[The problem of comorbid disorders in attention deficit hyperactivity disorder in children and adolescents: clinical cases]

The problem of comorbid disorders in attention deficit hyperactivity disorder (ADHD) is considered, which occur in at least 60% of patients and lead to additional difficulties in intra-family, school and social adaptation. Children and adolescents with ADHD have a wide range of neurological and somatic disorders caused by complex polygenic pathogenetic mechanisms. Among the pathologies associated with ADHD in this cohort of children, neurotic and anxiety manifestations, motor disorders: dyspraxia, discoordination, impaired gross and fine motor skills, tics, behavioral disorders, enuresis, tension cephalgia are common disorders. Treatment of ADHD should be pathogenetic, taking into account the main symptoms of ADHD and manifestations of comorbid disorders, since it is quite long. When choosing pharmacotherapy, it is preferable to use drugs with verified efficacy not only in the correction of ADHD, but also concomitant behavioral, motor and emotional disorders. Also an important aspect in the pediatric clinic is the use of drugs with a reliable safety profile.

Severe Neurological Complications Associated With Tourette Syndrome

BACKGROUND

Tics and Tourette syndrome are common problems evaluated by both the general pediatrician and pediatric neurologist. The common comorbidities of tics are well known, but the severe neurological complications are rare and may not be appreciated.

METHODS

This is a retrospective case series and literature review.

RESULTS

We present here four adolescents with Tourette syndrome who had severe neurological complications secondary to motor tics. We provide the history, neurological examination, and radiological findings in addition to a review of previously reported cases of vascular and cervical cord complications associated with violent motor tics.

CONCLUSIONS

We highlight the importance of recognizing the presenting signs of these complications early and the need to vigorously treat violent motor tics to prevent significant neurological complications.

Abnormal neuronal activity in Tourette syndrome and its modulation using deep brain stimulation

Tourette syndrome (TS) is a common childhood-onset disorder characterized by motor and vocal tics that are typically accompanied by a multitude of comorbid symptoms. Pharmacological treatment options are limited, which has led to the exploration of deep brain stimulation (DBS) as a possible treatment for severe cases. Multiple lines of evidence have linked TS with abnormalities in the motor and limbic cortico-basal ganglia (CBG) pathways. Neurophysiological data have only recently started to slowly accumulate from multiple sources: noninvasive imaging and electrophysiological techniques, invasive electrophysiological recordings in TS patients undergoing DBS implantation surgery, and animal models of the disorder. These converging sources point to system-level physiological changes throughout the CBG pathway, including both general altered baseline neuronal activity patterns and specific tic-related activity. DBS has been applied to different regions along the motor and limbic pathways, primarily to the globus pallidus internus, thalamic nuclei, and nucleus accumbens. In line with the findings that also draw on the more abundant application of DBS to Parkinson's disease, this stimulation is assumed to result in changes in the neuronal firing patterns and the passage of information through the stimulated nuclei. We present an overview of recent experimental findings on abnormal neuronal activity associated with TS and the changes in this activity following DBS. These findings are then discussed in the context of current models of CBG function in the normal state, during TS, and finally in the wider context of DBS in CBG-related disorders.

Adult-Onset Primary Dystonic Tics: A Different Entity?

Based on their phenomenology, tics can be classified as clonic, dystonic, and tonic. Although tic syndromes are considered to be childhood disorders, there are reports on (clonic) tics developing late in life. Literature on dystonic tics is sparse, and it is unclear whether adult-onset dystonic tics are part of the same disorder spectrum that includes Tourette's syndrome or represent a discrete entity. We describe here 11 patients with adult-onset primary dystonic tics. Ten patients (90.1%) were males. Mean age at onset was 42.2 ± 14.9 years. More than 60% had both motor clonic and dystonic tics. Dystonic tics most frequently involved the cranial-cervical region and the shoulders and, less frequently, the limbs. Psychiatric comorbidities were present in 5 patients. Family history for any movement disorder or for psychiatric disorders was present in 2 cases. One patient showed a sensory geste, which allowed him to partially control his tics, whereas another developed overt dystonia 3 years after his first assessment. The hyperkinesias exhibited by these patients were likely consistent with tics. However, other clinical features would allow us to argue that adult-onset dystonic tics may represent a discrete entity, which is intermediate between tics and dystonia.

Gilles de la Tourette's syndrome associated with head injury: a case report

A case of Gilles de la Tourette's syndrome in a Kuwaiti woman is described, and the possibility of antecedent head injury as the organic etiological factor is discussed.