by the Yale Global Tic Severity Scale (YGTSS) at the end of fourth week. The short-term effectiveness and adverse reaction to the treatment were assessed at the end of treatment.

RESULTS

The YGTSS score in both groups decreased after 4 weeks of treatment, but the clonidine adhesive patch group showed a higher reduction in the overall tic symptom scores (40.05 ± 3.44%) than that of the control group (17.88 ± 4.40%; P < 0.05). In the clonidine adhesive patch group, the effectiveness was 81.3% (effective in 104 patients), while it was 66.4% in the control group (effective in 77 patients). The overall effectiveness rate showed no statistical significance between the two groups (p > 0.05). There were no severe adverse events in both groups, but mild side effects (decrease of blood pressure and dizziness) were observed in 3 patients in the clonidine adhesive patch group. 2 had mild cervical muscle tension and 4 had mild drowsiness and fatigue in the control group.

CONCLUSION

In the treatment of TS in children and adolescents, the clonidine adhesive patch is superior to the standard treatment with haloperidol with a safer and better-tolerated profile.

Sensory sensitivity to external stimuli in Tourette syndrome patients

Patients with Tourette Syndrome often state that their sensitivity to sensations is equally or more disruptive than are motor tics. However, their sensory sensitivity is not addressed by standard clinical assessments nor is it a focus of research. This lapse likely results from our limited awareness and understanding of the symptom. In this study (1) we defined the patients' experience of sensitivity to external stimuli in detail, and (2) we tested 2 hypotheses regarding its origin. First, we interviewed in depth and administered a lengthy questionnaire to adult Tourette patients (n = 19) and age-matched healthy volunteers (n = 19). Eighty percent of patients described heightened sensitivity to external stimuli, with examples among all 5 sensory modalities. Bothersome stimuli were characterized as faint, repetitive or constant, and nonsalient, whereas intense stimuli were well tolerated. We then determined whether the sensitivity could be the result of an increased ability to detect faint stimuli. After measuring the threshold of detection for olfactory and tactile stimuli among the patients and healthy volunteers, we found no significant differences between them for either sensory modality. These results indicate that patients' perceived sensitivity derives from altered central processing rather than enhanced peripheral detection. Last, we assessed one aspect of processing: the perception of intensity. When subjects rated the intensity of near-threshold tactile and olfactory stimuli, there was a surprising difference: Tourette patients more frequently used the lowest range of the scale than did healthy volunteers. Future research is necessary to define the anatomical and physiological basis of the patients' experience of heightened sensitivity. © 2011 Movement Disorder Society.

Medium spiny neurons of the neostriatal matrix exhibit specific, stereotyped changes in dendritic arborization during a critical developmental period in mice

In mice, the matrix compartment of the striatum (caudate/putamen) undergoes major developmental changes during the second postnatal week, including the establishment of corticostriatal and nigrostriatal afferents, the maturation of parvalbumin-positive interneurons and the appearance of perineuronal nets. It is not known if any of these events influence the dendritic structure of medium spiny neurons, the principal output cells of the striatum. To determine whether any measurable changes in the dendrites of matrix medium spiny neurons occur during this important developmental period, we labeled individual cells at different time points flanking the second postnatal week. These cells exhibit distinct dendritic morphologies from the earliest postnatal time points examined. Furthermore, our data show that the dendritic arbors of these neurons change in length, branch points, diameter and tortuosity, regardless of morphological type. The increase in dendritic length is accompanied by a decrease in the number of branch points that occur in different, but consistent, parts of the dendritic arbor. All of these changes are most pronounced during the second postnatal week, coinciding with a number of developmental events considered important for consolidating circuitry within the striatal matrix. Our results further support the critical importance of this early postnatal period in striatal development.