Differences in clinical characteristics between Tourette syndrome patients with and without 'generalized tics' or coprolalia

Refractory Gilles de la Tourette Syndrome-Many Pieces That Define the Puzzle

Gilles de la Tourette syndrome (GTS) is a childhood onset neuropsychiatric disorder characterized by the presence of motor and vocal tics. The clinical spectrum of GTS is heterogeneous and varies from mild cases that do not require any medical attention to cases that are refractory to standard treatments. One of the unresolved issues is the definition of what constitutes treatment-refractory GTS. While for some other neuropsychiatric disorders, such as obsessive-compulsive disorder (OCD), a clear definition has been established, there is still no consensus with regard to GTS. One important issue is that many individuals with GTS also meet criteria for one or more other neurodevelopmental and neuropsychiatric disorders. In many individuals, the severity of these comorbid conditions contributes to the degree to which GTS is treatment refractory. The scope of this paper is to present the current state-of-the-art regarding refractory GTS and indicate possible approaches to define it. In closing, we discuss promising approaches to the treatment of individuals with refractory GTS.

Are there distinct subtypes in Tourette syndrome? Pure-Tourette syndrome versus Tourette syndrome-plus, and simple versus complex tics

This study addressed several questions relating to the core features of Tourette syndrome (TS) including in particular coprolalia (involuntary utterance of obscene words) and copropraxia (involuntary and inappropriate rude gesturing). A cohort of 400 TS patients was investigated. We observed that coprolalia occurred in 39% of the full cohort of 400 patients and copropraxia occurred in 20% of the cohort. Those with coprolalia had significantly higher Yale Global Tic Severity Scale (YGTSS) and Diagnostic Confidence Index (DCI) total scores and a significantly higher proportion also experienced copropraxia and echolalia. A subgroup of 222 TS patients with full comorbidity data available were also compared based on whether they had pure-TS (motor and vocal tics only) or associated comorbidities and co-existent psychopathologies (TS-plus). Pure-TS and TS-plus groups were compared across a number of characteristics including TS severity, associated clinical features, and family history. In this subgroup, 13.5% had pure-TS, while the remainder had comorbidities and psychopathologies consistent with TS-plus. Thirty-nine percent of the TS-plus group displayed coprolalia, compared to (0%) of the pure-TS group and the difference in proportions was statistically significant. The only other significant difference found between the two groups was that pure-TS was associated with no family history of obsessive compulsive disorder which is an interesting finding that may suggest that additional genes or environmental factors may be at play when TS is associated with comorbidities. Finally, differences between individuals with simple versus complex vocal/motor tics were evaluated. Results indicated that individuals with complex motor/vocal tics were significantly more likely to report premonitory urges/sensations than individuals with simple tics and TS. The implications of these findings for the assessment and understanding of TS are discussed.

Obsessive-compulsive symptom dimensions in Japanese tourette syndrome subjects

OBJECTIVES

To investigate the current and lifetime frequency and severity of obsessive-compulsive (OC) symptom dimensions in Tourette syndrome (TS) patients, and how these dimensions affect clinical characteristics.

METHODS

Forty TS outpatients (29 males, 11 females) were interviewed with the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS), the Yale Global Tic Severity Scale (YGTSS), the Shapiro Tourette Syndrome Severity Scale, and the Global Assessment of Functioning (GAF).

RESULTS

OC symptoms were present in 80% of the total sample. The miscellaneous and the symmetry dimensions were the most frequent at the "current" and "lifetime" surveys, respectively. The aggression dimension had the smallest difference between "worst ever" and current ratings among the all OC symptom dimensions. TS patients with the aggression dimension (n=7) had significantly lower scores in the GAF scale and higher frequencies of coprolalia. There were significant correlations between the YGTSS severity scores and specific DY-BOCS dimensions.

CONCLUSION

OC symptoms are frequent in TS subjects and there were differences in the frequency, severity, and course of the OC symptom dimensions. These results emphasize the need for future longitudinal studies using a dimensional approach for the evaluation of OC symptoms in tic disorders.

Association between Tourette syndrome and comorbidities in Japan

The purpose of this study was (1) to document cases of Tourette syndrome (TS) with comorbidities such as obsessive-compulsive symptoms (OCS) and hyperkinetic disorder (HD), and (2) to examine differences in clinical characteristics between TS patients with OCS and HD and those without these comorbidities. The subjects in the study were 88 Japanese TS patients (67 males and 21 females; mean age: 15.2years) who were treated by 31 clinicians including psychiatrists and pediatricians. Data on tic symptoms, comorbidities and severity were scrutinized. OCS were present in 42.0% of the subjects, while HD accounted for 28.4%. In the TS+OCS and/or HD group, coprophenomana, impulsiveness/aggression, school refusal, self-injurious behaviors (SIB), and clumsiness were significantly more frequent than in the TS-only group. Also, tic symptoms and impairment during the worst period was significantly severer in the TS+OCS and/or HD than in the TS-only group. When the age-matched TS+all OCS group (i.e., the young TS+OCS and TS+OCS+HD group) was compared with the TS-only group, it was found that the rates of impulsiveness/aggression, school refusal and SIB were significantly higher and the degree of global severity was significantly more intense in the young TS+all OCS group than in the TS-only group. The impact to clinical characteristics of TS from OCS was suggested to be slightly greater than that from HD. There was little ethnic difference in TS pathogenesis in terms of the impact of comorbidities. Further investigation is required to gain deeper insights into the relationships between TS, OCD or OCS and HD.

Coprophenomena in Tourette syndrome

The aims of this descriptive study were to examine the prevalence and associations of coprophenomena (involuntary expression of socially unacceptable words or gestures) in individuals with Tourette syndrome. Participant data were obtained from the Tourette Syndrome International Database Consortium. A specialized data collection form was completed for each of a subset of 597 consecutive new patients with Tourette syndrome from 15 sites in seven countries. Coprolalia occurred at some point in the lifetime of 19.3% of males and 14.6% of females, and copropraxia in 5.9% of males and 4.9% of females. Coprolalia was three times as frequent as copropraxia, with a mean onset of each at about 11 years, 5 years after the onset of tics. In 11% of those with coprolalia and 12% of those with copropraxia these coprophenomena were one of the initial symptoms of Tourette syndrome. The onsets of tics, coprophenomena, smelling of non-food objects, and spitting were strongly intercorrelated. Early onset of coprophenomena was not associated with its longer persistence. The most robust associations of coprophenomena were with the number of non-tic repetitive behaviors, spitting, and inappropriate sexual behavior. Although coprophenomena are a frequently feared possibility in the course of Tourette syndrome, their emergence occurs in only about one in five referred patients. Because the course and actual impact of coprophenomena are variable, additional prospective research is needed to provide better counseling and prognostic information.

Clinical characteristics of adult patients with tics and/or Tourette's syndrome

OBJECTIVE

This study was conducted to describe the natural course of tic disorders over a long period of time in Japanese adults patients with Tourette's syndrome (TS) in terms of symptomatology.

METHODS

An extensive literature on TS cases was reviewed selectively and 31 TS patients (mean age: 31.4 years; sex: 28 males and 3 females) at our outpatient clinic were examined. The mean follow-up period of the patients was 7.6 years (SD: 8.1; 0 to 26). All the data available for this study, including medical charts, were examined systematically by two experienced child psychiatrists.

RESULTS

The adult patients with tic disorders could be classified into the four groups: group A - tics only, group B - tics + comorbidities, group C - comorbidities only and group D - sub-clinical (remission) cases. Our 31 subjects consisted of 10 patients (32.3%) for group A, 14 (45.2%) for group B, 7 (22.6%) for group C, and 0 for group D.

CONCLUSIONS

Further investigation into the natural course and clinical characteristics of adult TS needs to be done in order to acquire a better understanding of the broad spectrum of TS and to make improvements to the treatment for this illness.

A family study of Tourette syndrome in Japan

Although the mode of inheritance remains in doubt, twin and family studies conducted mostly in the United States and western Europe suggest that genetic factors play an important role in the transmission and expression of Tourette syndrome (TS). In an effort to evaluate population-based genetic differences, we generated risk estimates for first-degree relatives of TS probands in Japan using methods similar to those utilized in recent Western studies. The subjects were 52 TS probands seen at an outpatient clinic of Tokyo University Hospital and their 165 first-degree relatives. All probands and one or more first-degree relatives in each family were interviewed concerning the presence of tic and obsessive-compulsive symptoms by expert clinicians. The age-corrected rates of TS, chronic motor tics, obsessive-compulsive disorder, and subclinical obsessive-compulsive symptoms in the first-degree relatives were 2.0%, 12.0%, 1.6%, and 7.0%, respectively. Rates of TS and related disorders in Japan appear to be much lower than those in recent Western family studies. If replicated, these data suggest that there may be differences in the nature and frequency of vulnerable alleles for TS and related disorders in the Japanese compared to European populations.

Expletives: neurolinguistic and neurobehavioral perspectives on swearing

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.