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Lamanna J, Ferro M, Spadini S, Racchetti G, Malgaroli A. The Dysfunctional Mechanisms Throwing Tics: Structural and Functional Changes in Tourette Syndrome. Behav Sci (Basel) 2023; 13:668. [PMID: 37622808 PMCID: PMC10451670 DOI: 10.3390/bs13080668] [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: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
Tourette Syndrome (TS) is a high-incidence multifactorial neuropsychiatric disorder characterized by motor and vocal tics co-occurring with several diverse comorbidities, including obsessive-compulsive disorder and attention-deficit hyperactivity disorder. The origin of TS is multifactorial, with strong genetic, perinatal, and immunological influences. Although almost all neurotransmettitorial systems have been implicated in TS pathophysiology, a comprehensive neurophysiological model explaining the dynamics of expression and inhibition of tics is still lacking. The genesis and maintenance of motor and non-motor aspects of TS are thought to arise from functional and/or structural modifications of the basal ganglia and related circuitry. This complex wiring involves several cortical and subcortical structures whose concerted activity controls the selection of the most appropriate reflexive and habitual motor, cognitive and emotional actions. Importantly, striatal circuits exhibit bidirectional forms of synaptic plasticity that differ in many respects from hippocampal and neocortical plasticity, including sensitivity to metaplastic molecules such as dopamine. Here, we review the available evidence about structural and functional anomalies in neural circuits which have been found in TS patients. Finally, considering what is known in the field of striatal plasticity, we discuss the role of exuberant plasticity in TS, including the prospect of future pharmacological and neuromodulation avenues.
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Affiliation(s)
- Jacopo Lamanna
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Faculty of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Mattia Ferro
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Department of Psychology, Sigmund Freud University, 20143 Milan, Italy
| | - Sara Spadini
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Division of Neuroscience, Scientific Institute Ospedale San Raffaele, 20132 Milan, Italy
| | - Gabriella Racchetti
- Division of Neuroscience, Scientific Institute Ospedale San Raffaele, 20132 Milan, Italy
| | - Antonio Malgaroli
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, 20132 Milan, Italy
- Faculty of Psychology, Vita-Salute San Raffaele University, 20132 Milan, Italy
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McCann B, Lam M, Shiohama T, Ijner P, Takahashi E, Levman J. Magnetic Resonance Imaging Demonstrates Gyral Abnormalities in Tourette Syndrome. Int J Dev Neurosci 2022; 82:539-547. [PMID: 35775746 DOI: 10.1002/jdn.10209] [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: 08/18/2021] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/07/2022] Open
Abstract
Tourette syndrome (TS) is a neurological disorder characterized by involuntary and repetitive movements known as tics. A retrospective analysis of magnetic resonance imaging (MRI) scans from 39 children and adolescents with TS was performed and subsequently compared to MRI scans from 834 neurotypical controls. The purpose of this study was to identify any differences in the regions of motor circuitry in TS to further our understanding of their disturbances in motor control (i.e., motor tics). Measures of volume, cortical thickness, surface area, and surface curvature for specific motor regions were derived from each MRI scan. The results revealed increased surface curvature in the opercular part of the inferior frontal gyrus and the triangular part of the inferior frontal gyrus in the TS group compared to the neurotypical control group. These novel findings offer some of the first evidence for surface curvature differences in motor circuitry regions in TS, which may be associated with known motor and vocal tics.
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Affiliation(s)
- Bernadette McCann
- Department of Human Kinetics, St. Francis Xavier University, Antigonish, NS, Canada
| | - Melanie Lam
- Department of Human Kinetics, St. Francis Xavier University, Antigonish, NS, Canada
| | - Tadashi Shiohama
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Japan
| | - Prahar Ijner
- Department of Computer Science, St. Francis Xavier University, Antigonish, NS, Canada
| | - Emi Takahashi
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Department of Pediatrics, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Harvard Medical School, Massachusetts Institute of Technology, Charlestown, MA, USA
| | - Jacob Levman
- Department of Computer Science, St. Francis Xavier University, Antigonish, NS, Canada.,Nova Scotia Health Authority - Research, Innovation and Discovery, Center for Clinical Research, Halifax, NS, Canada
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Mana S, Paillère Martinot ML, Martinot JL. Brain imaging findings in children and adolescents with mental disorders: A cross-sectional review. Eur Psychiatry 2020; 25:345-54. [PMID: 20620025 DOI: 10.1016/j.eurpsy.2010.04.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 04/08/2010] [Accepted: 04/22/2010] [Indexed: 01/18/2023] Open
Abstract
AbstractBackgroundWhile brain imaging studies of juvenile patients has expanded in recent years to investigate the cerebral neurophysiologic correlates of psychiatric disorders, this research field remains scarce. The aim of the present review was to cluster the main mental disorders according to the differential brain location of the imaging findings recently reported in children and adolescents reports. A second objective was to describe the worldwide distribution and the main directions of the recent magnetic resonance imaging (MRI) and positron tomography (PET) studies in these patients.MethodsA survey of 423 MRI and PET articles published between 2005 and 2008 was performed. A principal component analysis (PCA), then an activation likelihood estimate (ALE) meta-analysis, were applied on brain regional information retrieved from articles in order to cluster the various disorders with respect to the cerebral structures where alterations were reported. Furthermore, descriptive analysis characterized the literature production.ResultsTwo hundred and seventy-four articles involving children and adolescent patients were analyzed. Both the PCA and ALE methods clustered, three groups of diagnosed psychiatric disorders, according to the brain structural and functional locations: one group of affective disorders characterized by abnormalities of the frontal-limbic regions; a group of mental disorders with “cognition deficits” mainly related to cortex abnormalities; and one psychomotor condition associated with abnormalities in the basal ganglia. The descriptive analysis indicates a focus on attention deficit hyperactivity disorders and autism spectrum disorders, a general steady rise in the number of annual reports, and lead of US research.ConclusionThis cross-sectional review of child and adolescent mental disorders based on neuroimaging findings suggests overlaps of brain locations that allow to cluster the diagnosed disorders into three sets with respectively marked affective, cognitive, and psychomotor phenomenology. Furthermore, the brain imaging research effort was unequally distributed across disorders, and did not reflect their prevalence.
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Affiliation(s)
- S Mana
- Service hospitalier central de médecine nucléaire et neurospin, INSERM-CEA, Research Unit 1000 Neuroimaging & psychiatry, University Paris Sud and University Paris Descartes, 4, place Gl.-Leclerc, 91401 Orsay, France.
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Yang X, Liu W, Yi M, Zhang R, Xu Y, Huang Z, Liu S, Li T. Choline acetyltransferase may contribute to the risk of Tourette syndrome: Combination of family-based analysis and case-control study. World J Biol Psychiatry 2018; 19:521-526. [PMID: 28090804 DOI: 10.1080/15622975.2017.1282176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Twin and family analyses have revealed a genetic contribution to Tourette syndrome (TS) and post-mortem studies have raised the intriguing possibility of a reduction in cholinergic interneuronsin TS patients. METHODS We selected five tag SNPs (rs100824791, rs12264845, rs1880676, rs3793790 and rs3793798) of choline acetyltransferase (CHAT) from the Han Chinese population Hapmap database. Genotyping was conducted on 401 TS nuclear family trios and 405 control subjects. Transmission disequilibrium test (TDT) and haplotype relative risk (HRR) analyses were used to analyse the family-based study and a case-control study was also used to assess the genetic susceptibility to TS. RESULTS The results revealed a significant over-transmission of rs3793790 (TDT, χ2 = 9.121, P = 0.003; HRR, χ2 = 6.579, P = 0.01), while case-control analysis found no differences between the two groups (genotype, χ2 = 0.436, P = 0.804; allele, χ2 = 0.149, P = 0.700). Also, rs3793798 also indicated a positive association associated with TS (TDT, χ2 = 5.025, P = 0.028; HRR, χ2 = 0.250, P = 0.617). However, the other three SNPs investigated were found not to be associated with TS in both in the family-based and case-control studies. CONCLUSIONS Our association analysis demonstrates that CHAT may contribute to TS susceptibility in the Han Chinese population. This gives strong support to the involvement of cholinergic interneurons in the aetiology of TS and reveals a potential therapeutic target.
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Affiliation(s)
- Xiuling Yang
- a Department of Pediatrics , The Affiliated Hospital of Qingdao University , Qingdao , China.,b Department of Nursing , Medical College of Qingdao University , Qingdao , China
| | - Wenmiao Liu
- c Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University , Qingdao , China.,d Genetic Laboratory , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Mingji Yi
- e Child Health Care Department , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Ru Zhang
- c Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University , Qingdao , China.,d Genetic Laboratory , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Yinglei Xu
- c Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University , Qingdao , China.,d Genetic Laboratory , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Zuzhou Huang
- c Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University , Qingdao , China.,d Genetic Laboratory , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Shiguo Liu
- c Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University , Qingdao , China.,d Genetic Laboratory , The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Tang Li
- a Department of Pediatrics , The Affiliated Hospital of Qingdao University , Qingdao , China
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Malaty IA, Akbar U. Updates in medical and surgical therapies for Tourette syndrome. Curr Neurol Neurosci Rep 2014; 14:458. [PMID: 24871966 DOI: 10.1007/s11910-014-0458-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tourette syndrome is a complex neurobehavioral disorder defined by multiple motor and at least 1 vocal tic, persisting over 1 year, waxing and waning in severity, and not explained by another condition. The condition may range from mild nuisance to debilitating and disabling in severity. Management includes counseling and reassurance, behavioral interventions, pharmacologic, and rarely, surgical interventions. Traditionally, alpha-2 agonists and dopamine receptor antagonists have been utilized. In addition, a number of different pharmacotherapies have been implemented in the search for improved management of tics with better tolerability. In rare, severely disabling cases, neuromodulation with deep brain stimulation may be indicated. Optimal brain targets and candidate selection are still in evolution. This article will review the evidence for current medical and surgical therapies with a focus on recent updates.
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Affiliation(s)
- Irene A Malaty
- Department of Neurology, University of Florida, UF Center for Movement Disorders and Neurorestoration, P.O. Box 100236, Gainesville, FL, 32610, USA,
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Abstract
Tourette syndrome has been examined using many different neuroimaging techniques. There has been a recent surge of neuroimaging research papers related to Tourette syndrome that are exploring many different aspects of the disorder and its comorbidities. This brief review focuses on recent MRI-based imaging studies of pediatric Tourette syndrome, including anatomical, functional, resting state, and diffusion tensor MRI techniques. Consistencies across studies are explored, and particularly important issues involved in acquiring data from this special population are discussed.
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Affiliation(s)
- Jessica A Church
- Department of Psychology, University of Texas at Austin, Austin, TX 78712
| | - Bradley L Schlaggar
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110 ; Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110 ; Department of Anatomy&Neurobiology, Washington University School of Medicine, St. Louis, MO 63110 ; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110
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Cavanna AE, Nani A. Antiepileptic Drugs and Tourette Syndrome. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 112:373-89. [DOI: 10.1016/b978-0-12-411546-0.00012-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Paschou P, Stylianopoulou E, Karagiannidis I, Rizzo R, Tarnok Z, Wolanczyk T, Hebebrand J, Nöthen MM, Lehmkuhl G, Farkas L, Nagy P, Szymanska U, Lykidis D, Androutsos C, Tsironi V, Koumoula A, Barta C, Klidonas S, Ypsilantis P, Simopoulos C, Skavdis G, Grigoriou M. Evaluation of the LIM homeobox genes LHX6 and LHX8 as candidates for Tourette syndrome. GENES BRAIN AND BEHAVIOR 2012; 11:444-51. [PMID: 22435649 DOI: 10.1111/j.1601-183x.2012.00778.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The etiology and pathophysiology of Tourette Syndrome (TS) remain poorly understood. Multiple lines of evidence suggest that a complex genetic background and the cortico-striato-thalamo-cortical circuit are involved. The role of Lhx6 and Lhx8 in the development of the striatal interneurons, prompted us to investigate them as novel candidate genes for TS. We performed a comparative study of the expression of Lhx6 and Lhx8 and investigated genetic association with TS using two samples of trios (TSGeneSEE and German sample - 222 families). We show that Lhx6 and Lhx8 expression in the forebrain is evolutionarily conserved, underlining their possible importance in TS-related pathophysiological pathways. Our tagging-single nucleotide polymorphism (tSNP)-based association analysis was negative for association with LHX8. However, we found positive association with LHX6 in the TSGeneSEE sample (corrected P-value = 0.006 for three-site haplotype around SNP rs3808901) but no association in the sample of German families. Interestingly, the SNP allele that was identified to be significantly associated in the TSGeneSEE dataset, showed an opposite trend of transmission in the German dataset. Our analysis of the correlation of the LHX6 region with individual ancestry within Europe, revealed the fact that this particular SNP demonstrates a high degree of population differentiation and is correlated with the North to South axis of European genetic variation. Our results indicate that further study of the LHX6 gene in relation to the TS phenotype is warranted and suggest the intriguing hypothesis that different genetic factors may contribute to the etiology of TS in different populations, even within Europe.
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Affiliation(s)
- P Paschou
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Panepistimioupoli, Dragana, Greece.
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Brumback RA. Neurobiology of disease in children: a decade of successful symposia and a robust partnership with the Journal of Child Neurology. J Child Neurol 2011; 26:1475-9. [PMID: 22114242 DOI: 10.1177/0883073811426934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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Govindan RM, Makki MI, Wilson BJ, Behen ME, Chugani HT. Abnormal water diffusivity in corticostriatal projections in children with Tourette syndrome. Hum Brain Mapp 2010; 31:1665-74. [PMID: 20162597 PMCID: PMC6871238 DOI: 10.1002/hbm.20970] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 10/15/2009] [Accepted: 11/11/2009] [Indexed: 01/18/2023] Open
Abstract
The fronto-striato-thalamic circuit has been implicated in the pathomechanism of Tourette Syndrome (TS). To study white and gray matter comprehensively, we used a novel technique called Tract-Based Spatial Statistics (TBSS) combined with voxel-based analysis (VBA) of diffusion tensor MR images in children with TS as compared to typically developing controls. These automated and unbiased methods allow analysis of cerebral white matter and gray matter regions. We compared 15 right-handed children with TS (mean age: 11.6 ± 2.5 years, 12 males) to 14 age-matched right-handed healthy controls (NC; mean age: 12.29 ± 3.2 years, 6 males). Tic severity and neurobehavioral scores were correlated with FA and ADC values in regions found abnormal by these methods. For white matter, TBSS analysis showed regions of increased ADC in the corticostriatal projection pathways including left external capsule and left and right subcallosal fasciculus pathway in TS group compared to NC group. Within the TS group, ADC for the left external capsule was negatively associated with tic severity (r= -0.586, P = 0.02). For gray matter, VBA revealed increased ADC for bilateral orbitofrontal cortex, left putamen, and left insular cortex. ADC for the right and left orbitofrontal cortex was highly correlated with internalizing problems (r = 0.665; P = 0.009, r = 0.545; P = 0.04, respectively). Altogether, this analysis revealed focal diffusion abnormalities in the corticostriatal pathway and in gray matter structures involved in the fronto-striatal circuit in TS. These diffusion abnormalities could serve as a neuroimaging marker related to tic severity and neurobehavioral abnormalities in TS subjects.
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Affiliation(s)
- Rajkumar Munian Govindan
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
- Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Malek I. Makki
- Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
- Department of Radiology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Benjamin J. Wilson
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
- Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Michael E. Behen
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
- Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
| | - Harry T. Chugani
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
- Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
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Morer A, Chae W, Henegariu O, Bothwell ALM, Leckman JF, Kawikova I. Elevated expression of MCP-1, IL-2 and PTPR-N in basal ganglia of Tourette syndrome cases. Brain Behav Immun 2010; 24:1069-73. [PMID: 20193755 DOI: 10.1016/j.bbi.2010.02.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 02/22/2010] [Accepted: 02/23/2010] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Post-infectious autoimmunity has been implicated in pathogenesis of Tourette's syndrome (TS) but no evidence of inflammation in central nervous system has been reported yet. We evaluated the expression of genes encoding selected inflammatory factors in post-mortem specimen of adult TS patients: interferon-γ (a cytokine released from CD8 and Thelper 1 CD4 subset of T lymphocytes), interleukin-2 (IL-2, a growth factor derived from T lymphocytes), interleukin-1 β (a cytokine involved in initiation of inflammation), monocyte chemotactic factor -1 (MCP-1, a marker of chronic inflammation) and CD45 (pan-leukocytic marker). For validation purposes, we determined expression of three genes that were previously reported to be elevated in post-mortem specimen of other TS cases: protein tyrosine phosphatase receptor-N (PTPR-N), PTPR-U and recoverin. METHODS Total RNA was isolated from formalin fixed brain tissue sections of basal ganglia area from four patients with TS and four control subjects, and real-time reverse transcription-polymerase chain reaction analysis was employed to quantitatively evaluate gene expression of the selected genes. RESULTS Significantly increased expression of MCP-1, IL-2 and PTPR-N was observed in TS cases (6.5-fold, 2.3-fold and 16.1-fold increase, respectively, p<0.05). CONCLUSIONS Elevated expression of MCP-1 and IL-2 supports the possibility of chronic inflammatory processes in the basal ganglia. Replication of elevated expression of PTPR-N in TS specimen suggests that pathway(s) involving this molecule may be important in TS pathogenesis.
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Affiliation(s)
- Astrid Morer
- Department of Immunobiology, Child Study Center of Yale University School of Medicine, New Haven, CT, USA
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Somatosensory–motor bodily representation cortical thinning in Tourette: Effects of tic severity, age and gender. Cortex 2010; 46:750-60. [DOI: 10.1016/j.cortex.2009.06.008] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 05/27/2009] [Accepted: 06/10/2009] [Indexed: 11/23/2022]
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Stein DJ, Fineberg NA, Bienvenu OJ, Denys D, Lochner C, Nestadt G, Leckman JF, Rauch SL, Phillips KA. Should OCD be classified as an anxiety disorder in DSM-V? Depress Anxiety 2010; 27:495-506. [PMID: 20533366 DOI: 10.1002/da.20699] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In DSM-III, DSM-III-R, and DSM-IV, obsessive-compulsive disorder (OCD) was classified as an anxiety disorder. In ICD-10, OCD is classified separately from the anxiety disorders, although within the same larger category as anxiety disorders (as one of the "neurotic, stress-related, and somatoform disorders"). Ongoing advances in our understanding of OCD and other anxiety disorders have raised the question of whether OCD should continue to be classified with the anxiety disorders in DSM-V. This review presents a number of options and preliminary recommendations to be considered for DSM-V. Evidence is reviewed for retaining OCD in the category of anxiety disorders, and for moving OCD to a separate category of obsessive-compulsive (OC)-spectrum disorders, if such a category is included in DSM-V. Our preliminary recommendation is that OCD be retained in the category of anxiety disorders but that this category also includes OC-spectrum disorders along with OCD. If this change is made, the name of this category should be changed to reflect this proposed change.
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Affiliation(s)
- Dan J Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
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Kawikova I, Grady BP, Tobiasova Z, Zhang Y, Vojdani A, Katsovich L, Richmand BJ, Park TW, Bothwell AL, Leckman JF. Children with Tourette's syndrome may suffer immunoglobulin A dysgammaglobulinemia: preliminary report. Biol Psychiatry 2010; 67:679-83. [PMID: 20006327 PMCID: PMC3974615 DOI: 10.1016/j.biopsych.2009.09.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Revised: 09/10/2009] [Accepted: 09/16/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postinfectious autoimmunity has been implicated in Tourette's syndrome and obsessive-compulsive disorder (TS/OCD), whereas increased frequency of upper respiratory tract infections (URTI) in TS/OCD patients suggests immune deficiency. We hypothesized that antineuronal antibodies may be elevated in patients (reflecting autoimmune processes), and levels of total immunoglobulins (Igs) may be decreased (reflecting immune deficiency). METHODS We analyzed plasma of TS/OCD patients (n = 24) and healthy age- and sex-matched control subjects (n = 22) by enzyme-linked immunosorbent assay (ELISA) for the levels of total and specific IgG, IgM, and IgA against antigens previously identified in multiple sclerosis (myelin basic protein and myelin-associated glycoprotein) and Sydenham's chorea (ganglioside-GM1, lysoganglioside, and tubulin). RESULTS Total IgA was decreased in TS/OCD patients (median 115 mg/100 mL) compared with control subjects (141 mg/100 mL; p = .02). Specific IgA against all antigens, except tubulin were also decreased in the patients (MPB 0 vs. 13 [ELISA units [EU]; myelin-associated glycoprotein 29 vs. 44 EU, p = .04; ganglioside GM1 21 vs. 35 EU, p = .01; lysoganglioside 44 vs. 56 EU, p = .03; tubulin 44 vs. 44 EU, p = .8). The levels of total IgA and anti-myelin basic protein (MBP) IgA were significantly lower in the subgroup of pediatric autoimmune neuropsychiatric disorder associated with Streptococcus (PANDAS) cases (n = 10) than in non-PANDAS cases (n = 9; total IgA 98 mg/100 mL vs. 133 mg/mL, p = .03; anti-MBP IgA 1 vs. 6 EU, p = .03) or healthy control subjects (total IgA 141 mg/100 mL, p = .02; anti-MBP IgA 13 EU, p = .005). CONCLUSIONS At least some TS/OCD patients may suffer IgA dysgammaglobulinemia, possibly rendering the children more prone to URTI.
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Affiliation(s)
- Ivana Kawikova
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
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Roessner V, Overlack S, Baudewig J, Dechent P, Rothenberger A, Helms G. No brain structure abnormalities in boys with Tourette's syndrome: a voxel-based morphometry study. Mov Disord 2010; 24:2398-403. [PMID: 19890999 DOI: 10.1002/mds.22847] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Morphometric findings in Tourette's syndrome (TS) are still inconsistent probably due to differences in analysis approaches as well as several confounders (coexisting psychiatric conditions, medication status, etc.). Our aim was to identify possible morphometric changes in a well-defined sample of drug-naïve boys with "pure" TS. High-resolution structural magnetic resonance images of 38 boys with TS were compared with those of 38 healthy boys matched for age and IQ using voxel-based morphometry (VBM). Coexisting psychiatric conditions and previous medication were excluded. The inclusion of 10- to 15-year-old boys minimized the well known compensatory changes due to tic suppression over many years. VBM analyses revealed no differences between the treatment naïve boys with "pure" TS and healthy controls. Brain morphology is not altered in boys with "pure" TS. Further studies should reveal whether previous findings might be ascribed to confounding factors like coexisting psychiatric conditions or long-term compensatory mechanisms due to voluntary tic suppression.
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Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, University Medical Center, University of Dresden, Dresden, Germany.
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Taylor JL, Rajbhandari AK, Berridge KC, Aldridge JW. Dopamine receptor modulation of repetitive grooming actions in the rat: potential relevance for Tourette syndrome. Brain Res 2010; 1322:92-101. [PMID: 20114036 DOI: 10.1016/j.brainres.2010.01.052] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 01/08/2010] [Accepted: 01/17/2010] [Indexed: 12/21/2022]
Abstract
Studies of rodent grooming can provide valuable insight for dopamine contributions to the initiation, organization, and repetition of motor patterns. This information is useful for understanding how brain dysfunctions contribute to movement disorders such as Tourette syndrome and obsessive compulsive disorder, in which patients are driven to reiterate particular movement patterns. In rodents, dopamine D1 receptor stimulation causes a complex behavioral super-stereotypy in the form of excessive production and rigid execution of whole sequences of movements known as syntactic grooming chains. Sequential super-stereotypy of grooming chains may be particularly advantageous for modeling movement sequences and treatments in Tourette syndrome and related disorders. Here, we report that co-administration of haloperidol, one available treatment for Tourette syndrome and primarily a D2 receptor antagonist, prevented D1 stimulation with SKF38393 from inducing sequential super-stereotypy, which manifests as an exaggeration of the tendency to complete all four phases of a syntactic chain in rigid serial order once the first phase has begun. In a separate experiment, we showed that in contrast to acute D1 agonist administration, 39h withdrawal from chronic (3weeks) administration of the D1 antagonist SCH23390 (which has been suggested to increase D1 receptor expression in the basal ganglia) did not elicit sequential super-stereotypy after drug cessation. Instead, rats suddenly removed from repeated SCH23390 spent more time performing simple stereotypies that included intense scratching and biting behaviors. Together, these results have implications for understanding how dopamine receptors facilitate particular stereotypies manifest in animal models of Tourette syndrome and obsessive compulsive disorder.
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Affiliation(s)
- Jennifer L Taylor
- Department of Psychology, University of Michigan, Ann Arbor, MI48109-1043, USA.
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Albin RL, Koeppe RA, Wernette K, Zhuang W, Nichols T, Kilbourn MR, Frey KA. Striatal [11C]dihydrotetrabenazine and [11C]methylphenidate binding in Tourette syndrome. Neurology 2009; 72:1390-6. [PMID: 19380698 DOI: 10.1212/wnl.0b013e3181a187dd] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Tourette syndrome (TS) is a common neurodevelopmental disorder marked by tics and behavioral comorbidities. Clinical pharmacology suggests that dopaminergic signaling abnormalities are part of the pathophysiology of TS. Prior molecular imaging studies of nigrostriatal dopaminergic terminal markers report conflicting results. Our goal was to characterize the distribution of nigrostriatal dopaminergic terminals in subjects with TS. METHODS Thirty-three adult subjects with TS were studied with PET using [11C]dihydrotetrabenazine (DTBZ), a ligand for the type 2 vesicular monoamine transporter, and with [11C] methylphenidate (MP), a ligand for the plasmalemmal dopamine transporter. Subjects were characterized with standard rating instruments for tic severity, obsessive-compulsive behaviors, and attentional deficits. RESULTS We found no differences between subjects with TS and control subjects in DTBZ and MP binding in any striatal region. There was no correlation between binding measures and clinical variables. Ventral striatal DTBZ and MP binding distributions in subjects with TS were normal. CONCLUSIONS We found no evidence of increased striatal dopaminergic innervation in Tourette syndrome (TS). Discrepancy between our present results and those of other studies may be explained by heterogeneity of TS.
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Affiliation(s)
- R L Albin
- Geriatrics Research, Education, and Clinical Center, Ann Arbor VAMC, Ann Arbor, MI, USA.
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Mukhida K, Bishop M, Hong M, Mendez I. Neurosurgical strategies for Gilles de la Tourette's syndrome. Neuropsychiatr Dis Treat 2008; 4:1111-28. [PMID: 19337454 PMCID: PMC2646643 DOI: 10.2147/ndt.s4160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Tourette's syndrome (TS) is a neurological disorder characterized by motor and vocal tics that typically begin in childhood and often are accompanied by psychiatric comorbidities. Symptoms of TS may be socially disabling and cause secondary medical complications. Pharmacological therapies remain the mainstay of symptom management. For the subset of patients in whom TS symptoms are medically recalcitrant and do not dissipate by adulthood, neurosurgery may offer an alternative treatment strategy. Greater understanding of the neuroanatomic and pathophysiologic basis of TS has facilitated the development of surgical procedures that aim to ameliorate TS symptoms by lesions or deep brain stimulation of cerebral structures. Herein, the rationale for the surgical management of TS is discussed and neurosurgical experiences since the 1960s are reviewed. The necessity for neurosurgical strategies to be performed with appropriate ethical considerations is highlighted.
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Affiliation(s)
- Karim Mukhida
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Departments of Anatomy and Neurobiology and Surgery (Neurosurgery), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew Bishop
- Departments of Anatomy and Neurobiology and Surgery (Neurosurgery), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Murray Hong
- Departments of Anatomy and Neurobiology and Surgery (Neurosurgery), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivar Mendez
- Departments of Anatomy and Neurobiology and Surgery (Neurosurgery), Dalhousie University, Halifax, Nova Scotia, Canada
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Porta M, Sassi M, Cavallazzi M, Fornari M, Brambilla A, Servello D. Tourette's syndrome and role of tetrabenazine: review and personal experience. Clin Drug Investig 2008; 28:443-59. [PMID: 18544005 DOI: 10.2165/00044011-200828070-00006] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Gilles de la Tourette's syndrome (Tourette's syndrome; TS) is an inherited tic disorder commonly associated with other neurobehavioural conditions such as attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). While the clinical presentation of TS and other features of this disorder have been well characterized, the genetic and neurobiological basis of the disease remains incompletely elucidated. The suggestion of a central role of dopamine in the aetiology of TS has been made on the basis of experimental studies, evidence from neuroimaging studies and the therapeutic response patients with TS have to agents that antagonize or interfere with putative dopaminergic pathways. Tetrabenazine is such an agent; it depletes presynaptic dopamine and serotonin stores and blocks postsynaptic dopamine receptors. In clinical studies, tetrabenazine has been found to be effective in a wide range of hyperkinetic movement disorders, including small numbers (<50) of patients with TS in some studies. Results of a retrospective chart review enrolling only patients with TS (n = 77; mean age approximately 15 years) showed that 2 years' treatment with tetrabenazine resulted in an improvement in functioning and TS-related symptoms in over 80% of patients, findings that suggest that treatment with tetrabenazine may have long-term benefits. The authors' experience with 120 heavily co-medicated patients with TS confirms these findings. Long-term (mean 19 months) tetrabenazine treatment resulted in a Clinical Global Impressions of Change scale rating of 'improved' in 76% of patients. Such findings are promising and suggest that tetrabenazine may be suitable as add-on therapy in patients for whom additional suppression of tics is required.
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Affiliation(s)
- Mauro Porta
- Tourette Clinic and Functional Neurosurgery, IRCCS Galaezzi Hospital, Milan, Italy.
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Abstract
Obsessive-compulsive disorder is currently classified as an anxiety disorder. However, there is growing interest in the concept of an obsessive-compulsive spectrum of disorders (OCSDs). The relationship between anxiety disorders and OCSDs has been questioned. The psychobiology of anxiety disorders and OCSDs is briefly reviewed in this article. While there appear to be several distinct contrasts in the underlying psychobiology of these conditions, there is also evidence of overlapping mechanisms. In addition, there are crucial gaps in our current database, confounding nosological decision-making. Conceptualizing various anxiety disorders and putative OCSDs as lying within a broader spectrum of emotional disorders may be useful. However, clinicians must also recognize that individual anxiety and obsessive-compulsive spectrum conditions, including disorders characterized by body-focused repetitive behaviors, have distinct psychobiological underpinnings and require different treatment approaches.
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Abstract
Tourette syndrome and obsessive-compulsive disorder are neuropsychiatric disorders that have sparked considerable interest over the decades. They are the focus of research for a remarkable diversity of disciplines, ranging from neuroimagers and prenatal epidemiologists to experts in the neural circuits that connect the cortex with the basal ganglia, as well as neuroimmunologists focusing on brain-based autoimmune phenomena. Several hypotheses have been put forward to explain the onset and exacerbation of these illnesses. Here, we discuss the clinical phenomenology and treatment options that are currently available. New psychopharmacological agents are being used that are based on a greater understanding of the neurobiology and are being used in combination with behavioral interventions. Longitudinal clinical investigations into clinical symptoms and the natural course are providing additional clues on the underlying pathophysiology. Recent advances in research models are also reviewed in an attempt to clarify some of the molecular etiologies that lead to these disorders.
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Affiliation(s)
- Paul J Lombroso
- Child Study Center, Yale University School of Medicine, New Haven, CT 06520, United States.
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Baym CL, Corbett BA, Wright SB, Bunge SA. Neural correlates of tic severity and cognitive control in children with Tourette syndrome. ACTA ACUST UNITED AC 2007; 131:165-79. [PMID: 18056159 DOI: 10.1093/brain/awm278] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by involuntary motor and phonic tics. It is hypothesized that excess dopamine leads to an imbalance in the pathways through the basal ganglia, resulting in unchecked movements via thalamic disinhibition. It has been unclear whether TS is associated with cognitive control deficits as well as pure motor control deficits, or whether cognitive deficits are associated with the presence of comorbid conditions. Furthermore, little is known about the neural underpinnings of TS in childhood, prior to the long-term effects of medication on brain function. Here, children with TS and typically developing children performed a cognitive control task during event-related fMRI data acquisition. The study included 18 native English-speaking 7-13-year-old children with TS (M = 10.42; 15 males), and 19 healthy, age-matched native English-speaking volunteers (M = 10.33; 11 males). The task involved three separate manipulations of cognitive control. Behaviourally, higher tic severity was correlated with slower task performance on the most demanding task conditions. Neurally, higher tic severity was associated with enhanced activation of dopaminergic nuclei (substantia nigra/ventral tegmental area) and cortical, striatal and thalamic regions in the direct pathway. Heightened tic severity was also associated with greater engagement of the subthalamic nucleus area, suggestive of a compensatory mechanism. Overall, patients engaged left prefrontal cortex more strongly than typicals during task performance. These data suggest that children aged 7-13 unmedicated for TS exhibit increased activation in the direct pathway through the basal ganglia, as well as increased compensatory activation in prefrontal cortex and the subthalamic nucleus.
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Affiliation(s)
- C L Baym
- Center for Mind and Brain, University of California at Davis, USA
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Alkin T, Onur E, Ozerdem A. Co-occurence of blepharospasm, tourettism and obsessive-compulsive symptoms during lamotrigine treatment. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:1339-40. [PMID: 17537560 DOI: 10.1016/j.pnpbp.2007.04.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Revised: 04/21/2007] [Accepted: 04/23/2007] [Indexed: 11/20/2022]
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Catarina Prior A, Tavares S, Figueiroa S, Temudo T. Tics en niños y adolescentes: análisis retrospectivo de 78 casos. An Pediatr (Barc) 2007; 66:129-34. [PMID: 17306098 DOI: 10.1157/13098929] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Tics are the most frequent abnormal movement in children. A familial history of tics and a personal and familial history of neurobehavioral disturbances are common in children with this abnormality. Tics may seriously compromise daily activities in affected individuals. OBJECTIVE To identify the characteristics of tics in children and adolescents followed-up in the Neuropediatric Unit of the Hospital Geral de Santo António. MATERIALS AND METHODS We performed a retrospective analysis of patients with tics based on information collected from medical records. The diagnostic criteria of the DSM IV-TR 2000 of the American Psychiatric Association were used. RESULTS The medical records of 78 children were analyzed, 84.6 % of whom were boys. More than one third of the patients were aged 4 to 8 years old. In 5.1 % of the patients tics developed before the age of 2 years. A familial history of tics, depression and obsessive disorder traits was found in approximately 30 % of patients. The most frequent comorbidity was attention deficit hyperactivity disorder (67.9 %). The occurrence of pediatric autoimmune neuropsychiatric disorders associated with streptococcus infection (PANDAS) was suggested in five patients. In all patients, motor tics occurred before vocal tics. In more than two thirds of the patients, tics were simple. In 59.0 % of the patients, tics were chronic, and in 45.7 % of these met the criteria for Tourette's syndrome. A total of 43.1 % of the patients with chronic tics received pharmacotherapy, risperidone being the most frequently used drug. CONCLUSIONS In general the results of the present study are in agreement with those of previous studies, underlining the need to consider a diagnosis of tics in young children and highlighting the importance of identification and appropriate treatment of comorbidities.
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Affiliation(s)
- A Catarina Prior
- Servicio de Pediatría, Hospital Geral de Santo António, EPE. Porto, Portugal
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