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McCane AM, Kronheim L, Torrado Pacheco A, Moghaddam B. Adolescents rats engage the orbitofrontal-striatal pathway differently than adults during impulsive actions. Sci Rep 2024; 14:8605. [PMID: 38615065 PMCID: PMC11016110 DOI: 10.1038/s41598-024-58648-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/02/2024] [Indexed: 04/15/2024] Open
Abstract
Adolescence is characterized by increased impulsive and risk-taking behaviors. To better understand the neural networks that subserves impulsivity in adolescents, we used a reward-guided behavioral model that quantifies age differences in impulsive actions in adult and adolescent rats of both sexes. Using chemogenetics, we identified orbitofrontal cortex (OFC) projections to the dorsomedial striatum (DMS) as a critical pathway for age-related execution of impulsive actions. Simultaneous recording of single units and local field potentials in the OFC and DMS during task performance revealed an overall muted response in adolescents during impulsive actions as well as age-specific differences in theta power and OFC-DMS functional connectivity. Collectively, these data reveal that the OFC-DMS pathway is critical for age-differences in reward-guided impulsive actions and provide a network mechanism to enhance our understanding of how adolescent and adult brains coordinate behavioral inhibition.
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Affiliation(s)
| | - Lo Kronheim
- Oregon Health and Science University, Portland, OR, USA
| | | | - Bita Moghaddam
- Oregon Health and Science University, Portland, OR, USA.
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Rodrigo S, Costi S, Ellul P, Aubart M, Boddaert N, Auvin S, Elmaleh M, Ntorkou A, Bader-Meunier B, Lebon V, Melki I, Chiron C. Brain 18 F-FDG PET reveals cortico-subcortical hypermetabolic dysfunction in juvenile neuropsychiatric systemic lupus erythematosus. EJNMMI Res 2024; 14:34. [PMID: 38564068 PMCID: PMC10987444 DOI: 10.1186/s13550-024-01088-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND In juvenile systemic lupus erythematosus (j-SLE) with neuropsychiatric (NP) symptoms, there is a lack of diagnostic biomarkers. Thus, we study whether PET-FDG may identify any metabolic dysfunction in j-NPSLE. METHODS A total of 19 18FDG-PET exams were consecutively performed using PET-MRI system in 11 non-sedated patients presenting with j-NPSLE (11-18y) for less than 18 months (m) and without any significant lesion at MRI. Psychiatric symptoms were scored from 0 (none) to 3 (severe) at PET time. PET images were visually analyzed and voxel-based analyses of cerebral glucose metabolism were performed using statistical parametric mapping (spm) with an age-matched control group, at threshold set > 50 voxels using both p < 0.001 uncorrected (unc.) and p < 0.05 corrected family wise error (FWE). RESULTS Patients exhibited mainly psychiatric symptoms, with diffuse inflammatory j-NPSLE. First PET (n = 11) was performed at a mean of 15y of age, second/third PET (n = 7/n = 1) 6 to 19 m later. PET individual analysis detected focal bilateral anomalies in 13/19 exams visually but 19/19 using spm (unc.), mostly hypermetabolic areas (18/19). A total of 15% of hypermetabolic areas identified by spm had been missed visually. PET group analysis (n = 19) did not identify any hypometabolic area, but a large bilateral cortico-subcortical hypermetabolic pattern including, by statistical decreasing order (unc.), thalamus, subthalamic brainstem, cerebellum (vermis and cortex), basal ganglia, visual, temporal and frontal cortices. Mostly the subcortical hypermetabolism survived to FWE analysis, being most intense and extensive (51% of total volume) in thalamus and subthalamus brainstem. Hypermetabolism was strictly subcortical in the most severe NP subgroup (n = 8, scores 2-3) whereas it also extended to cerebral cortex, mostly visual, in the less severe subgroup (n = 11, scores 0-1), but difference was not significant. Longitudinal visual analysis was inconclusive due to clinical heterogeneity. CONCLUSIONS j-NPSLE patients showed a robust bilateral cortico-subcortical hypermetabolic network, focused subcortically, particularly in thalamus, proportionally to psychiatric features severity. Further studies with larger, but homogeneous, cohorts are needed to determine the sensitivity and specificity of this dysfunctional pattern as a potential biomarker in diffuse inflammatory j-NPSLE with normal brain MRI.
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Affiliation(s)
- Sebastian Rodrigo
- CEA, SHFJ (Frederic Joliot Hospital), Orsay, France
- Biomedical Multimodal Imaging (BioMaps) Laboratory, CEA, INSERM, CNRS, and Paris-Saclay University, Orsay, France
| | - Stefania Costi
- Pediatric Rheumatology Unit, ASST-PINI-CTO (Regional Health Care and Social Agency Gaetano Pini), Milan, Italy
| | - Pierre Ellul
- Child and Adolescent Psychiatry, APHP, Robert Debré Hospital, Paris-Cité University, Paris, France
- Immunology-Immunopathology-Immunotherapy (i3) Laboratory, INSERM UMR-S 959 and Sorbonne University, Paris, France
| | - Melodie Aubart
- Pediatric Neurology, APHP, Hospital Necker for Sick Children, Paris-Cité University, Paris, France
- INSERM U1163, Imagine Institute, Paris, France
| | - Nathalie Boddaert
- INSERM U1163, Imagine Institute, Paris, France
- Pediatric Radiology, APHP, Hospital Necker for Sick Children, Paris-Cité University, Paris, France
| | - Stephane Auvin
- Pediatric Neurology, APHP, Robert Debré Hospital, Paris-Cité University, Institut Universitaire de France (IUF), Paris, France
| | - Monique Elmaleh
- Pediatric Radiology, APHP, Robert Debré Hospital, Paris-Cité University, Paris, France
- INSERM U1141 Neurodiderot and Neurospin Institute, Paris, France
| | - Alexandra Ntorkou
- Pediatric Radiology, APHP, Robert Debré Hospital, Paris-Cité University, Paris, France
| | - Brigitte Bader-Meunier
- INSERM U1163, Imagine Institute, Paris, France
- Pediatric Immunology and Rhumatology, APHP, Hospital Necker for Sick Children, Paris, France
| | - Vincent Lebon
- CEA, SHFJ (Frederic Joliot Hospital), Orsay, France
- Biomedical Multimodal Imaging (BioMaps) Laboratory, CEA, INSERM, CNRS, and Paris-Saclay University, Orsay, France
| | - Isabelle Melki
- INSERM U1163, Imagine Institute, Paris, France
- Robert Debré Hospital, General Pediatrics, Infectious Disease and Internal Medicine Department, Reference center for Rheumatic, APHP, AutoImmune and Systemic diseases in children (RAISE), Paris, France
- Paediatrics, Rheumatology and Paediatric Internal Medicine, Children's Hospital, Bordeaux, France
| | - Catherine Chiron
- CEA, SHFJ (Frederic Joliot Hospital), Orsay, France.
- Pediatric Neurology, APHP, Hospital Necker for Sick Children, Paris-Cité University, Paris, France.
- INSERM U1141 Neurodiderot and Neurospin Institute, Paris, France.
- Service Hospitalier Frederic Joliot (INSERM U1141), 4 Place du General Leclerc, Orsay, 91400, France.
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Timmers ER, Klamer MR, Marapin RS, Lammertsma AA, de Jong BM, Dierckx RAJO, Tijssen MAJ. [ 18F]FDG PET in conditions associated with hyperkinetic movement disorders and ataxia: a systematic review. Eur J Nucl Med Mol Imaging 2023; 50:1954-1973. [PMID: 36702928 PMCID: PMC10199862 DOI: 10.1007/s00259-023-06110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE To give a comprehensive literature overview of alterations in regional cerebral glucose metabolism, measured using [18F]FDG PET, in conditions associated with hyperkinetic movement disorders and ataxia. In addition, correlations between glucose metabolism and clinical variables as well as the effect of treatment on glucose metabolism are discussed. METHODS A systematic literature search was performed according to PRISMA guidelines. Studies concerning tremors, tics, dystonia, ataxia, chorea, myoclonus, functional movement disorders, or mixed movement disorders due to autoimmune or metabolic aetiologies were eligible for inclusion. A PubMed search was performed up to November 2021. RESULTS Of 1240 studies retrieved in the original search, 104 articles were included. Most articles concerned patients with chorea (n = 27), followed by ataxia (n = 25), dystonia (n = 20), tremor (n = 8), metabolic disease (n = 7), myoclonus (n = 6), tics (n = 6), and autoimmune disorders (n = 5). No papers on functional movement disorders were included. Altered glucose metabolism was detected in various brain regions in all movement disorders, with dystonia-related hypermetabolism of the lentiform nuclei and both hyper- and hypometabolism of the cerebellum; pronounced cerebellar hypometabolism in ataxia; and striatal hypometabolism in chorea (dominated by Huntington disease). Correlations between clinical characteristics and glucose metabolism were often described. [18F]FDG PET-showed normalization of metabolic alterations after treatment in tremors, ataxia, and chorea. CONCLUSION In all conditions with hyperkinetic movement disorders, hypo- or hypermetabolism was found in multiple, partly overlapping brain regions, and clinical characteristics often correlated with glucose metabolism. For some movement disorders, [18F]FDG PET metabolic changes reflected the effect of treatment.
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Affiliation(s)
- Elze R Timmers
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Marrit R Klamer
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Ramesh S Marapin
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Adriaan A Lammertsma
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen (UMCG), University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Bauke M de Jong
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen (UMCG), University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands.
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen (UMCG), PO Box 30.001, 9700 RB, Groningen, the Netherlands.
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Farber RH, Angelov A, Kim K, Carmack T, Thai-Cuarto D, Roberts E. Clinical development of valbenazine for tics associated with Tourette syndrome. Expert Rev Neurother 2021; 21:393-404. [PMID: 33682568 DOI: 10.1080/14737175.2021.1898948] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction: Significant need exists for effective, well-tolerated pharmacologic treatments for Tourette syndrome (TS). Medications that inhibit vesicular monoamine transporters (i.e. VMAT2 inhibitors) downregulate presynaptic packaging and release of dopamine into the neuronal synapse and are effective in treating hyperkinetic movement disorders such as Huntington's chorea and tardive dyskinesia (TD); thus, they may be useful in treating TS.Areas covered: This review describes the clinical program evaluating the safety and efficacy of valbenazine in the treatment of involuntary tics associated with TS in adult and pediatric subjects. While there was a trend in the 6 completed trials toward greater improvement in valbenazine-treated versus placebo subjects on the primary efficacy endpoint (Yale Global Tic Severity Scale Total Tic Score), this difference did not reach statistical significance. Valbenazine was generally well-tolerated in the studies, and treatment-emergent adverse events were consistent with valbenazine studies in TD.Expert opinion: Due to the failure to meet the primary endpoint in these trials, further investigation of valbenazine for TS is unlikely. Given the need for safe and effective TS therapies and the key role of VMAT2 in modulating dopaminergic activity, it is reasonable for future studies to investigate other VMAT2 inhibitors as potential treatments for TS.
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Affiliation(s)
- Robert H Farber
- Medical Affairs, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Angel Angelov
- Medical Affairs, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Kristine Kim
- Medical Affairs, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Tara Carmack
- Medical Affairs, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Dao Thai-Cuarto
- Medical Affairs, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Eiry Roberts
- Medical Affairs, Neurocrine Biosciences, Inc., San Diego, CA, USA
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Neural correlates of performance monitoring in adult patients with Gilles de la Tourette syndrome: A study of event-related potentials. Clin Neurophysiol 2020; 131:597-608. [DOI: 10.1016/j.clinph.2019.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/24/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022]
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Porta M, Servello D, Dell'Osso B, Dina CZ, Bona A, Alleva GC. Critical aspects in the legal defence of patients with Tourette's Syndrome: An Italian case series. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 61:1-5. [PMID: 30454556 DOI: 10.1016/j.ijlp.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 07/16/2018] [Accepted: 08/14/2018] [Indexed: 06/09/2023]
Abstract
Tourette's syndrome (TS) is a developmental neurobehavioral disorder with childhood onset and relevant burden in terms of disability and reduced quality of life. In Italy the biological basis of this syndrome is still frequently ignored and TS is often recognised as a psychiatric manifestation, or even it is not recognised as pathology, which may result in inadequate treatment, social isolation and improper hospitalization. Indeed, the organic medical nature of TS needs to be taken into great consideration in evaluating causality of committing crimes in affected patients. In addition, delaying the diagnosis and consequently proper treatment has a devastating impact on social as well as legal aspects in patients with TS. The present report is aimed to present an Italian case series of 4 TS patients who faced legal problems related to their mental condition, in the intent to add further evidence, raise the level of awareness and encourage further investigation in the field, as in most of the cases, patients' illness was not taken into adequate account by the Justice. The relevant law is discussed in detail.
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Affiliation(s)
- Mauro Porta
- Department of Functional Neurosurgery and Tourette Syndrome Center, Galeazzi Clinical and Research Hospital, 4 R. Galeazzi Street, 20100 Milan, Italy
| | - Domenico Servello
- Department of Functional Neurosurgery and Tourette Syndrome Center, Galeazzi Clinical and Research Hospital, 4 R. Galeazzi Street, 20100 Milan, Italy
| | - Bernardo Dell'Osso
- Department of Psychiatry, Ca Granda Clinical and Research Foundation, Maggiore Policlinico Hospital, University of Milan, 8 S. Barnaba Street, 20100 Milan, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA.
| | - Carlotta Zanaboni Dina
- Department of Functional Neurosurgery and Tourette Syndrome Center, Galeazzi Clinical and Research Hospital, 4 R. Galeazzi Street, 20100 Milan, Italy.
| | - Alberto Bona
- Department of Functional Neurosurgery and Tourette Syndrome Center, Galeazzi Clinical and Research Hospital, 4 R. Galeazzi Street, 20100 Milan, Italy
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Lavoie ME, O'Connor K. Toward a Multifactorial Conception of the Gilles de la Tourette Syndrome and Persistent Chronic Tic Disorder. Brain Sci 2017; 7:brainsci7060061. [PMID: 28574423 PMCID: PMC5483634 DOI: 10.3390/brainsci7060061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/31/2017] [Indexed: 12/28/2022] Open
Abstract
Despite recent giant leaps in understanding Gilles de la Tourette’s syndrome (now Tourette Disorder in the DSM 5), accurate multi-modal description, rigorous assessment procedures, and the improvement of evidence-based treatment currently pose a considerable challenge. In this context, the current special edition aims to elaborate three important dimensions in Tourette Disorder. Firstly, the effective characterization and etiological basis of the disorder are reviewed, since such characterization impacts accurate assessment. Secondly, subsequent articles cover the comprehensive evaluation and assessment of tic disorders, essential for treatment planning. Thirdly, the final group of articles propose novel and innovative treatment strategies for pharmacologically and behaviorally reducing tic frequency. In the current editorial address, two main issues seem crucial to the development of interventions for Tourette disorder. Primarily, integrating new technology in treatments, while supporting cognitive and behavioral recovery through learning self-controlled strategies. Additionally, the dissemination of study results to frontline resources, needs streamlining and empirically validated treatments for tic disorders should be the subject of knowledge translation to community organizations and be more widely available to the public.
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Affiliation(s)
- Marc E Lavoie
- Department of Psychiatry, University of Montréal, Montréal H1N-3V2, Canada.
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal H1N-3V2, Canada.
| | - Kieron O'Connor
- Department of Psychiatry, University of Montréal, Montréal H1N-3V2, Canada.
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal H1N-3V2, Canada.
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Mintzopoulos D, Gillis TE, Robertson HR, Dalia T, Feng G, Rauch SL, Kaufman MJ. Striatal magnetic resonance spectroscopy abnormalities in young adult SAPAP3 knockout mice. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 1:39-48. [PMID: 26858992 PMCID: PMC4742338 DOI: 10.1016/j.bpsc.2015.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) is a debilitating condition with lifetime prevalence of 1-3%. OCD typically arises in youth but delays in diagnosis impede optimal treatment and developmental studies of the disorder. Research using genetically modified rodents may provide models of etiology that enable earlier detection and intervention. The SAPAP3 knockout (KO) transgenic mouse was developed as an animal model of OCD and related disorders (OCRD). KO mice exhibit compulsive self-grooming behavior analogous to behaviors found in people with OCRD. Striatal hyperactivity has been reported in these mice and in humans with OCD. METHODS Striatal and medial frontal cortex 9.4 Tesla proton spectra were acquired from young adult SAPAP3 KO and wild-type control mice to determine whether KO mice have metabolic and neurochemical abnormalities. RESULTS Young adult KO mice had lower striatal lactate (P=0.006) and glutathione (P=0.039) levels. Among all mice, striatal lactate and glutathione levels were associated (R=0.73, P=0.007). We found no group differences in medial frontal cortex metabolites. At the age range studied, only 1 of 8 KO mice had skin lesions indicative of severe compulsive grooming. CONCLUSION Young adult SAPAP3 KO mice have striatal but not medial frontal cortex MRS abnormalities that may reflect striatal hypermetabolism accompanied by oxidative stress. These abnormalities typically preceded the onset of severe compulsive grooming. Our findings are consistent with striatal hypermetabolism in OCD. Together, these results suggest that striatal MRS measures of lactate or glutathione might be useful biomarkers for early detection of risk for developing compulsive behavior disorders.
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Abstract
INTRODUCTION Tourette syndrome (TS) is thought to be associated with striatal dysfunction. Changes within frontostriatal pathways in TS could lead to changes in abilities reliant on the frontal cortex. Such abilities include executive functions and aspects of social reasoning. METHODS This study aimed to investigate executive functioning and Theory of Mind (ToM; the ability to reason about mental states, e.g., beliefs and emotions), in 18 patients with TS and 20 controls. A range of tasks involving ToM were used. These required participants to make judgements about mental states based on pictures of whole faces or the eyes alone, reason about humour in cartoons that featured sarcasm, irony or "slapstick" style humour, and make economic decisions. The executive measures assessed inhibition and verbal fluency. RESULTS Patients with TS exhibited significantly poorer performance than controls on all four tasks involving ToM, even when patients with comorbid obsessive-compulsive disorder were excluded. These difficulties were despite no inhibitory deficits. Patients with TS exhibited impairment on the verbal fluency task but their performance on executive and ToM tasks was not related. CONCLUSIONS We propose that TS is associated with changes in ToM. The observed deficits could reflect dysfunction in frontostriatal pathways involving ventromedial prefrontal cortex.
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Affiliation(s)
- Clare M Eddy
- a Department of Neuropsychiatry , Barberry National Centre for Mental Health , Birmingham , UK
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Bronfeld M, Israelashvili M, Bar-Gad I. Pharmacological animal models of Tourette syndrome. Neurosci Biobehav Rev 2013; 37:1101-19. [DOI: 10.1016/j.neubiorev.2012.09.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/28/2012] [Accepted: 09/05/2012] [Indexed: 12/22/2022]
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Abstract
OBJECTIVE The need for symmetry and ordering objects related to a "just right"-feeling is a common symptom in Tourette's syndrome (TS) and resembles symmetry behavior in obsessive-compulsive disorder, but its pathophysiology is unknown. We used a symptom provocation paradigm to investigate the neural correlates of symmetry behavior in TS and hypothesized the involvement of frontal-striatal and limbic brain areas. METHODS Pictures of asymmetrically and symmetrically arranged objects were presented in randomized blocks (4 blocks of each condition) to 14 patients with TS and 10 matched healthy controls (HC). A H2 15O positron emission tomography scan was acquired during each stimulus block, resulting in 8 scans per subject. After each scan, state anxiety and symmetry behavior (the urge to rearrange objects) were measured using a visual analogue scale. RESULTS During the asymmetry condition, TS patients showed increased regional cerebral blood flow (rCBF) in the anterior cingulate cortex, supplementary motor area, and inferior frontal cortex, whereas HC showed increased rCBF in the visual cortex, primary motor cortex, and dorsal prefrontal cortex. Symmetry ratings during provocation correlated positively with orbitofrontal activation in the TS group and sensorimotor activation in the HC group, and negatively with dorsal prefrontal activity in HC. CONCLUSIONS Results suggest that both motor and limbic circuits are involved in symmetry behavior in TS. Motor activity may relate to an urge to move or perform tics, and limbic activation may indicate that asymmetry stimuli are salient for TS patients. In contrast, symmetry provocation in HC resulted in activation of brain regions implicated in sensorimotor function and cognitive control.
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Segura B, Strafella AP. Functional Imaging of Dopaminergic Neurotransmission in Tourette Syndrome. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 112:73-93. [DOI: 10.1016/b978-0-12-411546-0.00003-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Neuner I, Schneider F, Shah NJ. Functional Neuroanatomy of Tics. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 112:35-71. [DOI: 10.1016/b978-0-12-411546-0.00002-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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Abstract
PURPOSE OF REVIEW This review considers the recent literature pertaining to the neurobiology, genetics and treatment of Tourette syndrome. RECENT FINDINGS Over the last several years, both neuropathological and genetic findings have further focused attention on long-standing hypotheses regarding the role of the basal ganglia in causing tics and Tourette syndrome. Moreover, although the field awaits the results the first large-scale genetic studies, recent findings have already mirrored developments in the neuropsychiatric genetics literature more broadly, highlighting the value of the study of rare variation and the overlap of risks among seemingly disparate diagnostic categories. Finally, treatment studies have underscored the importance of cognitive-behavioral as well as pharmacological interventions for the treatment of tic disorders. SUMMARY Recent findings have led to novel, testable hypotheses regarding the molecular and cellular mechanisms underlying Tourette syndrome. These, in turn, have begun to provide new avenues to conceptualizing treatment strategies. Although the development of additional medication options is a pressing need, recent data has demonstrated both the safety and efficacy of nonpharmacological approaches.
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Debes NMMM, Hansen A, Skov L, Larsson H. A functional magnetic resonance imaging study of a large clinical cohort of children with Tourette syndrome. J Child Neurol 2011; 26:560-9. [PMID: 21464239 DOI: 10.1177/0883073810387928] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is evidence that cortico-striato-thalamo-cortical pathways are involved in the pathophysiology of Tourette syndrome. During the performance of neuropsychological tests in subjects with Tourette syndrome there are suggestions for increased activity in the sensimotor cortex, supplementary motor areas, and frontal cortex. To replicate findings, the authors examined 22 medication-naive children with Tourette syndrome only, 17 medication-naive children with Tourette syndrome and comorbidity, and 39 healthy controls with functional magnetic resonance imaging (MRI). There were no differences in activation in brain regions between the children with Tourette syndrome (divided according to the presence of comorbidity) and healthy controls after correction for the confounders age, sex, and intelligence. Activation in the cingulated gyrus, temporal gyrus, and medial frontal gyrus was correlated significantly with obsessive-compulsive disorder score. The authors did not find significant correlations between activation patterns and age, sex, duration of disease, intelligence, severity of tics, and attention-deficit hyperactivity disorder (ADHD) score.
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Lavoie ME, Imbriglio TV, Stip E, O'Connor KP. Neurocognitive Changes Following Cognitive-Behavioral Treatment in Tourette Syndrome and Chronic Tic Disorder. Int J Cogn Ther 2011. [DOI: 10.1521/ijct.2011.4.1.34] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Langen M, Durston S, Kas MJH, van Engeland H, Staal WG. The neurobiology of repetitive behavior: …and men. Neurosci Biobehav Rev 2010; 35:356-65. [PMID: 20153769 DOI: 10.1016/j.neubiorev.2010.02.005] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 02/05/2010] [Accepted: 02/08/2010] [Indexed: 10/19/2022]
Abstract
In young, typically developing children, repetitive behavior similar to that in certain neuropsychiatric syndromes is common. Whereas this behavior is adaptive in typical development, in many disorders it forms a core component of symptoms and causes prominent impairment in the daily life of affected individuals. Understanding the neurobiological mechanisms involved repetitive behavior will improve our understanding of the pathogenesis of developmental neuropsychiatric disorders, stimulating novel approaches to these conditions. However, studies on the neurobiology of human repetitive behavior have often been limited to distinct conditions and generalization has been hindered by inconsistent terminology. In this paper, we synthesize the 'disorder-driven' literature, building on findings from fundamental animal research and translational models. These findings suggest a model for classifying repetitive behavior by its neuroanatomical correlates.
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Affiliation(s)
- Marieke Langen
- Department of Child and Adolescent Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands.
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Steeves TDL, Ko JH, Kideckel DM, Rusjan P, Houle S, Sandor P, Lang AE, Strafella AP. Extrastriatal dopaminergic dysfunction in tourette syndrome. Ann Neurol 2010; 67:170-81. [DOI: 10.1002/ana.21809] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Thibault G, O’Connor KP, Stip E, Lavoie ME. Electrophysiological manifestations of stimulus evaluation, response inhibition and motor processing in Tourette syndrome patients. Psychiatry Res 2009; 167:202-20. [PMID: 19395047 PMCID: PMC3757001 DOI: 10.1016/j.psychres.2008.03.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 02/22/2008] [Accepted: 03/19/2008] [Indexed: 10/20/2022]
Abstract
Gilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder with childhood onset presenting with multiple fluctuating motor tics and one or more phonic tics. A significant proportion of people suffering from GTS are still symptomatic in adulthood and present other emotional and cognitive difficulties, along with motor problems that often accompany these comorbid conditions. The nature of these difficulties is still poorly understood and multiple comorbidities are often inadequately controlled. The current study investigates both stimulus evaluation and motor processing in GTS while controlling for comorbidity. Fifteen adults with GTS and 20 control participants were matched on gender, laterality and intelligence. The P300 component, the no-go anteriorization (NGA) as well as the stimulus and response-locked lateralized-readiness potentials (S-LRP, R-LRP) were elicited during a stimulus-response compatibility (SRC) paradigm. The standard version of the Stroop Color-Word Test (SCWT) was also administered. Reaction times showed that participants with GTS processed both the SRC and the SCWT more rapidly than the control group, while producing a delayed P300 peak latency. The GTS group also showed faster S-LRP onset in response to the incompatible and faster processing of interference in the SCWT. There was also a tendency toward a greater frontal shift of the NGA in the GTS group. The P300 latency showed that with GTS patients, stimulus evaluation occurs later whereas the overlapping pre-motor response selection processes occur faster. Our findings are congruent with a probable cortical motor over-activation hypothesis of GTS involving faster motor program selection in processing conflicting SR configuration.
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Affiliation(s)
- Genevieve Thibault
- Centre de Recherche Fernand-Seguin and Hôpital Louis-H. Lafontaine, Montréal, Québec, Canada,Département de Psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Kieron P. O’Connor
- Centre de Recherche Fernand-Seguin and Hôpital Louis-H. Lafontaine, Montréal, Québec, Canada,Département de Psychiatrie, Université de Montréal, Montréal, Québec, Canada,Département de Psychologie et Psychoéducation, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | - Emmanuel Stip
- Centre de Recherche Fernand-Seguin and Hôpital Louis-H. Lafontaine, Montréal, Québec, Canada,Département de Psychiatrie, Université de Montréal, Montréal, Québec, Canada
| | - Marc E. Lavoie
- Centre de Recherche Fernand-Seguin and Hôpital Louis-H. Lafontaine, Montréal, Québec, Canada,Département de Psychiatrie, Université de Montréal, Montréal, Québec, Canada,Corresponding author. Fernand-Seguin Research Center, 7331, Hochelaga Street, Montréal, QC, Canada H1N 3V2. Tel.: +1 514 251 4015x3587; fax: +1 514 251 2617. (M.E. Lavoie)
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Abstract
A developmental approach to the study of psychopathology can broaden understanding of a wide variety of complex psychological disorders. This article reviews research on Tourette's syndrome (TS), a developmental disorder characterized by unwanted motor and vocal tics. Over the past decade, knowledge of the neurobiology and pathophysiology of TS has progressed rapidly. The application of brain imaging techniques, primarily magnetic resonance imaging, to the study of Tourette's has increased knowledge of structural and functional deficits in brain areas associated with behavioral and psychological disturbances in the disorder. By reviewing some of this work, we will describe one way in which knowledge of brain function in TS has both informed and been informed by a developmental science approach. In particular, we will consider the extent to which the cognitive and emotional development of persons with TS may be affected by specific neurobiological characteristics of the disorder.
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Affiliation(s)
- Emily R Stern
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, 2701 Rachel Upjohn Building, Ann Arbor, MI 48109, USA.
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Behen M, Chugani HT, Juhász C, Helder E, Ho A, Maqbool M, Rothermel RD, Perry J, Muzik O. Abnormal brain tryptophan metabolism and clinical correlates in Tourette syndrome. Mov Disord 2008; 22:2256-62. [PMID: 17708557 DOI: 10.1002/mds.21712] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Symptoms in Tourette syndrome (TS) are likely related to abnormalities involving multiple neurotransmitter systems in striatal-thalamo-cortical circuitry. Although prior studies have found abnormal levels of tryptophan, serotonin, and their metabolites in blood, cerebrospinal fluid and brain tissue of TS patients, understanding of focal brain disturbances and their relationship to clinical phenotype remains poor. We used alpha-[(11)C]methyl-L-tryptophan (AMT) positron emission tomography (PET) to assess global and focal brain abnormalities of tryptophan metabolism and their relationship to behavioral phenotype in 26 children with TS and nine controls. Group comparisons on regional cortical and subcortical AMT uptake revealed decreased AMT uptake in bilateral dorsolateral prefrontal cortical and bilaterally increased uptake in the thalamus (P = 0.001) in TS children. The ratio of AMT uptake in subcortical structures to dorsolateral prefrontal cortex was significantly increased bilaterally (P < 0.01) in TS patients also. Behaviorally defined subgroups within the TS sample revealed differences in the pattern of AMT uptake in the fronto-striatal-thalamic circuit. This study demonstrates cortical and subcortical abnormalities of tryptophan metabolism in TS and provides neuroimaging evidence for a role of serotonergic mechanisms in the pathophysiology of TS.
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Affiliation(s)
- Michael Behen
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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Sukhodolsky DG, Leckman JF, Rothenberger A, Scahill L. The role of abnormal neural oscillations in the pathophysiology of co-occurring Tourette syndrome and attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2007; 16 Suppl 1:51-9. [PMID: 17665283 DOI: 10.1007/s00787-007-1007-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the role of aberrant neural oscillatory activity in the pathophysiology of co-occurring Tourette Syndrome (TS) and Attention-Deficit/Hyperactivity Disorder (ADHD). METHOD Neural oscillations refer to periodic variations in the recording of neural activity. The temporal synchronization of oscillations represents a mechanism of neural communication implicated in normal brain functioning as well as psychopathology. We reviewed physiological, imaging, and neuropsychological evidence that tics and symptoms of ADHD may result from abnormal oscillatory activity in the brain. RESULTS Structural and functional abnormalities in the cortical-striatal-thalamo-cortical circuits may result in the disruption of oscillatory activity within the basal ganglia of individuals with TS and lead to transient hyperpolarization of selected thalamocortical regions. Extended to TS plus ADHD this or similar mechanisms, in turn, would lead to the dysrhythmia of particular vulnerable cortical regions and give rise to various deficits in motor control (TS + ADHD) as well as impulsivity and attention (ADHD). Compensatory systems within the prefrontal cortex could be activated and trained to modulate the misguided striatal and thalamocortical oscillations. CONCLUSIONS Although it is highly likely that abnormal neural oscillations have a prominent role in co-occurrence of TS + ADHD, its final relevance in this case deserves further differentiated research (i.e. oscillatory networks disentangled from other neuropsychiatric disorders).
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Affiliation(s)
- Denis G Sukhodolsky
- Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06520, USA.
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24
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Abstract
The boundaries between obsessive-compulsive disorder (OCD) and other neuropsychiatric disorders remain unresolved and may well differ from one disorder to another. Endophenotypes are heritable, quantitative traits hypothesized to more closely represent genetic risk for complex polygenic mental disorders than overt symptoms and behaviors. They may have a role in identifying how closely these disorders are associated with another and with other mental disorders with which they share major comorbidity. This review maps the nosological relationships of OCD to other neuropsychiatric disorders, using OCD as the prototype disorder and endophenotype markers, such as cognitive, imaging, and molecular data as well as results from demographic, comorbidity, family, and treatment studies. Despite high comorbidity rates, emerging evidence suggests substantial endophenotypic differences between OCD and anxiety disorders, depression, schizophrenia, and addictions, though comparative data is lacking and the picture is far from clear. On the other hand, strong relationships between OCD, Tourette syndrome, body dysmorphic disorder, hypochondriasis, grooming disorders, obsessive-compulsive personality disorder, and pediatric autoimmune neuropsychiatric disorders associated with streptococcus are likely. Studies designed to delineate the cause, consequences, and common factors are a challenging but essential goal for future research in this area.
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Affiliation(s)
- Naomi A Fineberg
- Postgraduate School of Medicine, University of Hertfordshire, Gueen Elizabeth II Hospital, Welwyn Garden City, UK.
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Sambataro F, Dimalta S, Di Giorgio A, Taurisano P, Blasi G, Scarabino T, Giannatempo G, Nardini M, Bertolino A. Preferential responses in amygdala and insula during presentation of facial contempt and disgust. Eur J Neurosci 2006; 24:2355-62. [PMID: 17042790 DOI: 10.1111/j.1460-9568.2006.05120.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Some authors consider contempt to be a basic emotion while others consider it a variant of disgust. The neural correlates of contempt have not so far been specifically contrasted with disgust. Using functional magnetic resonance imaging (fMRI), we investigated the neural networks involved in the processing of facial contempt and disgust in 24 healthy subjects. Facial recognition of contempt was lower than that of disgust and of neutral faces. The imaging data indicated significant activity in the amygdala and in globus pallidus and putamen during processing of contemptuous faces. Bilateral insula and caudate nuclei and left as well as right inferior frontal gyrus were engaged during processing of disgusted faces. Moreover, direct comparisons of contempt vs. disgust yielded significantly different activations in the amygdala. On the other hand, disgusted faces elicited greater activation than contemptuous faces in the right insula and caudate. Our findings suggest preferential involvement of different neural substrates in the processing of facial emotional expressions of contempt and disgust.
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Affiliation(s)
- Fabio Sambataro
- Department of Psychiatry, University of Bari, Piazza Giulio Cesare, 9, 70124 Bari, Italy
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Vloet TD, Neufang S, Herpertz-Dahlmann B, Konrad K. Bildgebungsbefunde bei Kindern und Jugendlichen mit ADHS, Tic-Störungen und Zwangserkrankungen. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2006; 34:343-55. [PMID: 16981155 DOI: 10.1024/1422-4917.34.5.343] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: ADHS, Tic-Störung, Tourette-Syndrom und Zwangsstörung sind gekennzeichnet durch Defizite in der Handlungskontrolle und treten überzufällig häufig komorbid auf. Es bestehen Hinweise auf eine gemeinsame neurobiologische Basis. Der folgende Übersichtsartikel fasst Ergebnisse aus Bildgebungsstudien zu diesen Störungen im Kindes- und Jugendalter zusammen, wobei strukturelle und funktionelle Befunde durch Magnetresonanztomographie einen Schwerpunkt einnehmen. Übereinstimmend zeigen sich im Vergleich zu gesunden Kontrollen morphologische Veränderungen im Bereich von Basalganglien und präfrontalem Kortex sowie abnorme Aktivierungen in fronto-striatalen Systemen. Vor allem beim ADHS und Tourette-Syndrom werden präfrontale Abweichungen gefunden, die beim letzteren milder ausgeprägt sind und unter Umständen auf Kompensationsmechanismen zurückzuführen sein könnten. Beim ADHS finden sich zusätzlich kleine, globale morphologische Veränderungen im gesamten Kortex und im Zerebellum, beim Tourette-Syndrom werden zudem Auffälligkeiten im okzipitalen Kortex beschrieben. Bei der Zwangserkrankung bestehen weitere strukturelle und funktionelle Aberrationen im Bereich von Amygdala und Thalamus und zudem orbito-frontale Funktionsveränderungen, die beim ADHS eher im ventralen präfrontalen Kortex zu finden sind. Diese Befunde scheinen insgesamt mit Störungen in kortiko-striato-thalamiko-kortikalen Regelkreisen assoziiert zu sein und u. a. in Verbindung mit Dysfunktionen im Bereich der Inhibition von motorischen Reaktionen, impulsiven Handlungen und unerwünschten Gedanken zu stehen. Generell wird die Aussagekraft und Vergleichbarkeit vieler Studien durch kleine und heterogene Gruppen sowie methodische Unterschiede eingeschränkt.
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Affiliation(s)
- Timo D Vloet
- Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsklinikum Aachen, Neuenhofer Weg 21, DE-52074 Aachen.
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27
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Abstract
Traditional neuropathologic methods have provided only limited insight into the central nervous system abnormalities underlying Tourette syndrome. In the past 20 years, investigators have turned increasingly to in vivo neuroimaging approaches to localize, quantify, and characterize neuroanatomic, functional, and neurochemical distinctions in living subjects with Tourette syndrome. Research methods have included aggregate measures of cerebral energy metabolism, assessments of cerebral structure and size, and highly specific assessments of neurochemical markers of select neurons and synapses. Although the available data have important limitations, an encouraging convergence of findings implicates abnormal function in the Tourette syndrome striatum and in associated limbic and frontal cortical systems.
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Affiliation(s)
- Kirk A Frey
- Department of Neurology, The University of Michigan, Ann Arbor, MI 48109-0028, USA.
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Cunningham MG, Goldstein M, Katz D, O'Neil SQ, Joseph A, Price B. Coalescence of psychiatry, neurology, and neuropsychology: from theory to practice. Harv Rev Psychiatry 2006; 14:127-40. [PMID: 16787885 DOI: 10.1080/10673220600748536] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In a climate of renewed interest in the synergy between neurology and psychiatry, practitioners are increasingly recognizing the importance of exchange and collaboration between these two disciplines. However, there are few working models of interdisciplinary teams that freely share expertise in real time, while providing clinical and academic training to future physicians who specialize in the central nervous system. Over the past 11 years, the McLean Hospital Neuropsychiatry and Behavioral Neurology service has provided proof-of-principle for such collaboration, demonstrating that a team comprising psychiatrists, neurologists, and neuropsychologists can function effectively as a unit while maintaining the autonomy of these three disciplines and also synthesizing their combined knowledge. In addition to delivering enhanced patient care and promoting medical research, this clinical service has provided enriched cross-specialty training for fellows, residents, and medical students. The practical functioning of the team is described, and case vignettes are presented to illustrate the team's collaborative synergism in practice.
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29
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Albin RL, Mink JW. Recent advances in Tourette syndrome research. Trends Neurosci 2006; 29:175-82. [PMID: 16430974 DOI: 10.1016/j.tins.2006.01.001] [Citation(s) in RCA: 306] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Revised: 11/09/2005] [Accepted: 01/03/2006] [Indexed: 11/16/2022]
Abstract
Tourette syndrome (TS) is a developmentally regulated neurobehavioral disorder characterized by involuntary, stereotyped, repetitive movements. Recent anatomical and neuroimaging studies have provided evidence for abnormal basal ganglia and dopaminergic function in TS. Basic research on striatal inhibitory mechanisms and dopaminergic function complements the recent neuroimaging and anatomical data. Parallel studies of basal ganglia participation in the normal performance and learning of stereotyped repetitive behaviors or habits has provided additional insight. These lines of research have provided new pieces to the TS puzzle, and their increasing convergence is showing how those pieces can be put together.
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Affiliation(s)
- Roger L Albin
- Geriatrics Research, Education, and Clinical Center, Ann Arbor VAMC, Department of Neurology, University of Michigan, MI 48109, USA
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SEGAWA M. Epochs of development of the sleep-wake cycle reflect the modulation of the higher cortical function particular for each epoch. Sleep Biol Rhythms 2006. [DOI: 10.1111/j.1479-8425.2006.00205.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mink JW, Walkup J, Frey KA, Como P, Cath D, Delong MR, Erenberg G, Jankovic J, Juncos J, Leckman JF, Swerdlow N, Visser-Vandewalle V, Vitek JL. Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome. Mov Disord 2006; 21:1831-8. [PMID: 16991144 DOI: 10.1002/mds.21039] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In response to recent publicity regarding the potential use of deep brain stimulation (DBS) for reducing tic severity in Tourette's syndrome (TS), the Tourette Syndrome Association convened a group of TS and DBS experts to develop recommendations to guide the early use and potential clinical trials of DBS for TS and other tic disorders. The goals of these recommendations are to ensure that all surgical candidates are (1) fully informed about the risks, benefits, and alternative treatments available; (2) receive a comprehensive evaluation before surgery to ensure that DBS is clearly the appropriate clinical treatment choice; and (3) that early clinical experience will be documented publicly to facilitate rational decision-making for both clinical care and future clinical trials.
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Affiliation(s)
- Jonathan W Mink
- Department of Neurology, University of Rochester, Rochester, New York, USA.
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Lubman DI, Yücel M, Pantelis C. Addiction, a condition of compulsive behaviour? Neuroimaging and neuropsychological evidence of inhibitory dysregulation. Addiction 2004; 99:1491-502. [PMID: 15585037 DOI: 10.1111/j.1360-0443.2004.00808.x] [Citation(s) in RCA: 214] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Addiction has been conceptualized as a shift from controlled experimentation to uncontrolled, compulsive patterns of use. Current neurobiological models of addiction emphasize changes within the brain's reward system, such that drugs of abuse 'hijack' this system and bias behaviour towards further drug use. While this model explains the involuntary nature of craving and the motivational drive to continue drug use, it does not explain fully why some addicted individuals are unable to control their drug use when faced with potentially disastrous consequences. In this review, we argue that such maladaptive and uncontrolled behaviour is underpinned by a failure of the brain's inhibitory control mechanisms. DESIGN Relevant neuroimaging, neuropsychological and clinical studies are reviewed, along with data from our own research. FINDINGS The current literature suggests that in addition to the brain's reward system, two frontal cortical regions (anterior cingulate and orbitofrontal cortices), critical in inhibitory control over reward-related behaviour, are dysfunctional in addicted individuals. These same regions have been implicated in other compulsive conditions characterized by deficits in inhibitory control over maladaptive behaviours, such as obsessive-compulsive disorder. CONCLUSIONS We propose that in chronically addicted individuals, maladaptive behaviours and high relapse rates may be better conceptualized as being 'compulsive' in nature as a result of dysfunction within inhibitory brain circuitry, particularly during symptomatic states. This model may help to explain why some addicts lose control over their drug use, and engage in repetitive self-destructive patterns of drug-seeking and drug-taking that takes place at the expense of other important activities. This model may also have clinical utility, as it allows for the adoption of treatments effective in other disorders of inhibitory dysregulation.
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Affiliation(s)
- Dan I Lubman
- Substance Use Research and Recovery Focused (SURRF) Program, ORYGEN Research Centre, University of Melbourne, Victoria, Australia
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Abstract
Impulsivity is associated with the functioning of prefrontal-subcortical circuits particularly, the orbitofrontal circuit, which is shown in neuro-imaging studies of neurological and psychological disorders. Objective behavioral measures, such as go/no-go, antisaccades, and delayed alternation, have demonstrated sensitivity to prefrontal function. This study examined the relationship between orbitofrontal-sensitive measures and impulsivity in healthy adults, as measured by the Barratt Impulsiveness Scale-11 (BIS). Go/no-go and antisaccades correlated positively and delayed alternations correlated negatively with BIS subscales, even after controlling for demographic influences. The results add to the validity of the BIS and support a role for prefrontal cortex in impulse control.
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Affiliation(s)
- Marcello Spinella
- Division of Social and Behavioral Sciences, Richard Stockton College of New Jersey, Pomona, New Jersey 08240-0195, USA.
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Abstract
OBJECTIVES It is often difficult to discern how findings of a neuroimaging study relate to the pathophysiology of an illness because imaging correlates may variously represent causes, consequences, or epiphenomena of the condition. The objective of this paper is to exemplify the complexities of interpreting neuroimaging data by reviewing anatomical and functional studies of Tourette syndrome (TS). METHODS Medline and Psychological Abstracts (PsycInfo) databases were searched for functional and anatomical neuroimaging studies of TS. RESULTS 9 anatomical and 21 functional cross-sectional imaging studies of TS contributed to this review. Anatomical studies comparing TS patients to age-matched controls have found that lenticular nucleus volumes are reduced in TS adults, while caudate nucleus volumes are reduced in both adults and children with TS. In a study of the cerebral cortex, prefrontal volumes in TS adults were smaller, but in TS children were larger than in those of age-matched controls. Complementing the anatomical findings of reduced volumes of the caudate nucleus in TS, functional studies have suggested that frontal-striatal projections play an important role in the regulation of tic symptoms. The majority of functional studies to date, however, have been limited to the study of adults. These functional studies have yielded variable results that have limited generalizability to the pathophysiology of children with TS. CONCLUSIONS Although many of the findings in TS imaging may represent pathological causes of the disease, they may also be indicative of compensatory changes in the nervous system of TS subjects. Prospective studies of young children at risk will be necessary to help clarify the relationship between brain abnormalities and the course of the disease.
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Affiliation(s)
- Elizabeth Gerard
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA
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Kang DH, Kwon JS, Kim JJ, Youn T, Park HJ, Kim MS, Lee DS, Lee MC. Brain glucose metabolic changes associated with neuropsychological improvements after 4 months of treatment in patients with obsessive-compulsive disorder. Acta Psychiatr Scand 2003; 107:291-7. [PMID: 12662252 DOI: 10.1034/j.1600-0447.2003.00070.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The study was designed to elucidate regional brain metabolic changes according to a treatment and their relationship with neuropsychological performance changes in obsessive-compulsive disorder (OCD). METHOD Cerebral glucose metabolic rates were repeatedly measured before and after treatment in 10 patients with OCD using [18F]-2-fluoro-deoxyglucose positron emission tomography (PET). They were compared on a voxel-basis, and the correlations were counted between the regional metabolic changes and the degree to improvement on the neuropsychological assessments. RESULTS After treatment, the patients showed significant (P < 0.005, two-tailed) regional metabolic changes in multiple brain areas involving frontal-subcortical circuits and parietal-cerebellar networks. Especially, the metabolic changes of the putamen, the cerebellum, and the hippocampus were significantly correlated with the improvement of the immediate- and delayed-recall scores of the Rey-Osterrieth Complex Figure Test (RCFT). CONCLUSION These results suggest a possibility that metabolic changes of frontal-subcortical and parietal-cerebellar circuit changes may underlie cognitive improvements in patients with OCD.
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Affiliation(s)
- D-H Kang
- Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
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37
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Abstract
Tourette's syndrome (TS) is a childhood onset neurological disorder characterized by motor and vocal tics. It may be associated with a number of co-morbidities including attention deficit hyperactivity disorder, obsessive compulsive symptomatology, and behaviour disorders. Prevalence of TS is higher than previously thought, and may be present in up to 2% of the population. Tourette's syndrome has a significant genetic component. Inheritance may involve several mechanisms including autosomal dominant, bilinear, or polygenic mechanisms. Pathophysiology is still unknown, although is thought to involve striatocortical circuits. Treatment begins with modification of the work and home environment. For more severe cases, medications such as tetrabenazine and neuroleptics may be helpful. Treatment of co-morbidities needs to be considered, as these may result in moredisability than the tics themselves.
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Affiliation(s)
- Kia Faridi
- Department of Psychiatry, McGill University, Montreal, QC, Canada
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38
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Kessler AR. Tourette syndrome associated with body temperature dysregulation: possible involvement of an idiopathic hypothalamic disorder. J Child Neurol 2002; 17:738-44. [PMID: 12546427 DOI: 10.1177/08830738020170101301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tourette syndrome is a neuropsychiatric disorder that holds the potential to afflict the emotional, familial, social, or scholastic performances of patients with Tourette syndrome in day-to-day life functioning. The disorder is today characterized mainly and diagnosed by clinical observations, yet false-negative results obtained in the diagnosis of Tourette syndrome are numerous and well documented. There is still no laboratory or imaging technique available for the diagnosis of Tourette syndrome. This article reports on changes of the ambient thermal perception (38%) and a circadian dysregulation of the body-temperature profile present in Tourette syndrome probands, irrespective of their chronologic age, sex, or comorbid symptoms. An involvement of idiopathic hypothalamic dysfunctions associated with Tourette syndrome is proposed. Such a phenomenon, if substantiated, could lead to a better understanding of Tourette syndrome and the development of unbiased physical diagnostic criteria of Tourette syndrome and potentiate possible production of novel therapeutic possibilities.
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39
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Kim MS, Park SJ, Shin MS, Kwon JS. Neuropsychological profile in patients with obsessive-compulsive disorder over a period of 4-month treatment. J Psychiatr Res 2002; 36:257-65. [PMID: 12191630 DOI: 10.1016/s0022-3956(02)00017-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study investigated the changes of the neuropsychological functions over a 4-month period of treatment in patients with obsessive-compulsive disorder (OCD). Thirty-nine OCD patients and 31 healthy controls were evaluated with neuropsychological and clinical tests. The same tests were readministered 4-months after pharmacological treatment for the OCD patients. At the first series of tests, compared to the controls, the OCD patients were significantly impaired on the immediate and delayed recall of Rey-Osterrieth Complex Figure Test (RCFT), and on the letter and category of Controlled Oral Word Association Test (COWA). They also showed a prolonged response time on Trail Making Test (TMT), part A. The severity of OCD measured by Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) correlated well with the performance on the immediate and delayed recall of RCFT and the response time on TMT, part A. After 4-months' follow-up, the OCD patients still showed impairment on the immediate and delayed recall of RCFT and COWA category. This is despite the fact that they had improved significantly on these functions in comparison with the controls over the period of treatment. In addition, an association between OCD symptoms and the performance on the neuropsychological tests was not observed. The neuropsychological profile of the OCD patients found in the present study is consistent with current theories proposing that the frontal-striatal system is the possible pathophysiological mechanism underlying the development of OCD.
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Affiliation(s)
- Myung-Sun Kim
- Department of Psychiatry, Seoul National University College of Medicine, 28 Yeongon-dong, Chongno-gu, Seoul 110-744, South Korea
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Kulisevsky J, Litvan I, Berthier ML, Pascual-Sedano B, Paulsen JS, Cummings JL. Neuropsychiatric assessment of Gilles de la Tourette patients: comparative study with other hyperkinetic and hypokinetic movement disorders. Mov Disord 2001; 16:1098-104. [PMID: 11748741 DOI: 10.1002/mds.1225] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The role of the basal ganglia in conditions with co-occurring movement disorders and neuropsychiatric symptoms is not well known. It has been hypothesized that hyperkinesia -disinhibited behaviors and hypokinesia-inhibited behaviors result from an imbalance between the direct and indirect striatal output pathways, and that differential involvement of these pathways could account for the concurrent abnormalities in movement and behavior observed in these disorders. This study aimed to evaluate whether the pattern and the extent of the neuropsychiatric manifestations of patients with GTS, a hyperkinetic movement disorder of basal ganglia origin, differs from that of patients with other basal ganglia hyperkinetic (e.g., HD) or hypokinetic (e.g., PSP) movement disorders, and to determine whether patients with GTS show a greater frequency of hyperactive behaviors (e.g., agitation, irritability, euphoria, or anxiety) than PSP patients, and are comparable to patients with HD. The Neuropsychiatric Inventory (NPI), a scale with established validity and reliability, was administered to 26 patients with GTS (mean age, 30.2 +/- 2.2 years), and the results were compared with that of 29 patients with HD (mean age, 43.8 +/- 2 years) and 34 with PSP (mean +/- S.D. age, 66.6 +/- 1.2 years). There was no difference between the groups in the total NPI scores. However, there was a double dissociation in behaviors: patients with hyperkinetic disorders (HD and GTS) exhibited significantly more agitation, irritability, anxiety, euphoria, and hyperkinesia, whereas hypokinetic patients (PSP) exhibited more apathy. Patients with GTS showed greater scores than HD patients in all those scores differentiating HD and GTS from PSP patients (e.g., agitation, irritability, anxiety and euphoria), and were differentiated in a logistic regression analysis from both HD and PSP patients in having significantly more anxiety. We found that patients with GTS manifested predominantly hyperactive behaviors similar but more pronounced than those presented by patients with HD, while those with PSP manifested hypoactive behaviors. Based on our findings and the proposed models of basal ganglia dysfunction in these disorders, we suggest that the hyperactive behaviors in GTS are comparable to those observed in HD, being both secondary to an excitatory subcortical output through the medial and orbitofrontal cortical circuits, while in PSP the hypoactive behaviors are secondary to hypostimulation of these circuits. Abnormalities of other brain structures (e.g., amygdala, brainstem nuclei) may account for the significantly higher anxiety scores differentiating GTS from HD patients.
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Affiliation(s)
- J Kulisevsky
- Movement Disorders Unit, Department of Neurology, Sant Pau Hospital, Autonomous University of Barcelona, Spain.
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Abstract
For over 60 years, ideas about emotion in neuroscience and psychology have been dominated by a debate on whether emotion can be encompassed within a single, unifying model. In neuroscience, this approach is epitomized by the limbic system theory and, in psychology, by dimensional models of emotion. Comparative research has gradually eroded the limbic model, and some scientists have proposed that certain individual emotions are represented separately in the brain. Evidence from humans consistent with this approach has recently been obtained by studies indicating that signals of fear and disgust are processed by distinct neural substrates. We review this research and its implications for theories of emotion.
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Affiliation(s)
- A J Calder
- MRC Cognition and Brain Sciences Unit, 15 Chaucer Road, Cambridge CB2 2EF, UK.
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Abstract
The etiology of tic disorder includes idiopathic, postencephalitic, head injury, carbon monoxide poisoning, stroke, and developmental syndromes. We report a case of new-onset complex motor and vocal tics that began after hemorrhage of an arteriovenous malformation located in the left frontal lobe. We have found no reported cases of new-onset tics related to arteriovenous malformations or hemorrhage into the frontal lobes. The patient is a 16-year-old right-hand-dominant boy who presented with generalized tonic-clonic seizures. Evaluation, including magnetic resonance imaging, revealed a left frontal arteriovenous malformation, confirmed by angiogram. Following resection, there was an intraparenchymal hemorrhage of the left frontal lobe with intraventricular hemorrhage, noted most prominently in the left lateral and IIIrd ventricles, and a subdural hematoma caudal to the craniotomy. The postoperative course was complicated by hemiparesis and global aphasia. During recovery, the patient developed what was thought to be a complex partial seizure evidenced by head turning to the right with vocalization and left upper extremity clonic jerks. These were brief and occurred multiple times per day. A trial of carbamazepine was given with no improvement. It was noted that the spells occurred more frequently under stress, as when the patient was frustrated with communication. The diagnosis was changed to complex motor tics and the therapy changed to clonidine. The tics subsequently improved by 80%, although they were still present. We believe the development of complex motor tics due to frontal hemorrhage represents a unique etiology and could complicate postsurgical recovery in similar cases.
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Affiliation(s)
- M R Yochelson
- Department of Child and Adolescent Neurology, Walter Reed Army Medical Center, Washington, DC 20307, USA.
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Abstract
Advances in obsessive-compulsive disorder (OCD) research have led to increased attention to a range of disorders with possibly overlapping phenomenological and neurobiological features; the so-called OCD spectrum disorders. This article briefly reviews neurobiological data relevant to the construction of an OCD spectrum, including neurochemical, neuroanatomic, genetic, neuroimmunology, and animal studies. OCD and related disorders may be heterogenous conditions, and the neurobiology of many putative OCD spectrum disorders has not been well studied. Nevertheless, a gradual accumulation of neurobiological data has provided a number of exciting, and partially overlapping, approaches to an hypothesized OCD spectrum.
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Affiliation(s)
- D J Stein
- Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
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Van Lancker D, Cummings JL. Expletives: neurolinguistic and neurobehavioral perspectives on swearing. BRAIN RESEARCH. BRAIN RESEARCH REVIEWS 1999; 31:83-104. [PMID: 10611497 DOI: 10.1016/s0165-0173(99)00060-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Severe aphasia, adult left hemispherectomy, Gilles de la Tourette syndrome (GTS), and other neurological disorders have in common an increased use of swearwords. There are shared linguistic features in common across these language behaviors, as well as important differences. We explore the nature of swearing in normal human communication, and then compare the clinical presentations of selectively preserved, impaired and augmented swearing. These neurolinguistic observations, considered along with related neuroanatomical and neurochemical information, provide the basis for considering the neurobiological foundation of various types of swearing behaviors.
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Affiliation(s)
- D Van Lancker
- Department of Neurology, University of Southern California, Los Angeles, CA, USA.
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Farber RH, Swerdlow NR, Clementz BA. Saccadic performance characteristics and the behavioural neurology of Tourette's syndrome. J Neurol Neurosurg Psychiatry 1999; 66:305-12. [PMID: 10084528 PMCID: PMC1736262 DOI: 10.1136/jnnp.66.3.305] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To better understand the neuropathological correlates of Tourette's syndrome (TS), measures of saccadic eye movement performance were examined among patients with TS. METHODS A case-control design was used. Twenty one patients with DSM-IV TS (mean age 40.6 years (SD 11.0); 38% female) mainly recruited from UCSD Psychiatry Services, and a community based sample of 21 normal subjects (mean age 34.6 years (SD 13.4); 43% women) participated in this study. Participants were administered ocular motor tasks assessing visual fixation, and the generation of prosaccades, predictive saccades, and antisaccades. Saccadic reaction time, amplitude, duration, and mean and peak velocity were computed. Intrusive saccades during visual fixation and the proportion of correct antisaccade responses were also evaluated. RESULTS The groups had similar visual fixation performance. Whereas patients with TS generated prosaccades with normal reaction times and amplitudes, their saccade durations were shorter and their mean velocities were higher than in normal subjects. During a prosaccade gap task, patients with TS exhibited an increased proportion of anticipatory saccades (RTs<90). The proportion of "express" saccades (90<RTs<135) did not differ between groups. Patients with TS had fewer correct antisaccade responses than did normal subjects, an effect accounted for by 19% of the patients. Antisaccade reaction times among patients with TS were increased during an overlap version of the task. CONCLUSION These findings suggest that TS mildly affects the ocular motor control circuitry associated with saccade inhibition.
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Affiliation(s)
- R H Farber
- Department of Psychology, University of California, San Diego, USA
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Abstract
Stereotypic movement disorders (SMD) such as head-banging, which are common among children with mental retardation or pervasive developmental disorders, may also occur in intellectually normal adults. We report a 27-year history of daily head-banging with self-injury in a 49-year-old man with normal cognition. The patient had no personal or family history of Tourette's syndrome, tic disorder, obsessive-compulsive disorder (OCD), or mental retardation. The frequency of his stereotypical head-banging increased with anxiety, loud noises with startle, and boredom. He reported a sense of pleasure from his head-banging, and the frequency of this behavior decreased when he was treated with the opioid antagonist naltrexone. Although not diagnostic, the self-stimulatory or pleasurable component of head-banging, body-rocking, thumb-sucking, and other SMD may help distinguish them from tics, Tourette's syndrome, OCD, and deliberate self-harming behavior. This report reviews the disorders associated with SMD and discusses the potential mechanisms for these behaviors. The treatment of SMD includes drugs that work through opioid, serotonergic, or dopaminergic systems.
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Affiliation(s)
- M F Mendez
- Department of Neurology, University of California at Los Angeles and West Los Angeles VA Medical Center, 90073, USA
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Kano Y, Ohta M, Nagai Y. Differences in clinical characteristics between Tourette syndrome patients with and without 'generalized tics' or coprolalia. Psychiatry Clin Neurosci 1997; 51:357-61. [PMID: 9472118 DOI: 10.1111/j.1440-1819.1997.tb02599.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose of this study is to examine whether there are differences in clinical characteristics between Tourette syndrome (TS) patients with and without 'generalized tics' (GT) which involve the entire body, and/or coprolalia. Subjects were 64 patients (55 males and 9 females, mean age, 17.4 +/- 7.2 years) who visited Tokyo University's outpatient clinic of neuropsychiatry from 1974 to 1993 and who met criteria for Tourette's disorder of DSM-III-R. Data on clinical characteristics, including tic symptoms and courses of their development, complications and developmental histories, treatment and severity, were collected by systematic chart review of all subjects. Tourette syndrome patients with 'generalized tics' tended to show multiple complex vocal tics more frequently than TS patients without GT. Tourette syndrome patients with coprolalia tended to show significantly higher rates of copropraxia, echolalia, and 'cleaning/washing' compulsion than did the TS patients without coprolalia. Tourette syndrome patients with both GT and coprolalia were classified as the severest group in terms of tic symptoms and social impairment. Tourette syndrome patients who had neither of these morbidities were classified into the mildest group in all aspects. Generalized tics and coprolalia seemed to indicate the severest end of the TS spectrum and seemed to be related with a need of intensive treatment.
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Affiliation(s)
- Y Kano
- Department of Neuropsychiatry, Faculty of Medicine, University of Tokyo, Japan
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