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Neuropsychiatric disorders often manifest with abnormal control of motor behavior. Common symptoms include restricted and repetitive patterns of behavior (RRBs). Cortico-basal ganglia circuits have been implicated in the etiology of RBBs. However, there is a vast range of behaviors encompassed in RRBs, from simple explosive motor tics to rather complex ritualized compulsions. In this review, we highlight how recent findings about the function of specific basal ganglia circuits can begin to shed light into defined motor symptoms associated with neuropsychiatric disorders. We discuss recent studies using genetic animal models that advocate that different aspects of motor repetition in neurodevelopmental disorders, like obsessive-compulsive disorder and autism spectrum disorder, emerge from particular dysregulations in distinct cortico-basal ganglia circuits.

The experiences of Tourette syndrome (TS) caregivers with supportive communication are examined in this qualitative investigation. TS is a childhood-onset neurodevelopmental disorder marked by a combination of involuntary verbal and motor tics lasting for more than 1 year. Although individuals are impacted the most by TS, the stress for caring for a child with TS takes an emotional and physical toll on the caregiver. Eleven participants shared their experiences with receiving supportive communication by taking part in semi-structured interviews. Data analysis yielded three themes: (a) TS caregivers describe their experiences as a struggle; (b) they seek out specific social support from friends and families; and (c) they frequently receive social support that increases instead of reducing stress.

Tourette syndrome (TS) is a neurological disorder of childhood onset that is characterised by the occurrence of motor and vocal tics. TS is associated with cortical-striatal-thalamic-cortical circuit [CSTC] dysfunction and hyper-excitability of cortical limbic and motor regions that are thought to lead to the occurrence of tics. Importantly, individuals with TS often report that their tics are preceded by 'premonitory sensory/urge phenomena' (PU) that are described as uncomfortable bodily sensations that precede the execution of a tic and are experienced as a strong urge for motor discharge. While the precise role played by PU in the occurrence of tics is largely unknown, they are nonetheless of considerable theoretical and clinical importance, not least because they form the core component in many behavioural therapies used in the treatment of tic disorders. Several lines of evidence indicate that the insular cortex may play a particularly important role in the generation of PU in TS and 'urges-for-action' more generally. In the current study we utilised voxel-based morphometry techniques together with 'seed-to-voxel' structural covariance network (SCN) mapping to investigate the putative role played by the right insular cortex in the generation of motor tics and the experience of PU in a relatively large group of young people TS. We demonstrate that clinical measures of motor tic severity and PU are uncorrelated with one another, that motor tic severity and PU scores are associated with separate regions of the insular cortex, and that the insula is associated with different structural covariance networks in individuals with TS compared to a matched group of typically developing individuals.

Phonic tics typically occur in the company of motor tics, and the combination usually suggests the diagnosis of Tourette syndrome. Although phonic tics are often mild, in some cases they may be severe and disabling. Forceful and repetitive vocalizations can cause vocal cord and throat irritation. Furthermore, complex phonic tics such as coprolalia can be socially isolating and lead to adversarial and even legal difficulties for the affected individual. When such “malignant phonic tics” fail to improve with antidopaminergic drugs, botulinum toxin treatment or even deep brain stimulation may be required.

Objectives: Dysregulated neuronal activity in Cortico-Striato-Thalamo-Cortical (CSTC) networks is primarily described as the pathophysiology of Tourette Syndrome (TS). New neuromodulation techniques including noninvasive transcranial Electrical Stimulation (tES) are increasingly considered among potential therapeutic options for TS.Materials and Methods: To test the therapy protocol with transcranial Direct Current Stimulation (tDCS) a 31 year-old male patient with TS was selected to be administered for 10 sessions over five days of bilateral cathodal tDCS (30 minutes, 2 mA) on C3 and FC5, while the anode electrodes were placed on FP2.Results: Tic severity and frequency were subjectively reported by the subject following the treatment on weekly basis and treatment response was objectively assessed by two experts. The patient noted that he was able to control his unwanted movement after over one year follow-up.Discussion: The current study results together with earlier reports support the therapeutic effects of cathodal tDCS on tics in patients with TS. Randomized sham-controlled studies are required to shed more light on such therapeutic impact and the optimized protocols.

Purpose Vitamin D deficiency has been found in children with chronic tic disorders (CTDs). Our previous data showed that serum 25-hydroxyvitamin D [25(OH)D] level in children with CTDs was lower than that of the healthy controls and lower serum 25(OH)D level was associated with increased severity of the tic disorder. Thus, we intend to further verify this phenomenon and examine the effect of vitamin D3 on CTDs. Patients and methods In total, 120 children with CTDs and 140 normal controls were enrolled in this study, with 36/120 of those in the CTD group receiving vitamin D3 treatment for 3 months. The Yale Global Tic Severity Scale (YGTSS) and Clinical Global Impression of Severity of Illness (CGI-SI) were, respectively, used to evaluate the tic severity. High-performance liquid chromatography and tandem mass spectrometry were used to measure serum 25(OH)D level. Results Those children with CTDs exhibited significantly lower 25(OH)D levels than did healthy controls, and these reduced 25(OH)D levels were linked to increasing severity of tic symptoms. After treatment with supplemental vitamin D3, serum 25(OH)D level and scores of YGTSS total, motor tics, phonic tics, total tic, impairment, and CGI-SI improved significantly in children with CTDs without any adverse reactions. Conclusion Supplementation vitamin D3, given its low cost and excellent safety, may be an effective means of improving symptoms in certain children with CTDs.

Although the DSM-5 chronic motor tic disorder (CMTD) and Tourette syndrome (TS) are distinct diagnostic categories, there is no genetic or phenotypic evidence that supports this diagnostic categorization. The aim of this study was to compare patients with both diagnoses along a number of clinical characteristics to provide further diagnostic clarity. Our sample consisted of 1018 patients (including adult and child patients) suffering from chronic tic disorders. Tic severity was assessed via Shapiro Tourette-Syndrome Severity Scale (STSS). Lifetime prevalence of other comorbid conditions was assessed in a semi-structured clinical interview. The data were gained through retrospective chart analysis. The two groups did not differ significantly in any of the clinical or demographic variables. Patients only differed in tic severity, with CMTD patients (n = 40) having lower mean tic severity (STSS = 2.0 vs. 2.8; p

Objectives This study aimed to report motor tics worsening by prednisolone acute treatment, despite the use of aripiprazole and clonidine. It was also aimed to discuss the mechanisms involved in neuropsychiatric adverse effects with the use of corticosteroids. Methods It was reported a 7-year-old boy patient with a history of autism spectrum disorder and motor tics. He has remitted motor tics with an association between aripiprazole and clonidine. However, was registered motor tics' recurrence with acute use of prednisolone. Conclusions The neuropsychiatric adverse effects mediated by corticosteroid use are low explored, mainly in pediatric clinical practice. The prednisolone prescription is widespread in childhood and, considering some vulnerable conditions to this type of adverse effects, is imperative.

Background Driving ability may be impaired in patients with various movement disorders, but it has not been studied in patients with Tourette syndrome (TS). Cases We describe a series of 6 patients from our large cohort of TS patients followed in our movement disorders clinic in whom severe tics have had interfered with their driving abilities. The motor tics involved facial muscles and caused visual impairment because of frequent blinking and transient blepharospasm (dystonic tic), but complex limb and truncal tics also seriously impacted their driving. Conclusions Although majority of patients with TS have no functional impairment, severe motor tics in some patients may adversely affect their driving ability, potentially causing danger to themselves and others. Screening for such troublesome tics should be considered in patients with TS, particularly in teenagers who are being evaluated for driver's licensing.

Dystonia; Parkinson's disease/Parkinsonism; Genetic linkage Malaltia de Parkinson/Parkinsonisme; Vinculació genètica; Distonia Enfermedad de Parkinson/Parkinsonismo; Enlace genético; Distonía This work was supported by the Health Institute Carlos III—General Subdirectorate for Research Evaluation and Promotion (PI16/01575, PI18/01898, PI18/00147, PI19/01576), the Spanish Ministry of Economy and Competitiveness (SAF2007-60700), the Ministry of Economy, Innovation, Science and Business of the Government of Andalucía (CVI-02526, CTS-7685), the Ministry of Health and Social Welfare of the Government of Andalucía (PI-0459-2018, PE-0210-2018, PE-0186-2019) and by the Valencian Government (PROMETEO/2018/135), within the framework of the National Research and Development Plan co-funded with European Regional Development Funds. Part of the equipment employed in this study was funded by the Valencian Government and co-financed with European Regional Development Funds (OP ERDF of Valencian Community 2014-2020). I. Hinarejos has a PFIS-PhD fellowship (FI19/00072), S. Jesús has a contract “Acción B Clínicos-Investigadores” (Action B Clinicians-Researchers) contract (B-0007-2019) funded by the Ministry of Health and Family of the Government of Andalucía, and D. Macías-García has a Río Hortega contract (CM18/00142) funded by the Health Institute Carlos III.

Tics are the most common hyperkinetic movement disorder, although they often are unrecognized. Motor and vocal tics are often accompanied by neurobehavioral features such as anxiety, attention deficit disorder, and obsessive-compulsive disorder. Management of tic disorders requires a thorough understanding of the role of comorbidities in affecting patients’ quality of life.

A 52-year-old man with intermittent head motor tics, aphasia and right upper extremity weakness had an F-FDG avid left front lobe brain lesion, and a left upper lobe lung lesion on PET/CT. The brain lesion was surgically resected, and was diagnosed pathologically as a histiocytic sarcoma (HS). The lung lesion was also a HS via bronchial biopsy. HS is rare and generally involves nodes as shown on PET/CT in a few case reports. The current case with simultaneous brain and lung HS lesions adds new imaging pattern information of the disease to the literature.

Motor tics are sudden, rapid, recurrent, non-rhythmic movements. There is a lack of quantitative assessment methods for the motor tics despite severe neck complications. We aimed to provide an improved quantitative method for neck tic assessment in motor tic disorders. We recorded neck motor tics in patients with motor tic disorders and voluntary neck movements in healthy controls. The maximum peak angular velocities and angular accelerations were calculated. Motor tics were assessed in three orthogonal planes (yaw, pitch, and roll) separately, and compared between the patients with motor tic disorders and controls. Correlations between the maximum angular velocities/accelerations and tic counts were also assessed. In the pitch plane, motor tics of the patients showed higher angular velocities/accelerations than voluntary movements of the controls. Angular acceleration in the yaw, and roll planes showed positive correlations with tic count. Some of the observed tics were comparable to the movements experienced in contact sports. Our findings may aid in the identification of populations at a high risk for severe neck complications among motor tic disorder patients.

Bidirectional overlap has long been described between obsessive–compulsive disorder (OCD) and tic disorders. Similar features, including underlying neurobiological genesis in frontal-striatal circuitry, familiality, relatively early onset, waxing and waning course, and overlapping phenomenology in repetitive behaviors, suggest different variations of the same disorder. Nevertheless, some differences have been described between OCD and tic disorders: tics begin early in childhood and typically attenuate or remit by late adolescence, whereas OCD tends to onset later and persist, and tic disorders are far more common in males than is the case in OCD. Individuals with OCD plus comorbid tics may represent a specific sub-type of OCD or tic disorders, and possess some important phenomenological differences from those with OCD without tics; for example, tic-related OCD tends to have earlier onset, higher prevalence in males, prominent symmetry, evening-up, counting, and “just-right” phenomenology, when compared with non-tic-related OCD. Recent DSM-5 classification changes now recognize presence of tics as a specifier in diagnosis of OCD; despite a 40 % prevalence rate of comorbid tics in childhood-onset OCD, there is still little data regarding risk factors, validated distinguishing features, course and treatment of this diagnostic group. Prominence of premonitory sensory phenomena, urges or sensations experienced prior to the repetitive behaviors, is no longer thought to distinguish complex motor tics from compulsions. Well established treatments of OCD include cognitive behavioral interventions and pharmacotherapy, specifically the serotonin re-uptake inhibitors (SRIs); although these treatments are also beneficial in tic-related OCD, some studies suggest that at least for pharmacotherapy, SRIs may not be as effective in OCD patients with comorbid tics. Given the frequent overlap of OCD and tics, and the recent designation of tic-related OCD as an OCD specifier, more investigation of the comorbid subtype is clearly needed.

Objective: To demonstrate the usefulness of neurophysiological evaluation to distinguish simple motor tics and functional myoclonus. Methods: Careful clinical assessments, multichannel surface EMG, and EEG-EMG jerk-locked back-averaging were performed. Results: Urge to move and ability to voluntarily suppress the movement were reported. EMG bursts showed variable duration and triphasic pattern of the antagonist muscles mimicking voluntary movements. Only the late component of the Bereitschaftspotential (BP2) was present prior to the involuntary movement onset. Conclusion: Combination of the isolated late BP, premonitory urge, and suppressibility leads to the diagnosis of simple motor tics rather than functional myoclonus. Significance: The physiological approach in addition to careful clinical assessment is helpful to support the diagnosis of tic. Keywords: Simple motor tics, Functional movement disorders, EEG–EMG jerk-locked back-averaging

Tourette syndrome is a tic disorder with onset in childhood. By contrast, we report a new Tourette syndrome with onset in late life. We use statistics to support our contention that this behavioral disorder is a hitherto unrecognized variety of Tourette syndrome. There are three tic disorders distinguished by the types of tics present (motor, vocal/ phonic, or both) and by the length of time that the tics have been present. Individuals with chronic tic disorder have either motor tics or vocal tics which have been present for more than 1 year.

Objective: Three patients with intractable Tourette syndrome (TS) underwent thalamic deep brain stimulation (DBS). To investigate the role of thalamic electrical activity in tic generation, local field potentials (LFP), EEG and EMG simultaneously were recorded.Methods: Event related potentials and event related spectral perturbations of EEG and LFP, event related cross-coherences between EEG/LFP and LFP/LFP were analyzed. As time locking events, the tic onsets were used. Spontaneous tics were compared to voluntary tic mimicking. The effect of tic suppression and DBS on thalamic LFPs was evaluated.Results: All three patients showed time-locked and prior to onset of spontaneous motor tics thalamic synchronization and thalamo-cortical cross-coherence. Also in three patients, not time-locked to motor tics, increased intra-thalamic coherences in the 1-8 Hz frequency band were found. In one patient it was demonstrated that voluntary mimicked tics were preceded by premotor cortical and thalamic potentials. In this patient unilateral thalamic DBS contralaterally decreased the background thalamic activity.Conclusions: The present study in three cases with TS shows that spontaneous tics in TS are preceded by repetitive coherent thalamo-cortical discharges, indicating that preceding a tic the basal ganglia circuits are "charged up", ultimately leading to a motor tic.Significance: Thalamic LFP recording may lead to more insight in underlying pathophysiological mechanisms in TS. (c) 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

This report examined the most frequently reported bothersome tics among individuals with chronic tic disorders and evaluated the improvement and remission of tics and their associated characteristics. Youths and adults (N = 240) were randomly assigned to receive the comprehensive behavioral intervention for tics (CBIT) or psychoeducation and supportive therapy (PST). At baseline, motor tics and tics with an urge were rated as more bothersome relative to vocal tics and tics without premonitory urges. The five most common bothersome tics included eye blinking, head jerks, sniffing, throat clearing, and other complex motor tics. While CBIT outperformed PST across tic type and urge presence, tics preceded by premonitory urges at baseline had higher severity at posttreatment across treatment condition. Six individual tic types had lower severity at posttreatment following CBIT relative to PST. Baseline urge presence was associated with tic remission for CBIT but not PST. Specific bothersome tics were more likely to remit with CBIT relative to PST. Findings suggest that individual tics respond and remit differently to CBIT relative to PST, with implications highlighting the negative reinforcement hypothesis in tic symptom maintenance. CLINICALTRIALS.NCT00218777; NCT00231985.

Tourette's syndrome is a clinical condition characterized by multiple motor tics and vocal tics which occurs in the age range 5-25 years and the intensity of the symptoms changes with time. It is felt that at least two remarkable personalities namely, Dr. Samuel Johnson from England, a man of letters and the compiler of the first ever English dictionary, and Wolfgang Amadeus Mozart from Austria, one of the greatest musical genius of all time, possibly suffered from this condition. Tourette's syndrome is often described as the classical borderzone between neurology and psychiatry and every neurologist wonders at the curious and fascinating clinical features of this condition. It seems that at least two remarkable personalities, Dr. Samuel Johnson, a man of letters and the first person to compile an English dictionary, and Wolfgang Amadeus Mozart, arguably the most creative musical composer of all time, were possibly afflicted with this condition.

Background To evaluate the efficacy and tolerability of a clonidine transdermal patch in the treatment of children with tic disorders (TD) and to establish a predictive model for patients. Methods Forty-one patients who met the inclusion criteria entered into 12 weeks of prospective, open, single-group, self-controlled treatment with a clonidine transdermal patch. The Yale Global Tic Severity Scale (YGTSS) was employed before therapy (baseline) and at 4, 8, and 12 weeks after therapy. Results (1) The total effect rates of treatment with a clonidine transdermal patch were 29.27, 53.66, and 63.41% at 4, 8, and 12 weeks, respectively. Compared with the baseline, the differences were significant at three different observation periods. (2) Compared to the level of 25% reduction, there were significant decreases in the score-reducing rate of motor tic and total tic severities at 12 weeks. (3) If the disease course was ≤24 months and the motor tic score was 16, there was an effective rate of 57.1%. If the disease course was >24 months and the clinical classification was chronic TD, there was an effective rate of 62.5%. If the disease course was >24 months and the clinical classification was Tourette’s syndrome, 90% of the patients were invalid. (4) The main adverse events were rash, slight dizziness, and headache. Conclusion (1) When patients were pretreated with a D2-dopamine receptor antagonist that was ineffective or not tolerated well, switching to a clonidine transdermal patch treatment was effective and safe. (2) A clonidine transdermal patch could be a first-line medication for mild and moderate TD cases that are characterized by motor tics.

This study included brief functional analyses and treatment for motor tics exhibited by two children with Tourette Syndrome. Brief functional analyses were conducted in an outpatient treatment center and results were used to develop individualized habit reversal procedures. Treatment data were collected in clinic for one child and in clinic and school for the other child. Brief functional analysis results were mixed for each child, but provided useful information for informing unique habit reversal components for each child. Treatment results indicated reductions in motor tics for each child. Results are discussed in terms of utility of functional analysis for tics.

Tourette’s syndrome is a neuropsychiatric movement disorder often first noted in early childhood and dissipating with age. The condition results in a combination of verbal and motor tics which often require treatment to reduce the pain, distraction and social consequences of the repetitive movements. I present a case of a 46 y/o treatment refractory patient whom has suffered vertebral artery dissection resulting in stroke and two distinctly separate spinal cord injuries as a result of his cervicogenic tics. _10.21885/wvmj.2016.11_

Background: Gilles de la Tourette syndrome (TS) is a complex neuropsychiatric disorder defined by the presence of motor and phonic tics, but often associated with psychiatric comorbidities. The main objective of this study was to explore the clinical presentation and comorbidities of TS. Method: We analyzed clinical data obtained from a large sample (n = 1032; 529 children and 503 adults) of patients with tic disorders from one single German TS center assessed by one investigator. Data was collected with the help of an expert-reviewed semi-structured interview, designed to assess tic severity and certain comorbidities. Group comparisons were carried out via independent sample t-tests and chi-square tests. Results: The main findings of the study are: (1) tic severity is associated with the presence of premonitory urges (PU), copro-, echo-, and paliphenomena and the number of comorbidities, but not age at tic onset; it is higher in patients with comorbid obsessive-compulsive disorder (OCD) than in patients with comorbid attention deficit/hyperactivity disorder (ADHD). (2) PU were found to be highly associated with “not just right experiences” and to emerge much earlier than previously thought alongside with the ability to suppress tics (PU in >60% and suppressibility in >75% at age 8–10 years). (3) Self-injurious behavior (SIB) is highly associated with complex motor tics and coprophenomena, but not with OCD/obsessive-compulsive behavior (OCB). While comorbid ADHD is associated with a lower ability to suppress tics, comorbid depression is associated with sleeping problems. Discussion: Our results demonstrate that tic severity is not influenced by age at onset. From our data, it is suggested that PU represent a specific type of “not just right experience” that is not a prerequisite for tic suppression. Comorbid ADHD reduces patients' ability of successful tic suppression. Our data suggest that SIB belongs to the coprophenomena spectrum and hence should be conceptualized as a complex tic rather than a compulsion. Finally, this study strongly supports the hypothesis that TS+OCD is a more severe form of TS and that comorbid OCD/OCB, depression, and anxiety belong to the TS spectrum, while ADHD should be better conceptualized as a separate problem.

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.

Objectives :The goals of the present study are to assess children with tic disorders, their clinical characteristic and to prove the effectiveness of herbal treatments of tic disorders.Methods :The present study was conducted from January 2006 to April 2011 , with 200 out-patient children between the age of 6 to 12 diagnosed with tic disorder (after excluding 10 children who could not be clearly diagnosed) at the "H’herbal medicine clinic located in Seoul. Of these 200 children, we hav e evaluated the epidemiology and clinical manifestation, and analyzed the results of herbal medicine treatments. Results :1. Among the children diagnosed with tic disorder, TTD was most p revalent (43.3%) and males were more likely than females to express tics (5.45:1). Children with TD sought help significantly later (average age of 9.03 years) than the other types. 2. The analysis results of herbal medicine treatments are as foll ows. Compared to the pre-treatment assessment, children who received herbal medicine treatment for more than three months (n=52) showed a marked decrease in symptoms of motor tics (the number of motor tics, f requency, severity, complexity) and vocal tics (the number of vocal tics, frequency, severity), in the impairment l evel of combined tics (motor and vocal tics together) and in the overall score.Conclusions :In conclusion, we apprehended demographic and clinical characte ristics of tic disorder patients who visited a Korean traditional medicine clinic by analyzing the psychological asse ssment results. Furthermore, we identified the effectiveness of herb formula in tic disorder. Key Words: Tic disorders, Yale Global Tic Se verity Scale(YGTSS), Herbal treatments.

TS is a neurodevelopmental disorder characterised by multiple motor tics and vocal tics which leads to significant social and educational impairment with frequent comorbid conditions such as ADHD, OCD. The diagnosis is based predominantly on the history and observation of the tics and there are no investigations which will prove or disprove TS. TS children may benefit from combined assessment from paediatricians and child psychiatry/psychology teams particularly if the children have associated comorbidities. Outcome is likely to be favourable in at least 50% of children.

Hallervorden-Spatz disease (HSD) is a rare autosomal-recessive hereditary disorder characterized by the early onset of progressive movement alterations, including dystonia, rigidity, choreoathetosis, and mental deterioration. HSD is also associated with a variety of psychiatric symptoms, primarily depression and mental deterioration. However, psychosis has rarely been reported as a major symptom of HSD. We report two siblings who presented psychiatric symptoms as major clinical presentations, accompanied by ataxic and spastic gait, dysarthria, and typical neuroimaging findings of HSD. A 14-year-old girl presented complex motor tics, stereotypic behavior and anxiety symptoms. Her older brother, a 16-year-old boy, presented prominent auditory hallucinations, persecutory delusions and social withdrawal symptoms. Psychiatric symptoms were improved after atypical antipsychotic treatment. HSD is a rare disease but should be carefully considered in the diagnosis of patients with both motor disorder and various psychiatric symptoms.

This study intended to examine the impact of TD on adult psychosocial functioning. A 29-item self-report questionnaire was mailed to 180 former and current adult TD patients. Adult TD patients reported relatively good psychosocial adjustment although many continued to be dependent upon their families for living and financial support. For adults with TD, personal acceptance and medication use were the most important factors in coping with the disorder. The severity of vocal tics had a much greater influence on adult functioning than the severity of motor tics. Although TD continued to interfere with patient's lives in adulthood, the impact was relatively modest. Most patients were able to cope utilizing family and medical support. Clinicians need to be aware of the greater influence of vocal tics on adult functioning compared with motor tics.

Background Tourette syndrome is a stress-sensitive neurologic disorder characterized by involuntary vocal and motor tics. Both Tourette syndrome and the medical treatment for this condition can affect the eye. Case reports Case 1: A 5-year-old boy was brought in to see the optometrist by his mother for excessive “flinching” of the eyes. The flinching was actually excessive blinking and, after consulting with the patient's pediatrician and a neurologist, Tourette syndrome was diagnosed. Case 2: An adult male patient complained that, on occasion, he would forcibly blink out his soft contact lenses. He had previously received a diagnosis of Tourette syndrome, which is successfully managed with medication. Conclusion Eye signs in Tourette syndrome include excessive blinking, squinting, eye rolling, exaggerated eye opening and closing, and problems with saccades. Because the eye can be involved in Tourette syndrome, the optometrist should be aware of the different manifestations of the condition, which often go unrecognized.

Habit reversal (HR) is a multicomponent treatment for tic disorders. This case study incorporated elements of HR (awareness training, self-monitoring, response competition), combined with relaxation, as an intervention for vocal and motor tics in a 10-year-old boy with Tourette's syndrome (TS). Therapy was provided on an outpatient basis at a pediatric clinic. In-home data collection by the boy's mother documented decreased tic frequency during the course of treatment. Clinical improvement was maintained at a 3-month follow-up. These results support previous research demonstrating efficacy of simplified HR in controlling multiple tics associated with TS.

Lamotrigine is an anticonvulsant medication that also has utility in the treatment of bipolar disorder. It has been associated with many side effects, including rashes that can progress to Stevens-Johnson syndrome or toxic epidermal necrolysis. It has also been associated with the development of motor tics, most commonly in the head, neck, and shoulders. We will now present the case of a 45-year-old woman who developed tics that involved the entire left side of her body after her dose of lamotrigine was increased from 200 mg daily (2.0 mg/kg/day) to 225 mg daily (2.3 mg/kg/day). We will review the prior cases of lamotrigine induced tics, and compare them to the circumstances surrounding our patient. We will also discuss the neurobiology of tics and make suggestions to improve the tics, based on the reported cases.

Tourette syndrome is a neuropsychiatric condition characterized by multiple motor tics and at least one vocal tic that persist for more than 1 year. On September 28, 2005, a symposium was held to (1) describe current diagnostic strategies, (2) discuss recent thoughts on pathogenesis, (3) review current therapies and clinical trials, and (4) define future research directions in Tourette syndrome. In her opening remarks, Dr Story Landis, director of the National Institute of Neurological Disorders and Stroke, emphasized the influence that this conference series has not only on the advancement of research but also on the education of practicing clinicians. Dr Landis also discussed the role of the Institute and the crucial function of volunteer research organizations in funding research to further improve the management of this condition. This article summarizes the presentations and includes the verbatim edited transcript of question and answer sessions. (J Child Neurol 2006;21:630—641; DOI 10.2310/7010.2006.00163).

SummaryTourette's syndrome (TS) is a neurodevelopmental disorder characterized by the presence of chronic vocal and motor tics. Tics are sudden, highly stereotyped, movements that can be simple or complex in appearance. Since patients with TS have difficulties preventing unwanted movements, one might expect that their ability to voluntarily control goal-directed movements would be similarly poor. Indeed, it has been suggested that TS sufferers are impaired at inhibiting reflexively triggered movements and in rapidly selecting or switching between different motor sets [1]. This idea is consistent with current views on the neurological basis of TS that posit a dysfunction of the neural circuits linking the frontal lobes and the striatum [2]. These circuits are known to be involved in the voluntary control of action [3, 4]. By using an oculomotor switching task, we show for the first time that young people with TS exhibit paradoxically greater levels of cognitive control over their movements than their age-matched controls. This finding is consistent with an increased need to monitor and control movements and may indicate a subcortical locus for the triggering of tics. It also suggests that the constant need to suppress tics could have resulted in an enhancement of the executive processes involved in inhibitory control.

Habit reversal was used to treat vocal tics in 5 children with Tourette syndrome. Vocal tics were reduced in 4 of the 5 children, the untreated motor tics did not increase, and treatment was acceptable to the children's parents.

Tourette’s syndrome is a complex and distressing condition characterized by vocal and motor tics. It is also associated with attentional and obsessional difficulties, which may be of greater concern than the tics to the child and their family. Parents attending specialist clinics report that attentional and learning difficulties are their greatest concern. Teachers are also concerned with attentional problems. However, overall, they report fewer behaviours as being of concern and rate those that they do report as less severe than parents. This can lead to conflict, with parents often feeling blamed and criticized for poor parenting. The article emphasizes the need for comprehensive and systemic assessment of children incorporating multiple perspectives. The need for a combination of treatment approaches, including the provision of educational material to help teachers understand the complex nature of Tourette’s syndrome, is described.

Motor tics are a cardinal feature of Tourette syndrome and are traditionally associated with an excess of striatal dopamine in the basal ganglia. Recent evidence increasingly supports a more articulated view where cerebellum and cortex, working closely in concert with basal ganglia, are also involved in tic production. Building on such evidence, this article proposes a computational model of the basal ganglia-cerebellar-thalamo-cortical system to study how motor tics are generated in Tourette syndrome. In particular, the model: (i) reproduces the main results of recent experiments about the involvement of the basal ganglia-cerebellar-thalamo-cortical system in tic generation; (ii) suggests an explanation of the system-level mechanisms underlying motor tic production: in this respect, the model predicts that the interplay between dopaminergic signal and cortical activity contributes to triggering the tic event and that the recently discovered basal ganglia-cerebellar anatomical pathway may support the involvement of the cerebellum in tic production; (iii) furnishes predictions on the amount of tics generated when striatal dopamine increases and when the cortex is externally stimulated. These predictions could be important in identifying new brain target areas for future therapies. Finally, the model represents the first computational attempt to study the role of the recently discovered basal ganglia-cerebellar anatomical links. Studying this non-cortex-mediated basal ganglia-cerebellar interaction could radically change our perspective about how these areas interact with each other and with the cortex. Overall, the model also shows the utility of casting Tourette syndrome within a system-level perspective rather than viewing it as related to the dysfunction of a single brain area., Author summary Tourette syndrome is a neuropsychiatric disorder characterized by vocal and motor tics. Tics represent a cardinal symptom traditionally associated with a dysfunction of the basal ganglia leading to an excess of the dopamine neurotransmitter. This view gives a restricted clinical picture and limits therapeutic approaches because it ignores the influence of altered interactions between the basal ganglia and other brain areas. In this respect, recent evidence supports a more articulated framework where cerebellum and cortex are also involved in tic production. Building on these data, we propose a computational model of the basal ganglia-cerebellar-thalamo-cortical network to investigate the specific mechanisms underlying motor tic production. The model reproduces the results of recent experiments and suggests an explanation of the system-level processes underlying tic production. Moreover, it furnishes predictions related to the amount of tics generated when there are dysfunctions in the basal ganglia-cerebellar-thalamo-cortical circuits. These predictions could be important in identifying new brain target areas for future therapies based on a system-level view of Tourette syndrome.

Tourette syndrome (TS) is a disorder that involves at least one vocal tic and two or more motor tics; however, associated symptoms of obsessive-compulsive disorder (OCD) and attention-deficit disorder or attention-deficit hyperactivity disorder (ADHD) are common. Many children with TS exhibit educational difficulties and one possible explanation may be deficits in executive functioning. The focus of this study was to look at the severity of symptoms often associated with TS (tics and OCD and ADHD symptoms) and its potential relationship with the Behavior Rating Inventory of Executive Function (BRIEF) Parent Form in 11 children diagnosed with TS aged 8 to 14 years old. The parent of the child completed the BRIEF along with symptom measures evaluating tics, OCD behaviors, and ADHD symptoms. Despite relatively low mean scores on the symptom measures and just a few children exhibiting clinically significant scores on the BRIEF indexes, at least half the children exhibited abnormal scores on the Working Memory, Inhibit, and Shift subscales of the BRIEF. Varying patterns of relationships were found on the BRIEF subscales for each symptom severity scale. Results suggest that the BRIEF may be useful in determining the specific areas of difficulty in a population with variable symptomatology.

Tics are stereotypical repetitive involuntary movements (motor tics) or sounds (vocal tics). Although the emergence of tics were reported in a few cases with the use of selective serotonin reuptake inhibitors, there was no case with bupropion extended-release (Bupropion XL). The current case report presents a male patient developing motor and vocal tics with the use of bupropion XL.

Background: Tourette syndrome (TS) is a neurodevelopmental condition characterized by motor and phonic tics, commonly presenting with comorbid behavioral problems. We report the case of a patient with TS who presented with salient complex motor symptoms, namely treatment-refractory kicking resulting in bilateral shoe deterioration. Case History: “A.B.” was referred to our specialist clinic for adults with TS at the age of 18, following an 11-year history of tics, which started with mouth opening. He subsequently developed more complex motor tics and phonic tics, as well as echolalia, echopraxia, palipraxia, coprolalia, and copropraxia. He scored 65% on the YGTSS, indicating marked tic severity, and had a concomitant diagnosis of obsessive-compulsive disorder, experiencing obsessional thoughts and performing counting rituals. As part of his tic repertoire, this patient presented with repetitive, bilateral kicking, which was associated with arithmomania. The repetitive movement was most apparent when walking, and caused marked shoe damage, particularly at the tip. The frequency and severity of this repetitive movement resulted in this patient’s requiring new pairs of shoes almost every week. This symptom also caused hip and toe pain, and at one time led to dislocation of the knee joint. Interestingly, the kicking tic did not respond to antidopaminergic medication, unlike the other motor and vocal symptoms, which showed marked improvement on aripiprazole. Conclusions: The repetitive and stereotypical nature of complex motor tics in the context of TS can result in self-injurious movements. The compulsive nature of these symptoms can contribute to their refractoriness to conventional antidopaminergic treatment.

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.

Valproic acid was successfully prescribed for a 10-year old boy suffering from Tourette's Disorder with a co-morbid bipolar diagnosis. Valproic acid has demonstrated efficacy in reducing the total number of motor tics, their frequency, intensity, complexity, and impairment in a patient who had failed to respond to numerous other medications. Valproic acid may be a useful agent to consider for children with treatment-resistant Tourette's disorder.

Gilles de la Tourette's syndrome, named after a nineteenth century French neurologist, is a tic disorder that is characterized by childhood onset, duration of more than a year, motor tics, vocal tics, and a waxing and waning of symptoms. Obsessive–compulsive disorder and attention deficit/hyperactivity disorder occur in many patients. Most cases appear to be hereditary, but a specific inheritance pattern is uncertain. Tourette's syndrome may be related to the overactivity of the dopaminergic systems. Although antipychotics are used to suppress tics, the potential side effects on the patient must be taken into consideration.

French physician Jean-Marc Gaspard Itard (1774–1838) is noted for his descriptions of tics and pneumothorax and for his contributions to otology and the education of those with deafness or mental retardation. Itard was lauded as an educator of deaf-mutes and tried his educational theories in the celebrated case of ‘Victor, the Wild Boy of Aveyron,’ a retarded teenager who had been abandoned by his parents. In 1825, Itard gave the first clear description of tic disorders when he reported the case of a young noblewoman, the Marquise (countess) de Dampierre, who was often surprised and embarrassed by her own involuntary vocal and motor tics.

This study examined the effect of tic-related talk on the vocal and motor tics of 2 boys with Tourette's syndrome. Using ABAB withdrawal designs, the boys were alternately exposed to conditions with and without talk of their tics. For both boys, vocal tics markedly increased when talk pertained to tics and decreased when talk did not pertain to tics, but motor tic covariance was less consistent.

Tourette syndrome (TS) is characterized by multiple motor tics plus one or more vocal (phonic) tics, which characteristically wax and wane. It can no longer be considered the rare and bizarre syndrome that it was once thought to be. The concepts surrounding TS, and our understanding of it, are also becoming increasingly complex and, in some individuals, TS is now recognized to be associated with a wide variety of associated behaviours and psychopathologies. It is suggested that TS is heterogeneous from a variety of standpoints including clinical presentation and psychopathology, and thus neuropharmacological responses and possibly even aetiological and genetic mechanisms. In this paper, mention is made of recent findings in epidemiology and genetics, highlighting the complexities of the disorder; these have been chosen because findings in both areas have clinical and management implications. The literature on the clinical manifestations, associated behaviours, psychopathology (and/or comorbid conditions) and management, in particular, is reviewed in detail.