1
|
Chi S, Mok YE, Kang J, Gim JA, Han C, Lee MS. Cytokine levels reflect tic symptoms more prominently during mild phases. BMC Neurosci 2023; 24:57. [PMID: 37907857 PMCID: PMC10617191 DOI: 10.1186/s12868-023-00830-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/23/2023] [Indexed: 11/02/2023] Open
Abstract
Tic disorder is a neuropsychiatric condition that affects 3% of all children and can have a significant impact on their quality of life. Cytokines, interferons, interleukins, lymphokines, and tumor necrosis factors are involved in the neuroinflammatory circuitry of tic disorders. This study aimed to identify the cytokines involved in the pathogenesis of tic disorders. We enrolled 44 patients with tic disorder and 38 healthy controls. Patients were free of psychotropic medications for at least 3 weeks. Whole blood samples were analyzed using a Luminex® human cytokine multiplex assay kit. Patients were divided into groups with "mild tics" and "above moderate tics" based on Yale Global Tic Severity Scale (YGTSS) scores for comparison. The final analysis included 35 patients (28 male and 7 female) and 31 controls (20 male and 11 female). In the mild tic group, interleukin (IL)-12 p70 negatively correlated with motor tic scores. Granulocyte-macrophage colony-stimulating factor, IL-4, IL-8, and tumor necrosis factor (TNF)-α were positively correlated to phonic tic scores. IL-12 p40 and TNF-α were positively correlated to total tic scores. IL-12 p70 and IL-17a negatively correlated to impairment scores and total YGTSS scores. Tic disorder patients and healthy controls exhibit different cytokine profiles. Only patients with mild symptoms exhibit significant correlations, suggesting that the correlations between cytokine levels and tic symptoms are more relevant during the mild or remission phases. Our results present the importance of IL-1β and TNF-α, among others, but the identification of key cytokines are still necessary.
Collapse
Affiliation(s)
- SuHyuk Chi
- Department of Psychiatry, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Young Eun Mok
- Department of Psychiatry, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - June Kang
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Jeong-An Gim
- Medical Science Research Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Moon-Soo Lee
- Department of Psychiatry, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| |
Collapse
|
2
|
Capriotti MR, Wellen BC, Young BN, Himle MB, Conelea CA, Espil FM, Simpson H, Mathews CA. Evaluating the feasibility, acceptability, and preliminary effectiveness of tele-comprehensive behavior therapy for tics (teleCBIT) for Tourette syndrome in youth and adults. J Telemed Telecare 2023:1357633X231189305. [PMID: 37545359 DOI: 10.1177/1357633x231189305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Comprehensive behavioral intervention for tics (CBIT) is an efficacious, first-line treatment for Tourette syndrome (TS) and other chronic or persistent tic disorders. However, CBIT's public health impact has been limited by suboptimal treatment access. Preliminary research has shown that providing CBIT over videoconference (teleCBIT) is a promising delivery method for patients who cannot access in-person care. However, extant studies have been small efficacy trials focused only on pediatric patients. Replication of these studies is needed in additional treatment settings and across a wider age range of patients, especially in light of advances in telehealth technology and increasing telehealth adoption among practitioners. METHODS We conducted a single-arm trial to evaluate the feasibility, acceptability, and effectiveness of teleCBIT embedded in comprehensive, medical tic specialty clinics. From October 2016 to September 2018, patients were offered teleCBIT at their usual care appointments. Those who were interested and met inclusion/exclusion criteria received 8 sessions of CBIT guided by a manualized protocol. An independent evaluator, masked to treatment progress, administered assessments at baseline, post-treatment, and 3 and 6 months after treatment. RESULTS Twenty-five percent of patients who were offered treatment initiated teleCBIT through the study, and all treatment initiators completed treatment. From pre- to post-treatment, decreases in Yale Global Tic Severity Scale (YGTSS) total tic severity scores showed a large effect size among pediatric patients (n = 19; t = 5.72, P < 0.001, d = 1.31) and a medium-to-large effect size for adult patients (n = 10, t = 1.41, P = 0.096, d = 0.664). Thirteen of 19 pediatric patients (68%) and 6 of 10 adult patients (60%) had a positive global treatment response at post-treatment. Patients rated the treatment as highly satisfactory. Ninety-three percent of sessions were free of substantial technical problems. DISCUSSION Within the context of medical tic specialty clinics, teleCBIT demonstrated strong evidence of feasibility, acceptability, and preliminary effectiveness comparable to in-person treatment for both pediatric and adult patients. TeleCBIT warrants study in future research on enhancing care systems for patients with TS. TRIAL REGISTRY https://clinicaltrials.gov/ct2/keydates/NCT04007913.
Collapse
Affiliation(s)
| | - Brianna Cm Wellen
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Brianna N Young
- Department of Psychology, San Jose State University, San Jose, CA, USA
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Michael B Himle
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Christine A Conelea
- Department of Psychiatry & Behavioral Sciences, Masonic Institute for the Developing Brain, University of Minnesota Medical School, Minneapolis, MI, USA
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Heather Simpson
- Department of Psychiatry, Center for OCD, Anxiety and Related Disorders, University of Florida College of Medicine, Gainesville, FL, USA
- UF Health, Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| | - Carol A Mathews
- Department of Psychiatry, Center for OCD, Anxiety and Related Disorders, University of Florida College of Medicine, Gainesville, FL, USA
| |
Collapse
|
3
|
Coleman J, Melia Y. Me, My Tics and I: An Exploration of Self-Identity and its Implications for Psychological Wellbeing in Young Women with Tourette's Syndrome. J Dev Phys Disabil 2023:1-23. [PMID: 37361460 PMCID: PMC10175913 DOI: 10.1007/s10882-023-09911-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 06/28/2023]
Abstract
Women with Tourette's syndrome (TS) continue to be under-researched, despite female sex being associated with increased tic-related impairment in adulthood. Existing literature indicates that individuals with TS are more likely than the general population to report self-stigma, but little is known about the subjective identities of women with TS and how this relates to psychological wellbeing. Semi-structured interviews were conducted via Zoom with a purposive sample of 11 females. All were diagnosed with TS and aged 18-28. Data was transcribed verbatim and thematic analysis applied. Five themes were established: "I'm not normal", "I just want to be me", I'm a "people pleaser", seeing oneself as an "outsider", and "it's just part of me…it's not going anywhere". Difficulties with self-acceptance and the autonomy to be one's true self were noted and appeared to be intensified by stereotypical gender roles and attempts to conceal tics. Findings also suggested that personal growth and feelings of mastery can be achieved through embracing TS as part of one's identity, or recognising it as just one aspect of the self. Psychological support focused on accepting and living with tics rather than reducing them may benefit this population and is currently difficult to access. Consideration should also be given to improving the availability of support groups where women with TS can meet others like themselves. Supplementary Information The online version contains supplementary material available at 10.1007/s10882-023-09911-x.
Collapse
Affiliation(s)
- Janine Coleman
- Department of Psychology, Staffordshire University, Stoke-on-Trent, UK
| | - Yvonne Melia
- Department of Psychology, Staffordshire University, Stoke-on-Trent, UK
| |
Collapse
|
4
|
Woods DW, Himle MB, Stiede JT, Pitts BX. Behavioral Interventions for Children and Adults with Tic Disorder. Annu Rev Clin Psychol 2023; 19:233-260. [PMID: 37159286 DOI: 10.1146/annurev-clinpsy-080921-074307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Over the past decade, behavioral interventions have become increasingly recognized and recommended as effective first-line therapies for treating individuals with tic disorders. In this article, we describe a basic theoretical and conceptual framework through which the reader can understand the application of these interventions for treating tics. The three primary behavioral interventions for tics with the strongest empirical support (habit reversal, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention) are described. Research on the efficacy and effectiveness of these treatments is summarized along with a discussion of the research evaluating the delivery of these treatments in different formats and modalities. The article closes with a review of the possible mechanisms of change underlying behavioral interventions for tics and areas for future research.
Collapse
Affiliation(s)
- Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
| | - Michael B Himle
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Jordan T Stiede
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Brandon X Pitts
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
| |
Collapse
|
5
|
Zito GA, Hartmann A, Béranger B, Weber S, Aybek S, Faouzi J, Roze E, Vidailhet M, Worbe Y. Multivariate classification provides a neural signature of Tourette disorder. Psychol Med 2023; 53:2361-2369. [PMID: 35135638 DOI: 10.1017/s0033291721004232] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Tourette disorder (TD), hallmarks of which are motor and vocal tics, has been related to functional abnormalities in large-scale brain networks. Using a fully data driven approach in a prospective, case-control study, we tested the hypothesis that functional connectivity of these networks carries a neural signature of TD. Our aim was to investigate (i) the brain networks that distinguish adult patients with TD from controls, and (ii) the effects of antipsychotic medication on these networks. METHODS Using a multivariate analysis based on support vector machine (SVM), we developed a predictive model of resting state functional connectivity in 48 patients and 51 controls, and identified brain networks that were most affected by disease and pharmacological treatments. We also performed standard univariate analyses to identify differences in specific connections across groups. RESULTS SVM was able to identify TD with 67% accuracy (p = 0.004), based on the connectivity in widespread networks involving the striatum, fronto-parietal cortical areas and the cerebellum. Medicated and unmedicated patients were discriminated with 69% accuracy (p = 0.019), based on the connectivity among striatum, insular and cerebellar networks. Univariate approaches revealed differences in functional connectivity within the striatum in patients v. controls, and between the caudate and insular cortex in medicated v. unmedicated TD. CONCLUSIONS SVM was able to identify a neuronal network that distinguishes patients with TD from control, as well as medicated and unmedicated patients with TD, holding a promise to identify imaging-based biomarkers of TD for clinical use and evaluation of the effects of treatment.
Collapse
Affiliation(s)
- Giuseppe A Zito
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, Paris, France
- Support Centre for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern CH-3010, Switzerland
| | - Andreas Hartmann
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, Paris, France
- National Reference Center for Tourette Syndrome, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Benoît Béranger
- Center for NeuroImaging Research (CENIR), Paris Brain Institute, Sorbonne University, UPMC Univ Paris 06, Inserm U1127, CNRS UMR, 7225, Paris, France
| | - Samantha Weber
- Psychosomatics Unit of the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern CH-3010, Switzerland
| | - Selma Aybek
- Psychosomatics Unit of the Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern CH-3010, Switzerland
| | - Johann Faouzi
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, ICM, Inria Paris, Aramis project-team, Paris, France
| | - Emmanuel Roze
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, Paris, France
| | - Marie Vidailhet
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, Paris, France
| | - Yulia Worbe
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, Paris Brain Institute, Movement Investigation and Therapeutics Team, Paris, France
- National Reference Center for Tourette Syndrome, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
6
|
Choi W, Hong SB, Kim JI, Lee J, Jang S, Ahn YD, Lim YB, Kim S, Oh MR, Kim BN. Association of Pre- and Perinatal Risk Factors With Tourette Syndrome or Chronic Tic Disorders in a Korean School-Age Population. Soa Chongsonyon Chongsin Uihak 2023; 34:37-44. [PMID: 36636494 PMCID: PMC9816007 DOI: 10.5765/jkacap.220024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 01/05/2023] Open
Abstract
Objectives Tic disorders are highly heritable; however, growing evidence suggests that environmental factors play a significant role in their pathogenesis. Studies on these factors have been inconsistent, with conflicting results. Therefore, this study aimed to examine the associations of pre- and perinatal exposure to Tourette syndrome (TS) or chronic tic disorders (CTD) in Korean school-aged children. Methods This case-control study used data from a large prospective cohort study. The primary outcome was TS/CTD diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria and Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version. Demographic, pre-, and perinatal information was obtained from the maternal questionnaires. Data between the TS/CTD and control groups were compared using the chi-squared or Student's t-test, as appropriate. Two-step logistic regression analyses were used to test the association between TS/CTD and pre- and perinatal risk factors. Results We included of 223 children (78 with TS/CTD and 145 controls). Significant differences in the demographic data between the two groups were observed. The male sex ratio, mean parental age, parental final education level, and family history of tics were included as confounders. In the final adjusted multivariable model, TS/CTD was significantly associated with antiemetic exposure during pregnancy (odds ratio [OR]=16.61, 95% confidence interval [CI] 1.49-185.22, p=0.02) and medically assisted reproduction (OR=7.89, 95% CI 2.28-27.28, p=0.01). Conclusion Antiemetic exposure and medically assisted reproduction are significantly associated with the risk of TS/CTD. These results should be replicated in future prospective and gene-by-environment studies.
Collapse
Affiliation(s)
- Wooseok Choi
- Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Soon-beom Hong
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | | | - Jung Lee
- Integrative Care Hub, Children’s Hospital, Seoul National University Hospital, Seoul, Korea
| | - Soomin Jang
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Yebin D Ahn
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - You Bin Lim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Sumin Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Mee Rim Oh
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Bung-Nyun Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Korea,Address for correspondence: Bung-Nyun Kim, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-3647, Fax: +82-2-747-2471, E-mail:
| |
Collapse
|
7
|
van der Veen S, Caviness JN, Dreissen YE, Ganos C, Ibrahim A, Koelman JH, Stefani A, Tijssen MA. Myoclonus and other jerky movement disorders. Clin Neurophysiol Pract 2022; 7:285-316. [PMID: 36324989 PMCID: PMC9619152 DOI: 10.1016/j.cnp.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/29/2022] [Accepted: 09/11/2022] [Indexed: 11/27/2022] Open
Abstract
Myoclonus and other jerky movements form a large heterogeneous group of disorders. Clinical neurophysiology studies can have an important contribution to support diagnosis but also to gain insight in the pathophysiology of different kind of jerks. This review focuses on myoclonus, tics, startle disorders, restless legs syndrome, and periodic leg movements during sleep. Myoclonus is defined as brief, shock-like movements, and subtypes can be classified based the anatomical origin. Both the clinical phenotype and the neurophysiological tests support this classification: cortical, cortical-subcortical, subcortical/non-segmental, segmental, peripheral, and functional jerks. The most important techniques used are polymyography and the combination of electromyography-electroencephalography focused on jerk-locked back-averaging, cortico-muscular coherence, and the Bereitschaftspotential. Clinically, the differential diagnosis of myoclonus includes tics, and this diagnosis is mainly based on the history with premonitory urges and the ability to suppress the tic. Electrophysiological tests are mainly applied in a research setting and include the Bereitschaftspotential, local field potentials, transcranial magnetic stimulation, and pre-pulse inhibition. Jerks due to a startling stimulus form the group of startle syndromes. This group includes disorders with an exaggerated startle reflex, such as hyperekplexia and stiff person syndrome, but also neuropsychiatric and stimulus-induced disorders. For these disorders polymyography combined with a startling stimulus can be useful to determine the pattern of muscle activation and thus the diagnosis. Assessment of symptoms in restless legs syndrome and periodic leg movements during sleep can be performed with different validated scoring criteria with the help of electromyography.
Collapse
Affiliation(s)
- Sterre van der Veen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - John N. Caviness
- Department of Neurology, Mayo Clinic Arizona, Movement Neurophysiology Laboratory, Scottsdale, AZ, USA
| | - Yasmine E.M. Dreissen
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Christos Ganos
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes H.T.M. Koelman
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marina A.J. Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands,Corresponding author at: Department of Neurology, University of Groningen, University Medical Centre Groningen (UMCG), PO Box 30.001, 9700 RB Groningen, The Netherlands.
| |
Collapse
|
8
|
Arbuzova P, Guo S, Koß C, Kurvits L, Faivre N, Kühn AA, Filevich E, Ganos C. No evidence of impaired visual and tactile metacognition in adults with tourette disorder. Parkinsonism Relat Disord 2022; 97:29-33. [PMID: 35294915 DOI: 10.1016/j.parkreldis.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/02/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Premonitory urges in Tourette disorder are often linked to altered somatosensory processing, which might include deficits in metacognition. We explored tactile and visual metacognitive ability in people with Tourette disorder and healthy control participants. METHODS Patients with Tourrete disorder and healthy control participants completed a tactile and a visual metacognitive task. On each trial, participants did a forced choice discrimination and then rated their confidence in their decision. To quantify metacognitive ability, we used m-ratio - a bias-free measure that allows for comparisons across modalities. Correlations between severity of tics and premonitory urges with tactile metacognitive sensitivity were also performed. RESULTS Metacognitive ability in both tactile and visual domains was comparable between adults with Tourette disorder and healthy controls. We also found no evidence for correlations between tactile metacognitive ability and severity of premonitory urges or tic severity. CONCLUSIONS Tactile and visual metacognition is not impaired in adults with Tourette disorder. These results question the role of altered tactile metacognition in pathophysiology of tic disorders.
Collapse
Affiliation(s)
- Polina Arbuzova
- Department of Psychology & Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Bernstein Center for Computational Neurosciences Berlin, Berlin, Germany.
| | - Siqi Guo
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Koß
- Department of Psychology, Humboldt-Universität zu Berlin, Bernstein Center for Computational Neurosciences Berlin, Berlin, Germany
| | - Lille Kurvits
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nathan Faivre
- Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Andrea A Kühn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elisa Filevich
- Department of Psychology & Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Bernstein Center for Computational Neurosciences Berlin, Berlin, Germany
| | - Christos Ganos
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
9
|
Ganos C, Sarva H, Kurvits L, Gilbert DL, Hartmann A, Worbe Y, Mir P, Müller-Vahl KR, Münchau A, Shprecher D, Singer HS, Deeb W, Okun MS, Malaty IA, Hallett M, Tijssen MA, Pringsheim T, Martino D; Tic Disorders and Tourette Syndrome Study Group of the International Parkinson and Movement Disorder Society. Clinical Practice Patterns in Tic Disorders Among Movement Disorder Society Members. Tremor Other Hyperkinet Mov (N Y) 2021; 11:43. [PMID: 34754602 DOI: 10.5334/tohm.656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/24/2021] [Indexed: 12/26/2022] Open
Abstract
Background Tic disorders belong to the broad spectrum of pediatric and adult movement disorders. The wide variability in clinical presentations, applied assessment tools, and treatments are poorly understood. Objectives To map practices and knowledge base of movement disorder clinicians concerning clinical features, pathophysiology, and treatment approaches in tic disorders. Methods A 33-item survey was developed by the Tic Disorders and Tourette syndrome Study Group members of the Movement Disorder Society. The survey was distributed to the complete society membership and included responses from 346 members, 314 of whom reported treating tic disorders. Results Approximately one third of survey respondents (35%) frequently evaluated patients with tics. The data revealed widespread use of existing guidelines (about 70%) and screening for comorbid disorders (>90%). The most common investigations used to rule out secondary causes of tics were imaging (92%), laboratory tests (66%) and neurophysiology (38%). Functional tics were the second most common tic etiology following primary tics. Only 27% of respondents reported confidence in knowledge about tic pathogenesis. Top rated interventions to treat tics were psychoeducation, cognitive behavioral intervention for tics (CBIT) and treatment for neuropsychiatric comorbidities. Antipsychotics were ranked as the most effective pharmacologic tic intervention. Conclusions The majority of movement disorders specialists do not frequently encounter tics. There was sparse knowledge about tic pathophysiology. Psychoeducation, CBIT, the treatment of neuropsychiatric comorbidities and use of antipsychotics emerged as the most common interventions to treat tics. These results provide insight into what will be needed to improve the diagnosis and treatment of tic disorders.
Collapse
|
10
|
Abstract
Introduction: Patients with Gilles de la Tourette syndrome (GTS) may experience blocking tics (BTs) defined as recurrent, brief cessations of motor acts. The aim of this study was to assess the prevalence, age of onset, and clinical correlates of BTs in GTS patients. Materials and Methods: We performed a one-time registration study in a cohort of 195 consecutive GTS patients aged 5–66 years (mean age: 15.0 ± 9.2; 47 females, 24.1%). All patients were personally interviewed and examined. Results: At least one BT occurred at some point in the lifetime of 73 patients (37.4%) with a mean age of onset of 10.4 ± 5.9 years. BTs occurred an average of 4.8 ± 5.3 years after tic onset. The most common BT was cessation of walking (n = 59, 80.8%), followed by speech (n = 19, 26.0%), running (n = 18, 24.7%), and writing (n = 9, 12.3%). Most of the patients (n = 52, 71.2%) reported cessation of only one activity. Clinical associations of BTs included more severe tics, overall greater number of tics, and, to a lesser extent, higher age at evaluation and comorbid obsessive-compulsive disorder. Conclusions: BTs represent complex tics, early and common symptoms of GTS, and are associated with a more severe form of GTS.
Collapse
Affiliation(s)
- Justyna Kaczyńska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Janik
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
11
|
Zoccante L, Ciceri ML, Chamitava L, Di Gennaro G, Cazzoletti L, Zanolin ME, Darra F, Colizzi M. Postural Control in Childhood: Investigating the Neurodevelopmental Gradient Hypothesis. Int J Environ Res Public Health 2021; 18:ijerph18041693. [PMID: 33578752 PMCID: PMC7916459 DOI: 10.3390/ijerph18041693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 01/26/2023]
Abstract
Neurodevelopmental disorders (NDDs) have been suggested to lie on a gradient continuum, all resulting from common brain disturbances, but with different degrees of impairment severity. This case-control study aimed to assess postural stability against such hypothesis in 104 children/adolescents aged 5–17, of whom 81 had NDDs and 23 were healthy controls. Compared to healthy controls, Autism Spectrum Disorder (ASD) resulted in the most severely impaired neurodevelopmental condition, followed by Attention Deficit Hyperactive Disorder (ADHD) and Tourette Syndrome (TS). In particular, while ASD children/adolescents performed worse than healthy controls in a number of sensory conditions across all parameters, ADHD children/adolescents performed worse than healthy controls only in the sway area for the most complex sensory conditions, when their vision and somatosensory functions were both compromised, and performance in Tourette Syndrome (TS) was roughly indistinguishable from that of healthy controls. Finally, differences were also observed between clinical groups, with ASD children/adolescents, and to a much lesser extent ADHD children/adolescents, performing worse than TS children/adolescents, especially when sensory systems were not operationally accurate. Evidence from this study indicates that poor postural control may be a useful biomarker for risk assessment during neurodevelopment, in line with predictions from the gradient hypothesis.
Collapse
Affiliation(s)
- Leonardo Zoccante
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (L.Z.); (M.L.C.); (F.D.)
| | - Marco Luigi Ciceri
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (L.Z.); (M.L.C.); (F.D.)
| | - Liliya Chamitava
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (L.C.); (M.E.Z.)
| | - Gianfranco Di Gennaro
- Department of Pathology and Diagnostics, Integrated University Hospital of Verona, 37126 Verona, Italy;
| | - Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (L.C.); (M.E.Z.)
| | - Maria Elisabetta Zanolin
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (L.C.); (L.C.); (M.E.Z.)
| | - Francesca Darra
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (L.Z.); (M.L.C.); (F.D.)
| | - Marco Colizzi
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, 37126 Verona, Italy; (L.Z.); (M.L.C.); (F.D.)
- Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- Correspondence: ; Tel.: +39-045-812-6832
| |
Collapse
|
12
|
McGuire JF, Piacentini J, Storch EA, Ricketts EJ, Woods DW, Peterson AL, Walkup JT, Wilhelm S, Ramsey K, Essoe JKY, Himle MB, Lewin AB, Chang S, Murphy TK, McCracken JT, Scahill L. Defining tic severity and tic impairment in Tourette Disorder. J Psychiatr Res 2021; 133:93-100. [PMID: 33338735 PMCID: PMC7867408 DOI: 10.1016/j.jpsychires.2020.12.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Treatment guidelines for Tourette's Disorder (TD) are based on patients' degree of tic severity and impairment. However, clear benchmarks for determining tic severity and impairment have not been established. This study examined benchmarks of tic severity and tic impairment using the Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impression of Severity (CGI-S). METHOD Individuals with TD or another Tic Disorder (N = 519) recruited across nine sites were administered a diagnostic interview, the YGTSS, and the CGI-S. Correlations and trend analyses contrasted YGTSS scores across CGI-S ratings. A logistic regression model examined predictive benchmarks for tic severity, tic impairment, and global severity. Model classifications were compared against CGI-S ratings, and agreement was examined using kappa. RESULTS Spearman correlations between the CGI-S and YGTSS scores ranged from 0.54 to 0.63 (p < 0.001). Greater CGI-S ratings were associated with a linear stepwise increase in YGTSS Total Tic scores, Impairment scores, and Global Severity scores. Despite moderate-to-strong associations (ρ = 0.45-0.56, p < 0.001) between the CGI-S and predictive logistical regression models, only fair agreement was achieved when applying classification benchmarks (κ = 0.21-0.32, p < 0.001). CONCLUSIONS CGI-S ratings are useful to characterize benchmarks for tic severity, tic impairment, and global severity on the YGTSS. Logistic regression model benchmarks had only fair agreement with the CGI-S and underscore the heterogeneity of TD symptoms. Collectively, findings offer guidance on the delineation of tic severity categorizations to apply evidence-based treatment recommendations.
Collapse
Affiliation(s)
- Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA; Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA.
| | - John Piacentini
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA
| | - Eric A Storch
- Department of Psychiatry, Baylor College of Medicine, USA
| | - Emily J Ricketts
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA
| | | | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, USA; Research and Development Service, South Texas Veterans Health Care System, USA; Department of Psychology, University of Texas at San Antonio, USA
| | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital of Chicago, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, USA
| | - Kesley Ramsey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | - Joey K-Y Essoe
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA
| | | | - Adam B Lewin
- Departments of Pediatrics, Psychiatry and Behavioral Neuroscience, University of South Florida, USA
| | - Susanna Chang
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA
| | - Tanya K Murphy
- Departments of Pediatrics, Psychiatry and Behavioral Neuroscience, University of South Florida, USA; All Children's Hospital, Johns Hopkins Medicine, USA
| | - James T McCracken
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, USA
| | | |
Collapse
|
13
|
Gagliano A, Puligheddu M, Ronzano N, Congiu P, Tanca MG, Cursio I, Carucci S, Sotgiu S, Grossi E, Zuddas A. Artificial Neural Networks Analysis of polysomnographic and clinical features in Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): from sleep alteration to "Brain Fog". Nat Sci Sleep 2021; 13:1209-1224. [PMID: 34326674 PMCID: PMC8315772 DOI: 10.2147/nss.s300818] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/17/2021] [Indexed: 02/05/2023] Open
Abstract
STUDY OBJECTIVES PANS (pediatric acute onset neuropsychiatric syndrome) is thought to be the result of several mechanisms and multiple etiologies, ranging from endocrine/metabolic causes to postinfectious autoimmune and neuroinflammatory disorders. Sleep disorders represent one of the most frequent manifestations of PANS, involving around 80% of patients. The present study describes the clinical and polysomnographic features in a group of PANS children identifying the relationships between sleep disorders and other PANS symptoms. METHODS All participants underwent a clinical evaluation including comprehensive sleep history, polysomnography, cognitive assessment and blood chemistry examination. A data mining approach with fourth-generation artificial neural networks has been used in order to discover subtle trends and associations among variables. RESULTS Polysomnography showed abnormality in 17 out of 23 recruited subjects (73.9%). In particular, 8/17 children (47%) had ineffective sleep, 10/17 (58.8%) fragmented sleep, 8/17 (47.1%) periodic limb movement disorder (PLMD) and 11/17 (64.7%) REM-sleep without atonia (RSWA). Most subjects presented more than one sleep disturbances. Notably, among the 19/23 patients diagnosed with Tic/Tourette disorder, 8/19 (42.1%) show PLMD and 10/19 (52.6%) RSWA. Artificial neural network methodology and the auto-contractive map exploited the links among the full spectrum of variables revealing the simultaneous connections among them, facing the complexity of PANS phenotype. CONCLUSION Disordered sleep represents, for prevalence and impact on quality of life, a cardinal symptom in patients with PANS. Thus, considering the weight of sleep disturbances on diagnosis and prognosis of PANS, we could consider the possibility of including them among the major diagnostic criteria.
Collapse
Affiliation(s)
- Antonella Gagliano
- Child & Adolescent Neuropsychiatry Unit, “Azienda Ospedaliera Brotzu” Hospital Trust, Cagliari, Italy
| | - Monica Puligheddu
- Sleep Disorder Centre, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Correspondence: Monica Puligheddu Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, asse didattico E. SS 554 bivio Sestu, Monserrato, Cagliari, 09042, ItalyTel +0706754952 Email
| | - Nadia Ronzano
- Section of Neuroscience & Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Patrizia Congiu
- Sleep Disorder Centre, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Marcello Giuseppe Tanca
- Section of Neuroscience & Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Ida Cursio
- Section of Neuroscience & Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Sara Carucci
- Child & Adolescent Neuropsychiatry Unit, “Azienda Ospedaliera Brotzu” Hospital Trust, Cagliari, Italy
| | - Stefano Sotgiu
- Child Neuropsychiatry Unit, Department of Medical, Surgical and Experimental Sciences, University Hospital of Sassari, Sassari, Italy
| | - Enzo Grossi
- Autism Research Unit, Villa Santa Maria Foundation, Como, Italy
| | - Alessandro Zuddas
- Child & Adolescent Neuropsychiatry Unit, “Azienda Ospedaliera Brotzu” Hospital Trust, Cagliari, Italy
- Section of Neuroscience & Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| |
Collapse
|
14
|
Heiman GA, Rispoli J, Seymour C, Leckman JF, King RA, Fernandez TV. Empiric Recurrence Risk Estimates for Chronic Tic Disorders: Implications for Genetic Counseling. Front Neurol 2020; 11:770. [PMID: 32849224 PMCID: PMC7432137 DOI: 10.3389/fneur.2020.00770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/22/2020] [Indexed: 01/18/2023] Open
Abstract
Background: Tourette disorder (TD) and other chronic tic disorders are neurodevelopmental/neuropsychiatric disorders characterized by motor and/or vocal tics. Family studies indicate that TD strongly aggregates within families and that other chronic tic disorders are biologically related such that studies typically combine them into any chronic tic disorder (CTD). Because of stigma, bullying, and comorbidity with other neuropsychiatric disorders, CTDs can severely impact the quality of life of individuals with these disorders. Objectives: The genetic architecture of CTDs is complex and heterogeneous, involving a myriad of genetic variants. Thus, providing familial recurrence risks is based on empirical recurrence risk estimates rather than genetic testing. Because empiric recurrence risks for CTDs have not been published, the purpose of this study is to calculate and report these recurrence risks estimates. Methods: Based on population prevalence and increased risk to different relatives from a large population-based family study, we calculated the empiric recurrent risk estimate for each relative type (full sibling, parents, offspring, all first-degree, and all second-degree). Results: The recurrence risk estimate for CTDs in first-degree relatives is 29.9% [95% confidence interval (CI) = 23.2–38.5%]. The risk is higher in males, 33.7% (95% CI = 26.2–43.3%), than females, 24.3% (95% CI = 18.9–31.3%). Conclusions: Given the complex, heterogeneous genetic architecture of CTDs, individuals concerned about recurrence risk should be referred to genetic counseling. Such counseling should include discussion of the derivation and limitations of these empiric recurrence risk estimates, including the upper and lower limits of the range of risk.
Collapse
Affiliation(s)
- Gary A Heiman
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Jessica Rispoli
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Christine Seymour
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - James F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Robert A King
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Thomas V Fernandez
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| |
Collapse
|
15
|
Abstract
It is not clear whether the development of tics can be prevented. Contextual variables can impact tic expression; therefore, shifting attention to behaviors that reduce tics is an important part of decreasing tic severity. Several medications are effective in reducing tic severity, but side effects restrict their use. Behavioral treatment is the gold standard psychotherapy intervention for tic disorders, with Comprehensive Behavioral Intervention for Tics being the most well-supported nonpharmacological treatment. Although children may be unable to prevent the development of tics, they can still use several strategies to reduce tic severity and impairment.
Collapse
Affiliation(s)
- Jordan T Stiede
- Psychology Department, Marquette University, Cramer Hall, 307, PO Box 1881, Milwaukee, WI 53201-1881, USA
| | - Douglas W Woods
- Marquette University, Holthusen Hall, 305, PO Box 1881, Milwaukee, WI 5320-1881, USA.
| |
Collapse
|
16
|
Abstract
Tourette's disorder (TD) is one of the five American Psychiatric Association's 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifications of tic disorders. Eponymously linked with the noted 19th century French physician, Gilles de la Tourette [1857-1904], this disorder is identified in 0.3% to 0.7% of the population. It is characterized as a familial neuropsychiatric condition with multiple motor tics and vocal tics (one or more) present for more than 1 year with varying severity. The underlying pathophysiology involves dysfunctional activity of the basal ganglia and circuitry of the frontal cortex as well as dorsolateral striatum deficits. Contributory factors include genetic features interacting with milieu influences. A number of comorbid disorders are seen including obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD). Concepts of management are considered including behavioral therapy and pharmacologic approaches with alpha-adrenoceptor agonists, atypical antipsychotics (AAs), haloperidol, pimozide and others. Other management includes botulinum injections and deep brain stimulation in adults.
Collapse
Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| | - Julia Tullio
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, USA
| |
Collapse
|
17
|
Atkinson-Clement C, Porte CA, de Liege A, Wattiez N, Klein Y, Beranger B, Valabregue R, Sofia F, Hartmann A, Pouget P, Worbe Y. Neural correlates and role of medication in reactive motor impulsivity in Tourette disorder. Cortex 2020; 125:60-72. [PMID: 31978743 DOI: 10.1016/j.cortex.2019.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/23/2019] [Accepted: 12/10/2019] [Indexed: 12/22/2022]
Abstract
Abnormality of inhibitory control is considered to be a potential cognitive marker of tics in Tourette disorder (TD), attention deficit hyperactivity disorder (ADHD), and impulse control disorders. The results of the studies on inhibitory control in TD showed discrepant results. The aim of the present study was to assess reactive inhibitory control in adult TD patients with and without antipsychotic medication, and under emotional stimulation (visual images with positive, neutral and negative content). We assessed 31 unmedicated and 19 medicated TD patients and 26 matched healthy controls using the stop signal task as an index of reactive motor impulsivity and emotional stimulation with the aim to increase impulsivity. We performed a multimodal neuroimaging analysis using a regions of interest approach on grey matter signal, resting-state spontaneous brain activity and functional connectivity analyses. We found a higher reactive motor impulsivity in TD patients medicated with antipsychotics compared to unmedicated TD patients and controls. This propensity for reactive motor impulsivity in medicated TD patients was not influenced by ADHD or emotional stimulation. Neuroimaging results in medicated TD patients suggested that reactive motor impulsivity was underpinned by an increased grey matter signal from the right supplementary motor area and inferior frontal gyrus; decreased resting-state spontaneous activity of the left putamen; higher functional connectivity between the inferior frontal gyrus and the superior temporal gyri (bilaterally); lower functional connectivity between the cerebellum and the right subthalamic nucleus. Taken together, our data suggested (i) a deficit in reactive motor impulsivity in TD patients medicated with atypical antipsychotics that was unrelated to ADHD and (ii) that motor impulsivity was underpinned by structures and by functional connectivity of the fronto-temporo-basal ganglia-cerebellar pathway.
Collapse
Affiliation(s)
- Cyril Atkinson-Clement
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, ICM, Movement Investigation and Therapeutics Team, Paris, France
| | - Camille-Albane Porte
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, ICM, Movement Investigation and Therapeutics Team, Paris, France
| | - Astrid de Liege
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, ICM, Movement Investigation and Therapeutics Team, Paris, France; National Reference Center for Tourette Syndrome, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Nicolas Wattiez
- Sorbonne University, Inserm, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Yanica Klein
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, ICM, Movement Investigation and Therapeutics Team, Paris, France; National Reference Center for Tourette Syndrome, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Benoit Beranger
- Centre de NeuroImagerie de Recherche (CENIR), Sorbonne Université, UMRS975, CNRS UMR7225, ICM, Paris, France
| | - Romain Valabregue
- Centre de NeuroImagerie de Recherche (CENIR), Sorbonne Université, UMRS975, CNRS UMR7225, ICM, Paris, France
| | - Fuaad Sofia
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Andreas Hartmann
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, ICM, Movement Investigation and Therapeutics Team, Paris, France; National Reference Center for Tourette Syndrome, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Pierre Pouget
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, ICM, Movement Investigation and Therapeutics Team, Paris, France
| | - Yulia Worbe
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, ICM, Movement Investigation and Therapeutics Team, Paris, France; National Reference Center for Tourette Syndrome, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Department of Neurophysiology, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, France.
| |
Collapse
|
18
|
Abstract
To investigate the contribution of de novo variants to Tourette disorder (TD) probands in China. Whole-exome sequencing (WES) conducted on 15 child-parent trios (45 samples) detected 25 coding de novo variants, including 2 de novo Likely Gene Disrupting (LGD) variants and 6 Missense3 variants. The de novo LGD variants were consistently associated with TD risk (Fisher's exact test OR 2.69; p = 0.1952), although statistical significance was not achieved due to the small sample size. We then assessed the relationship between the genetic events and phenotypic data by comparing Yale Global Tic Severity Scale (YGTSS) scores. The TD probands with damaging variants (defined as LGD variants and Mis3 variants) had significantly higher YGTSS scores, suggesting more severe tic symptoms (p = 0.019). We also observed a hit for a damaging compound heterozygous (CH) mutation in CELSR3, a high-confidence TD risk gene, in one of the TD probands. To our knowledge, this is the first study to investigate de novo variants in TD in a Chinese population. Our results showed that de novo LGD variants contributed to TD risk in our cohort and that TD probands with de novo damaging variants have more severe symptoms. Furthermore, our observation of damaging CH mutations in CELSR3 in an individual affected with TD further strengthened the confidence in a role for this gene in TD etiology.
Collapse
Affiliation(s)
- Xin Zhao
- Department of Traditional Chinese Medicine, Xinhua Hospital Affiliated to Shanghai Jiatong University School of Medicine, Shanghai, China
| | - Sheng Wang
- Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California
| | - Juanjuan Hao
- Department of Traditional Chinese Medicine, Xinhua Hospital Affiliated to Shanghai Jiatong University School of Medicine, Shanghai, China
| | - Pengcheng Zhu
- Department of Traditional Chinese Medicine, Xinhua Hospital Affiliated to Shanghai Jiatong University School of Medicine, Shanghai, China
| | - Xin Zhang
- Department of Traditional Chinese Medicine, Xinhua Hospital Affiliated to Shanghai Jiatong University School of Medicine, Shanghai, China
| | - Min Wu
- Department of Traditional Chinese Medicine, Xinhua Hospital Affiliated to Shanghai Jiatong University School of Medicine, Shanghai, China
| |
Collapse
|
19
|
Nam SH, Park J, Park TW. Clinical Aspects of Premonitory Urges in Patients with Tourette's Disorder. Soa Chongsonyon Chongsin Uihak 2019; 30:50-56. [PMID: 32595321 PMCID: PMC7289498 DOI: 10.5765/jkacap.180025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/12/2018] [Accepted: 12/06/2018] [Indexed: 11/06/2022] Open
Abstract
Most patients with Tourette’s disorder experience an uncomfortable sensory phenomenon called the premonitory urge immediately before experiencing tics. It has been suggested that premonitory urges are associated with comorbidities such as obsessive compulsive disorder, anxiety disorders, and attention-deficit/hyperactivity disorder, although these associations have been inconsistent. Most patients experience tics as a result of the premonitory urges, and after the tics occur, most patients report that the premonitory urges are temporarily relieved. As a consequence, several studies have assessed the premonitory urge and its potential therapeutic utility. Based on the concept that the premonitory urge induces tics, behavioral treatments such as Exposure and Response Prevention and Habit Reversal Therapy have been developed. However, it is still unclear whether habituation, the main mechanism of these therapies, is directly related to their effectiveness. Moreover, the observed effects of pharmacological treatments on premonitory urges have been inconsistent.
Collapse
Affiliation(s)
- Seok Hyun Nam
- Department of Psychiatry, College of Medicine, Chonbuk National University, Jeonju, Korea
| | - Juhyun Park
- College of Medicine, Seoul National University, Seoul, Korea
| | - Tae Won Park
- Department of Psychiatry, College of Medicine, Chonbuk National University, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| |
Collapse
|
20
|
Carulla-Roig M, Isomura K, Pérez-Vigil A, Larsson H, Hellner C, Mataix-Cols D, Fernández de la Cruz L. Pharmacoepidemiology of Tourette and Chronic Tic Disorders in Sweden 2005-2013. J Child Adolesc Psychopharmacol 2018; 28:637-645. [PMID: 29870273 DOI: 10.1089/cap.2017.0169] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Monitoring "real world" dispensation patterns over time is important to build the evidence base for safe and efficient use of psychotropic drugs. In this study, we aimed to comprehensively examine the patterns of psychotropic drug dispensations in patients with Tourette and chronic tic disorders (TD/CTD) in Sweden between 2005 and 2013. METHODS A cohort of 6979 TD/CTD patients was identified through the Swedish National Patient Register. Their drug dispensation patterns, collected in the Swedish Prescribed Drug Register, were examined between July 1, 2005 and December 31, 2013. Frequencies of drug dispensations were further stratified by gender and comorbidities. Additionally, differences in the patterns of dispensation in children and adolescents versus adults in the last year of the follow-up were examined, as well as the time trends of the dispensations over the 8-year study period. RESULTS A total of 5299 (75.9%) TD/CTD patients were dispensed at least one drug during the study period. The most frequently dispensed medications were attention-deficit/hyperactivity disorder (ADHD) drugs (53.8%), antidepressants (50.7%), hypnotics/sedatives (41.7%), and antipsychotics (41.5%). Most of the medicated patients (72.1%) were dispensed more than one drug during the study period. Patterns of dispensation varied according to patient's gender, associated comorbidities, and age group. Dispensation of quetiapine and aripiprazole, antiadrenergics, ADHD drugs, antiepileptics, and hypnotics/sedatives and anxiolytics (particularly the nonbenzodiazepine types) significantly increased over time, whereas dispensation of antidepressants, typical antipsychotics, and benzodiazepine-based anxiolytics significantly decreased over the study period. CONCLUSIONS Long-term monitoring of these drug dispensation patterns and the study of both their beneficial and adverse effects is warranted.
Collapse
Affiliation(s)
- Marta Carulla-Roig
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden .,2 Department of Child and Adolescent Psychiatry, Sant Joan de Déu Hospital , Barcelona, Spain
| | - Kayoko Isomura
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden .,3 Stockholm Health Care Services , Stockholm County Council, Stockholm, Sweden
| | - Ana Pérez-Vigil
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden
| | - Henrik Larsson
- 4 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm, Sweden .,5 School of Medical Sciences, Örebro University , Örebro, Sweden
| | - Clara Hellner
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden .,3 Stockholm Health Care Services , Stockholm County Council, Stockholm, Sweden
| | - David Mataix-Cols
- 1 Department of Clinical Neuroscience, Karolinska Institutet , Stockholm, Sweden .,3 Stockholm Health Care Services , Stockholm County Council, Stockholm, Sweden
| | | |
Collapse
|
21
|
Wang S, Mandell JD, Kumar Y, Sun N, Morris MT, Arbelaez J, Nasello C, Dong S, Duhn C, Zhao X, Yang Z, Padmanabhuni SS, Yu D, King RA, Dietrich A, Khalifa N, Dahl N, Huang AY, Neale BM, Coppola G, Mathews CA, Scharf JM, Fernandez TV, Buxbaum JD, De Rubeis S, Grice DE, Xing J, Heiman GA, Tischfield JA, Paschou P, Willsey AJ, State MW. De Novo Sequence and Copy Number Variants Are Strongly Associated with Tourette Disorder and Implicate Cell Polarity in Pathogenesis. Cell Rep 2018; 24:3441-3454.e12. [PMID: 30257206 PMCID: PMC6475626 DOI: 10.1016/j.celrep.2018.08.082] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/13/2018] [Accepted: 08/27/2018] [Indexed: 12/30/2022] Open
Abstract
We previously established the contribution of de novo damaging sequence variants to Tourette disorder (TD) through whole-exome sequencing of 511 trios. Here, we sequence an additional 291 TD trios and analyze the combined set of 802 trios. We observe an overrepresentation of de novo damaging variants in simplex, but not multiplex, families; we identify a high-confidence TD risk gene, CELSR3 (cadherin EGF LAG seven-pass G-type receptor 3); we find that the genes mutated in TD patients are enriched for those related to cell polarity, suggesting a common pathway underlying pathobiology; and we confirm a statistically significant excess of de novo copy number variants in TD. Finally, we identify significant overlap of de novo sequence variants between TD and obsessive-compulsive disorder and de novo copy number variants between TD and autism spectrum disorder, consistent with shared genetic risk.
Collapse
Affiliation(s)
- Sheng Wang
- College of Biological Sciences, China Agricultural University, Beijing, China; National Institute of Biological Sciences, Beijing, China; Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA; Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey D Mandell
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA; Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Yogesh Kumar
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | - Nawei Sun
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA; Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Montana T Morris
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA; Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Juan Arbelaez
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA; Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Cara Nasello
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Shan Dong
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Clif Duhn
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA; Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Xin Zhao
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA; Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA; Department of Traditional Chinese Medicine, Xinhua Hospital Affiliated to Shanghai Jiatong University School of Medicine, Shanghai, China
| | - Zhiyu Yang
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | | | - Dongmei Yu
- Center for Genomic Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert A King
- Yale Child Study Center and Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Andrea Dietrich
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Najah Khalifa
- Department of Neuroscience, Child and Adolescent Psychiatry Uppsala University, Uppsala, Sweden; Centre for Research and Development, Region Gävleborg, Gävle, Sweden
| | - Niklas Dahl
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Alden Y Huang
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Benjamin M Neale
- Center for Genomic Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Giovanni Coppola
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carol A Mathews
- Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Jeremiah M Scharf
- Center for Genomic Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas V Fernandez
- Yale Child Study Center and Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Joseph D Buxbaum
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Silvia De Rubeis
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dorothy E Grice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jinchuan Xing
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Gary A Heiman
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Jay A Tischfield
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, NJ, USA
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA.
| | - A Jeremy Willsey
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA; Institute for Neurodegenerative Diseases, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA; Quantitative Biosciences Institute (QBI), University of California, San Francisco, San Francisco, CA, USA.
| | - Matthew W State
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA; Quantitative Biosciences Institute (QBI), University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
22
|
Abstract
Anecdotal reports frequently suggest some dietary involvement in the maintenance of tics in children with Tourette syndrome (TS). This scoping review aimed to (1) understand the possible influence of diet as a trigger of tics and (2) map out the existing studies documenting dietary interventions in children with TS. Current evidence suggests no single diet to benefit individuals with TS. However, reports from parents of children with TS suggest that certain allergens in food may exacerbate tic-related symptoms. For example, an increase in tics has been related to the consumption of caffeine and refined sugar. Moreover, oligoantigenic diets and sugar-free diets have been identified as significantly reducing tics. More research is urgently needed to develop more accurate guidance for parents and children with TS, as many have reported using dietary and nutritional supplements, despite the lack of evidence detailing any benefits, side effects and recommended doses.
Collapse
Affiliation(s)
- Amanda K Ludlow
- 1 Department of Psychology and Sport Sciences, School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, UK
| | - Samantha L Rogers
- 2 Centre for Research in Primary and Community Care, School of Health and Social Work, University of Hertfordshire, College Lane, Hatfield, UK
| |
Collapse
|
23
|
Abstract
Tourette disorder is a developmental neuropsychiatric condition characterized by vocal and motor tics that can range in severity from mild to disabling. It represents one end of a spectrum of tic disorders and is estimated to affect 0.5-0.7% of the population. Accumulated evidence supports a substantial genetic contribution to disease risk, but the identification of genetic variants that confer risk has been challenging. Positive findings in candidate gene association studies have not replicated, and genomewide association studies have not generated signals of genomewide significance, in large part because of inadequate sample sizes. Rare mutations in several genes have been identified, but their causality is difficult to establish. As in other complex neuropsychiatric disorders, it is likely that Tourette disorder risk involves a combination of common, low-effect and rare, larger-effect variants in multiple genes acting together with environmental factors. With the ongoing collection of larger patient cohorts and the emergence of affordable high-throughput genomewide sequencing, progress is expected to accelerate in coming years.
Collapse
Affiliation(s)
- Thomas V Fernandez
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - Matthew W State
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, United States
| | - Christopher Pittenger
- Child Study Center, Yale School of Medicine, New Haven, CT, United States; Department of Psychiatry, Yale University, New Haven, CT, United States.
| |
Collapse
|
24
|
Willsey AJ, Fernandez TV, Yu D, King RA, Dietrich A, Xing J, Sanders SJ, Mandell JD, Huang AY, Richer P, Smith L, Dong S, Samocha KE, Neale BM, Coppola G, Mathews CA, Tischfield JA, Scharf JM, State MW, Heiman GA; Tourette International Collaborative Genetics (TIC Genetics)., Tourette Syndrome Association International Consortium for Genetics (TSAICG). De Novo Coding Variants Are Strongly Associated with Tourette Disorder. Neuron 2017; 94:486-499.e9. [PMID: 28472652 DOI: 10.1016/j.neuron.2017.04.024] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/15/2017] [Accepted: 04/18/2017] [Indexed: 12/30/2022]
Abstract
Whole-exome sequencing (WES) and de novo variant detection have proven a powerful approach to gene discovery in complex neurodevelopmental disorders. We have completed WES of 325 Tourette disorder trios from the Tourette International Collaborative Genetics cohort and a replication sample of 186 trios from the Tourette Syndrome Association International Consortium on Genetics (511 total). We observe strong and consistent evidence for the contribution of de novo likely gene-disrupting (LGD) variants (rate ratio [RR] 2.32, p = 0.002). Additionally, de novo damaging variants (LGD and probably damaging missense) are overrepresented in probands (RR 1.37, p = 0.003). We identify four likely risk genes with multiple de novo damaging variants in unrelated probands: WWC1 (WW and C2 domain containing 1), CELSR3 (Cadherin EGF LAG seven-pass G-type receptor 3), NIPBL (Nipped-B-like), and FN1 (fibronectin 1). Overall, we estimate that de novo damaging variants in approximately 400 genes contribute risk in 12% of clinical cases. VIDEO ABSTRACT.
Collapse
|
25
|
McGuire JF, McBride N, Piacentini J, Johnco C, Lewin AB, Murphy TK, Storch EA. The premonitory urge revisited: An individualized premonitory urge for tics scale. J Psychiatr Res 2016; 83:176-183. [PMID: 27643476 PMCID: PMC5107126 DOI: 10.1016/j.jpsychires.2016.09.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/27/2016] [Accepted: 09/08/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Premonitory urge ratings have advanced our understanding of urge phenomenology among individuals with tic disorders (TD). However, these ratings have been limited by their reliance on a single global dimension of urge severity. This study examined the psychometric properties of a novel scale called the Individualized Premonitory Urge for Tics Scale (I-PUTS) that assesses urge severity across multiple dimensions (number, frequency, and intensity). METHOD Seventy-five youth with a TD and their parents participated. Clinicians assessed youth's tic severity, depression severity, rages, and premonitory urges. Parents completed ratings of youth's anxiety, affect lability, and general psychopathology. Youth completed self-report ratings of anxiety, urge severity, and distress tolerance. RESULTS The I-PUTS identified that youth experienced an average of three distinct urges, but had an average of seven tics over the past week. Urges were primarily localized in the head/face, neck/throat, and arm regions. All I-PUTS dimensions exhibited excellent inter-rater reliability. The I-PUTS dimensions exhibited good convergent validity with global urge ratings and tic severity, and appropriate divergent validity from other clinical constructs. Youth who exhibited discrepant reports between clinician-administered and self-report urge ratings had less anxiety and tic severity, and greater inattention and externalizing problems compared to youth who exhibited good agreement. CONCLUSIONS The I-PUTS is a reliable and valid assessment of urge phenomena, which provides additional and complementary information to existing urge scales. It highlights the existence of multiple dimensions of urge severity, and presents particular utility when assessing urges in youth with TD who have inattention and externalizing problems.
Collapse
Affiliation(s)
- Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.
| | - Nicole McBride
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Carly Johnco
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neuroscience, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neuroscience, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neuroscience, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA; Department of Health Policy and Management, University of South Florida, Tampa, FL, USA
| |
Collapse
|
26
|
Abstract
Persistent tic disorders and Tourette disorder (TD) are neuropsychiatric conditions that commonly co-occur among youth with obsessive-compulsive disorder. Although historically managed with pharmacological agents such as antipsychotics and alpha-2 agonists, behavioral interventions like habit reversal training (HRT) and the comprehensive behavioral intervention for tics have demonstrated considerable efficacy in reducing tic symptom severity. This case study illustrates the implementation of behavior therapy in reducing tic symptom severity of an adolescent with TD. Arlene was a 14-year-old girl with TD who presented with moderate tic symptom severity that caused her physical, academic, and social impairment. In addition to concurrent pharmacotherapy, Arlene completed a 20-session weekly course of HRT, and experienced a clinically meaningful reduction in tic symptom severity and tic-related impairment. This example provides further evidence of the benefit of behavior therapy in reducing tic symptom severity and highlights key considerations for treatment of youth with TD.
Collapse
Affiliation(s)
- Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles.
| |
Collapse
|
27
|
McGuire JF, Piacentini J, Lewin AB, Murphy TK, Storch EA. Further evidence of behavioral interventions for tic disorders: A reply to Theule and colleagues. J Psychiatr Res 2016; 74:35-7. [PMID: 26736039 PMCID: PMC4744493 DOI: 10.1016/j.jpsychires.2015.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 12/10/2015] [Indexed: 12/26/2022]
Abstract
We were delighted to read the letter by Dr. Theule and colleagues (Theule et al., 2016) commenting on our meta-analysis of behavior therapy for Tourette Syndrome (TS)(McGuire et al., 2014). We welcome this discussion, and were interested to learn of their related meta-analysis on psychosocial treatments for tic disorders. This commentary addresses the similarities and distinctions between these two meta-analytic investigations, and concludes with recommendations regarding the future of treatment research for TS.
Collapse
Affiliation(s)
- Joseph F McGuire
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.
| | - John Piacentini
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL, USA; Rogers Behavioral Health-Tampa Bay, Tampa, FL, USA; Department of Health Policy and Management, University of South Florida, Tampa, FL, USA
| |
Collapse
|
28
|
Ricketts EJ, Gilbert DL, Zinner SH, Mink JW, Lipps TD, Wiegand GA, Vierhile AE, Ely LJ, Piacentini J, Walkup JT, Woods DW. Pilot Testing Behavior Therapy for Chronic Tic Disorders in Neurology and Developmental Pediatrics Clinics. J Child Neurol 2016; 31:444-50. [PMID: 26271790 DOI: 10.1177/0883073815599257] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 06/29/2015] [Indexed: 01/18/2023]
Abstract
Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious treatment with limited regional availability. As neurology and pediatric clinics are often the first point of therapeutic contact for individuals with tics, the present study assessed preliminary treatment response, acceptability, and feasibility of an abbreviated version, modified for child neurology and developmental pediatrics clinics. Fourteen youth (9-17) with Tourette disorder across 2 child neurology clinics and one developmental pediatrics clinic participated in a small case series. Clinician-rated tic severity (Yale Global Tic Severity Scale) decreased from pre- to posttreatment, z = -2.0, P < .05, r = -.48, as did tic-related impairment, z = -2.4, P < .05, r = -.57. Five of the 9 completers (56%) were classified as treatment responders. Satisfaction ratings were high, and therapeutic alliance ratings were moderately high. Results provide guidance for refinement of this modified CBIT protocol.
Collapse
Affiliation(s)
- Emily J Ricketts
- University of California, Los Angeles, CA, USA University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Donald L Gilbert
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Tara D Lipps
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Amy E Vierhile
- University of Rochester Medical Center, Rochester, NY, USA
| | - Laura J Ely
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - John T Walkup
- Weill Cornell Medical College, White Plains, NY, USA
| | | |
Collapse
|
29
|
Leclerc JB, O'Connor KP, J-Nolin G, Valois P, Lavoie ME. The Effect of a New Therapy for Children with Tics Targeting Underlying Cognitive, Behavioral, and Physiological Processes. Front Psychiatry 2016; 7:135. [PMID: 27563292 PMCID: PMC4980689 DOI: 10.3389/fpsyt.2016.00135] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/19/2016] [Indexed: 11/29/2022] Open
Abstract
Tourette disorder (TD) is characterized by motor and vocal tics, and children with TD tend to present a lower quality of life than neurotypical children. This study applied a manualized treatment for childhood tics disorder, Facotik, to a consecutive case series of children aged 8-12 years. The Facotik therapy was adapted from the adult cognitive and psychophysiological program validated on a range of subtypes of tics. This approach aims to modify the cognitive-behavioral and physiological processes against which the tic occurs, rather than only addressing the tic behavior. The Facotik therapy lasted 12-14 weeks. Each week 90-min session contained 20 min of parental training. The therapy for children followed 10 stages including: awareness training; improving motor control; modifying style of planning; cognitive and behavioral restructuring; and relapse prevention. Thirteen children were recruited as consecutive referrals from the general population, and seven cases completed therapy and posttreatment measures. Overall results showed a significant decrease in symptom severity as measured by the YGTSS and the TSGS. However, there was a discrepancy between parent and child rating, with some children perceiving an increase in tics, possibly due to improvement of awareness along therapy. They were also individual changes on adaptive aspects of behavior as measured with the BASC-2, and there was variability among children. All children maintained or improved self-esteem posttreatment. The results confirm the conclusion of a previous pilot study, which contributed to the adaptation of the adult therapy. In summary, the Facotik therapy reduced tics in children. These results underline that addressing processes underlying tics may complement approaches that target tics specifically.
Collapse
Affiliation(s)
- Julie B Leclerc
- Centre d'études troubles obsessionnels-compulsifs et tics, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Laboratoire d'étude des troubles de l'ordre de la psychopathologie en enfance, Département de psychologie, Université du Québec à Montréal, Montreal, QC, Canada
| | - Kieron P O'Connor
- Centre d'études troubles obsessionnels-compulsifs et tics, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Département de Psychiatrie, Université de Montréal, Montreal, QC, Canada
| | - Gabrielle J-Nolin
- Centre d'études troubles obsessionnels-compulsifs et tics, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Laboratoire d'étude des troubles de l'ordre de la psychopathologie en enfance, Département de psychologie, Université du Québec à Montréal, Montreal, QC, Canada
| | - Philippe Valois
- Centre d'études troubles obsessionnels-compulsifs et tics, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Laboratoire d'étude des troubles de l'ordre de la psychopathologie en enfance, Département de psychologie, Université du Québec à Montréal, Montreal, QC, Canada
| | - Marc E Lavoie
- Centre d'études troubles obsessionnels-compulsifs et tics, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Département de Psychiatrie, Université de Montréal, Montreal, QC, Canada; Laboratoire de Psychophysiologie Cognitive et Sociale, Montreal, QC, Canada
| |
Collapse
|
30
|
Ramanujam K, Himle MB, Hayes LP, Woods DW, Scahill L, Sukhodolsky DG, Wilhelm S, Deckersbach T, Peterson AL, Specht M, Walkup JT, Chang S, Piacentini J. Clinical Correlates and Predictors of Caregiver Strain in Children with Chronic Tic Disorders. Child Health Care 2014; 44:249-263. [PMID: 26855465 DOI: 10.1080/02739615.2014.948166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although tics are the defining feature of chronic tic disorders (CTD), many children experience comorbid internalizing and externalizing problems that contribute to impairment across several domains, including family functioning. The current study examined clinical correlates and predictors of caregiver strain in parents of children with CTD. Participants were 123 children and adolescents diagnosed with a CTD who participated in a randomized-controlled trial of behavior therapy for reducing tics. Results showed that a combination of disruptive behavior, inattention/hyperactivity, and tic intensity best explained objective strain and a combination of inattention/hyperactivity and tic intensity were the best predictors of subjective caregiver strain. Implications of these findings for care providers are discussed.
Collapse
Affiliation(s)
| | - Michael B Himle
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Loran P Hayes
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Douglas W Woods
- Department of Psychology, Texas A&M University, College Station, TX
| | - Lawrence Scahill
- Emory School of Medicine, Emory University, Atlanta, GA; Yale Child Studies Center, Yale University School of Medicine, New Haven, CT
| | - Denis G Sukhodolsky
- Yale Child Studies Center, Yale University School of Medicine, New Haven, CT
| | - Sabine Wilhelm
- Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | | | - Alan L Peterson
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
| | - Matt Specht
- Johns Hopkins Medical Institutions, Baltimore, MD
| | - John T Walkup
- Johns Hopkins Medical Institutions, Baltimore, MD; Weill Cornell Medical School, Cornell University, New York, NY
| | - Susanna Chang
- Semel Institute, University of California, Los Angeles, CA
| | | |
Collapse
|
31
|
Himle MB, Capriotti MR, Hayes LP, Ramanujam K, Scahill L, Sukhodolsky DG, Wilhelm S, Deckersbach T, Peterson AL, Specht MW, Walkup JT, Chang S, Piacentini J. Variables Associated With Tic Exacerbation in Children With Chronic Tic Disorders. Behav Modif 2014; 38:163-83. [PMID: 24778433 DOI: 10.1177/0145445514531016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research has shown that motor and vocal tics fluctuate in frequency, intensity, and form in response to environmental and contextual cues. Behavioral models have proposed that some of the variation in tics may reflect context-dependent interactive learning processes such that once tics are performed, they are influenced by environmental contingencies. The current study describes the results of a function-based assessment of tics (FBAT) from a recently completed study comparing Comprehensive Behavioral Intervention for Tics (CBIT) with supportive psychotherapy. The current study describes the frequency with which antecedent and consequence variables were reported to exacerbate tics and the relationships between these functional variables and sample baseline characteristics, comorbidities, and measures of tic severity. Results showed that tic-exacerbating antecedents and consequences were nearly ubiquitous in a sample of children with chronic tic disorder. In addition, functional variables were related to baseline measures of comorbid internalizing symptoms and specific measures of tic severity.
Collapse
Affiliation(s)
| | | | | | | | - Lawrence Scahill
- Emory University School of Medicine, Atlanta, GA, USA Yale University School of Medicine, New Haven, CT, USA
| | | | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Thilo Deckersbach
- Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Alan L Peterson
- The University of Texas Health Science Center at San Antonio, USA
| | - Matt W Specht
- Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - John T Walkup
- Johns Hopkins Medical Institutions, Baltimore, MD, USA Weill Cornell Medical College, New York, NY, USA
| | | | | |
Collapse
|
32
|
McGuire JF, Piacentini J, Brennan EA, Lewin AB, Murphy TK, Small BJ, Storch EA. A meta-analysis of behavior therapy for Tourette Syndrome. J Psychiatr Res 2014; 50:106-12. [PMID: 24398255 DOI: 10.1016/j.jpsychires.2013.12.009] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 11/30/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
Individual randomized controlled trials (RCTs) of habit reversal training and a Comprehensive Behavioral Intervention for Tics (collectively referred to as behavior therapy, BT) have demonstrated efficacy in reducing tic severity for individuals with Tourette Syndrome and Chronic Tic Disorders (collectively referred to as TS), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified eight RCTs that met inclusion criteria, and produced a total sample of 438 participants. A random effects meta-analysis found a medium to large ES for BT relative to comparison conditions. Participant mean age, average number of therapy sessions, and the percentage of participants with co-occurring attention deficit hyperactivity disorder (ADHD) were found to moderate treatment effects. Participants receiving BT were more likely to exhibit a treatment response compared to control interventions, and identified a number needed to treat (NNT) of three. Sensitivity analyses failed to identify publication bias. Overall, BT trials yield medium to large effects for TS that are comparable to treatment effects identified by meta-analyses of antipsychotic medication RCTs. Larger treatment effects may be observed among BT trials with older participants, more therapeutic contact, and less co-occurring ADHD.
Collapse
Affiliation(s)
- Joseph F McGuire
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA.
| | - John Piacentini
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Erin A Brennan
- Department of Pediatrics, University of South Florida Tampa, FL, USA
| | - Adam B Lewin
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida Tampa, FL, USA
| | - Eric A Storch
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA
| |
Collapse
|
33
|
De Nadai AS, Storch EA, McGuire JF, Lewin AB, Murphy TK. Evidence-based pharmacotherapy for pediatric obsessive-compulsive disorder and chronic tic disorders. J Cent Nerv Syst Dis 2011; 3:125-42. [PMID: 23861643 PMCID: PMC3663618 DOI: 10.4137/jcnsd.s6616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In recent years, much progress has been made in pharmacotherapy for pediatric obsessive-compulsive disorder (OCD) and chronic tic disorders (CTDs). What were previously considered relatively intractable conditions now have an array of efficacious medicinal (and psychosocial) interventions available at clinicians’ disposal, including selective serotonin reuptake inhibitors, atypical antipsychotics, and alpha-2 agonists. The purpose of this review is to discuss the evidence base for pharmacotherapy with pediatric OCD and CTDs with regard to efficacy, tolerability, and safety, and to put this evidence in the context of clinical management in integrated behavioral healthcare. While there is no single panacea for these disorders, there are a variety of medications that provide considerable relief for children with these disabling conditions.
Collapse
|