Tourette Syndrome and Other Tic Disorders Differential Diagnoses

  • Author: William C Robertson Jr, MD; Chief Editor: Amy Kao, MD   more...
 
Updated: Jun 15, 2011
 
 

Diagnostic Considerations

Other problems to be considered in patients with possible Tourette syndrome include the following:

  • Akathisia
  • Autism
  • Carbon monoxide
  • Dystonia
  • Encephalitis lethargic
  • Hyperekplexia and other startle syndromes
  • Mannerisms
  • Monoamine oxidase A deficiency
  • Motor Tic of Childhood
  • Myoclonus
  • Obsessive-compulsive disorder
  • Paroxysmal dyskinesias
  • Rett syndrome
  • Stimulants
  • Stroke Transient

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

William C Robertson Jr, MD  Professor, Departments of Neurology, Pediatrics, and Family Practice, Clinical Title Series, University of Kentucky College of Medicine

William C Robertson Jr, MD is a member of the following medical societies: American Academy of Neurology and Child Neurology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Raj D Sheth, MD  Professor, Mayo College of Medicine; Chief, Division of Pediatric Neurology, Nemours Children's Clinic

Raj D Sheth, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Neurological Association, and Child Neurology Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Amy Kao, MD  Attending Neurologist, Children's National Medical Center

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society

Disclosure: Nothing to disclose.

References

  1. American Psychiatric Association. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Revision. Washington, DC: American Psychiatric Association; 2000.

  2. The Tourette Syndrome Classification Study Group. Definitions and classification of tic disorders. Arch Neurol. Oct 1993;50(10):1013-6. [Medline].

  3. McHenry LC Jr. Samuel Johnson's tics and gesticulations. J Hist Med Allied Sci. Apr 1967;22(2):152-68. [Medline].

  4. Murray TJ. Dr Samuel Johnson's movement disorder. Br Med J. Jun 16 1979;1(6178):1610-4. [Medline]. [Full Text].

  5. Kushner HI. A Cursing Brain--The Histories of Tourette Syndrome. Cambridge, MA: Harvard University Press;. 1999.

  6. Gilles de la Tourette G. Etude sur une Affection Nerveuse Caracterisee par de l'Incoordination Motrice Accompagnee d'Echolalie et de Coprolalie. Archives de Neurologie. 1885;9:19-42, 158-200.

  7. Miller AM, Bansal R, Hao X, Sanchez-Pena JP, Sobel LJ, Liu J. Enlargement of thalamic nuclei in Tourette syndrome. Arch Gen Psychiatry. Sep 2010;67(9):955-64. [Medline].

  8. Kurlan R, Goetz CG, McDermott MP. Treatment of ADHD in children with tics: a randomized controlled trial. Neurology. Feb 26 2002;58(4):527-36. [Medline].

  9. Comings DE. Blood serotonin and tryptophan in Tourette syndrome. Am J Med Genet. Aug 1990;36(4):418-30. [Medline].

  10. Comings DE, Gade R, Muhleman D, et al. Exon and intron variants in the human tryptophan 2,3-dioxygenase gene: potential association with Tourette syndrome, substance abuse and other disorders. Pharmacogenetics. Aug 1996;6(4):307-18. [Medline].

  11. Muller-Vahl KR, Meyer GJ, Knapp WH, et al. Serotonin transporter binding in Tourette Syndrome. Neurosci Lett. Sep 9 2005;385(2):120-5. [Medline].

  12. Niesler B, Frank B, Hebebrand J, et al. Serotonin receptor genes HTR3A and HTR3B are not involved in Gilles de la Tourette syndrome. Psychiatr Genet. Dec 2005;15(4):303-4. [Medline].

  13. Toren P, Weizman A, Ratner S, et al. Ondansetron treatment in Tourette's disorder: a 3-week, randomized, double-blind, placebo-controlled study. J Clin Psychiatry. Apr 2005;66(4):499-503. [Medline].

  14. Muller-Vahl KR. Cannabinoids reduce symptoms of Tourette's syndrome. Expert Opin Pharmacother. Oct 2003;4(10):1717-25. [Medline].

  15. McGrath MJ, Campbell KM, Parks CR, Burton FH. Glutamatergic drugs exacerbate symptomatic behavior in a transgenic model of comorbid Tourette's syndrome and obsessive-compulsive disorder. Brain Res. Sep 15 2000;877(1):23-30. [Medline].

  16. van Wattum PJ, Anderson GM, Chappell PB, et al. Cerebrospinal fluid dynorphin A[1-8] and beta-endorphin levels in Tourette's syndrome are unaltered. Biol Psychiatry. Jun 1 1999;45(11):1527-8. [Medline].

  17. Weeks RA, Lees AJ, Brooks DJ. Tourette's syndrome and the opioid system. Lancet. Apr 30 1994;343(8905):1107-8. [Medline].

  18. Kumar R, Lang AE. Coexistence of tics and parkinsonism: evidence for non-dopaminergic mechanisms in tic pathogenesis. Neurology. Dec 1997;49(6):1699-701. [Medline].

  19. Damier P, Hirsch EC, Agid Y, Graybiel AM. The substantia nigra of the human brain. II. Patterns of loss of dopamine-containing neurons in Parkinson's disease. Brain. Aug 1999;122 (Pt 8):1437-48. [Medline].

  20. Black KJ, Mink JW. Response to levodopa challenge in Tourette syndrome. Mov Disord. Nov 2000;15(6):1194-8. [Medline].

  21. Gilbert DL, Sallee FR, Sine L. Behavioral and hormonal effects of low-dose pergolide in children and adolescents with Gilles de la Tourette's syndrome. Curr Ther Res Clin Exp. 2000;61:378.

  22. Gilbert DL, Dure L, Sethuraman G, et al. Tic reduction with pergolide in a randomized controlled trial in children. Neurology. Feb 25 2003;60(4):606-11. [Medline].

  23. Diaz-Anzaldua A, Joober R, Riviere JB, et al. Tourette syndrome and dopaminergic genes: a family-based association study in the French Canadian founder population. Mol Psychiatry. Mar 2004;9(3):272-7. [Medline].

  24. Lee CC, Chou IC, Tsai CH, et al. Dopamine receptor D2 gene polymorphisms are associated in Taiwanese children with Tourette syndrome. Pediatr Neurol. Oct 2005;33(4):272-6. [Medline].

  25. Heinz A, Knable MB, Wolf SS, et al. Tourette's syndrome: [I-123]beta-CIT SPECT correlates of vocal tic severity. Neurology. Oct 1998;51(4):1069-74. [Medline].

  26. Singer HS, Wong DF, Brown JE, et al. Positron emission tomography evaluation of dopamine D-2 receptors in adults with Tourette syndrome. Adv Neurol. 1992;58:233-9. [Medline].

  27. Turjanski N, Sawle GV, Playford ED, et al. PET studies of the presynaptic and postsynaptic dopaminergic system in Tourette's syndrome. J Neurol Neurosurg Psychiatry. Jun 1994;57(6):688-92. [Medline].

  28. Wong DF, Singer HS, Brandt J, et al. D2-like dopamine receptor density in Tourette syndrome measured by PET. J Nucl Med. Aug 1997;38(8):1243-7. [Medline].

  29. Wolf SS, Jones DW, Knable MB, et al. Tourette syndrome: prediction of phenotypic variation in monozygotic twins by caudate nucleus D2 receptor binding. Science. Aug 30 1996;273(5279):1225-7. [Medline].

  30. Robertson MM. D2 be or not to be?. Nat Med. Oct 1996;2(10):1076-7. [Medline].

  31. Albin RL, Koeppe RA, Bohnen NI, et al. Increased ventral striatal monoaminergic innervation in Tourette syndrome. Neurology. Aug 12 2003;61(3):310-5. [Medline]. [Full Text].

  32. Ernst M, Zametkin AJ, Jons PH, et al. High presynaptic dopaminergic activity in children with Tourette's disorder. J Am Acad Child Adolesc Psychiatry. Jan 1999;38(1):86-94. [Medline].

  33. Malison RT, McDougle CJ, van Dyck CH, et al. [123I]beta-CIT SPECT imaging of striatal dopamine transporter binding in Tourette's disorder. Am J Psychiatry. Sep 1995;152(9):1359-61. [Medline].

  34. Meyer P, Bohnen NI, Minoshima S, et al. Striatal presynaptic monoaminergic vesicles are not increased in Tourette's syndrome. Neurology. Jul 22 1999;53(2):371-4. [Medline].

  35. Peterson BS. Neuroimaging studies of Tourette syndrome: a decade of progress. In: Cohen DJ, Jankovic J, Goetz CG, eds. Tourette Syndrome. Philadelphia: Lippincott Williams & Wilkins. 2001:179-96.

  36. Serra-Mestres J, Ring HA, Costa DC, et al. Dopamine transporter binding in Gilles de la Tourette syndrome: a [123I]FP-CIT/SPECT study. Acta Psychiatr Scand. Feb 2004;109(2):140-6. [Medline].

  37. Singer HS, Szymanski S, Giuliano J, et al. Elevated intrasynaptic dopamine release in Tourette's syndrome measured by PET. Am J Psychiatry. Aug 2002;159(8):1329-36. [Medline].

  38. Stamenkovic M, Schindler SD, Asenbaum S, et al. No change in striatal dopamine re-uptake site density in psychotropic drug naive and in currently treated Tourette's disorder patients: a [(123)I]-beta-CIT SPECt-study. Eur Neuropsychopharmacol. Feb 2001;11(1):69-74. [Medline].

  39. Wong D, Singer H, Marenco S. Dopamine transporter reuptake sites measured by [11C]WIN 35,428 PET imaging are elevated in Tourette syndrome. J Nucl Med. 1994;35:130.

  40. Cheon KA, Ryu YH, Namkoong K, et al. Dopamine transporter density of the basal ganglia assessed with [123I]IPT SPECT in drug-naive children with Tourette's disorder. Psychiatry Res. Jan 15 2004;130(1):85-95. [Medline].

  41. Black KJ, Hershey T, Akbudak E, et al. Levodopa activation pharmacologic fMRI in Tourette syndrome. Abstract presented at: 34th Annual Meeting of the Society for Neuroscience. October 23-27, 2004;. San Diego, CA. [Full Text].

  42. Channon S, Sinclair E, Waller D, et al. Social cognition in Tourette's syndrome: intact theory of mind and impaired inhibitory functioning. J Autism Dev Disord. Dec 2004;34(6):669-77. [Medline].

  43. Goudriaan AE, Oosterlaan J, de Beurs E, et al. Decision making in pathological gambling: a comparison between pathological gamblers, alcohol dependents, persons with Tourette syndrome, and normal controls. Brain Res Cogn Brain Res. Apr 2005;23(1):137-51. [Medline].

  44. Serrien DJ, Orth M, Evans AH, et al. Motor inhibition in patients with Gilles de la Tourette syndrome: functional activation patterns as revealed by EEG coherence. Brain. Jan 2005;128(Pt 1):116-25. [Medline].

  45. Hershey T, Black KJ, Hartlein J, Braver TS, Barch DM, Carl JL, et al. Dopaminergic modulation of response inhibition: an fMRI study. Brain Res Cogn Brain Res. Aug 2004;20(3):438-48. [Medline].

  46. Braun AR, Stoetter B, Randolph C, et al. The functional neuroanatomy of Tourette's syndrome: an FDG-PET study. I. Regional changes in cerebral glucose metabolism differentiating patients and controls. Neuropsychopharmacology. Dec 1993;9(4):277-91. [Medline].

  47. Diler RS, Reyhanli M, Toros F, Kibar M, Avci A. Tc-99m-ECD SPECT brain imaging in children with Tourette's syndrome. Yonsei Med J. Aug 2002;43(4):403-10. [Medline].

  48. George MS, Trimble MR, Costa DC, et al. Elevated frontal cerebral blood flow in Gilles de la Tourette syndrome: a 99Tcm-HMPAO SPECT study. Psychiatry Res. Nov 1992;45(3):143-51. [Medline].

  49. Hall M, Costa DC, Shields J, et al. Brain perfusion patterns with Tc-99m-HMPAO/SPET in patients with Gilles de la Tourette syndrome. Eur J Nucl Med. 1990;16:WP18.

  50. Klieger PS, Fett KA, Dimitsopulos T, Karlan R. Asymmetry of basal ganglia perfusion in Tourette's syndrome shown by technetium-99m-HMPAO SPECT. J Nucl Med. Feb 1997;38(2):188-91. [Medline].

  51. Moriarty J, Costa DC, Schmitz B, et al. Brain perfusion abnormalities in Gilles de la Tourette's syndrome. Br J Psychiatry. Aug 1995;167(2):249-54. [Medline].

  52. Riddle MA, Rasmusson AM, Woods SW, Hoffer PB. SPECT imaging of cerebral blood flow in Tourette syndrome. Adv Neurol. 1992;58:207-11. [Medline].

  53. Braun AR, Randolph C, Stoetter B, et al. The functional neuroanatomy of Tourette's syndrome: an FDG-PET Study. II: Relationships between regional cerebral metabolism and associated behavioral and cognitive features of the illness. Neuropsychopharmacology. Oct 1995;13(2):151-68. [Medline].

  54. Crespo-Facorro B, Cabranes JA, Lopez-Ibor Alcocer MI, et al. Regional cerebral blood flow in obsessive-compulsive patients with and without a chronic tic disorder. A SPECT study. Eur Arch Psychiatry Clin Neurosci. 1999;249(3):156-61. [Medline].

  55. Eidelberg D, Moeller JR, Kazumata K, Antonini A, Sterio D, Dhawan V, et al. Metabolic correlates of pallidal neuronal activity in Parkinson's disease. Brain. Aug 1997;120 ( Pt 8):1315-24. [Medline].

  56. Peterson BS, Skudlarski P, Anderson AW, et al. A functional magnetic resonance imaging study of tic suppression in Tourette syndrome. Arch Gen Psychiatry. Apr 1998;55(4):326-33. [Medline].

  57. Stern E, Silbersweig DA, Chee KY, et al. A functional neuroanatomy of tics in Tourette syndrome. Arch Gen Psychiatry. Aug 2000;57(8):741-8. [Medline].

  58. Jeffries KJ, Schooler C, Schoenbach C, et al. The functional neuroanatomy of Tourette's syndrome: an FDG PET study III: functional coupling of regional cerebral metabolic rates. Neuropsychopharmacology. Jul 2002;27(1):92-104. [Medline].

  59. Gates L, Clarke JR, Stokes A, et al. Neuroanatomy of coprolalia in Tourette syndrome using functional magnetic resonance imaging. Prog Neuropsychopharmacol Biol Psychiatry. Mar 2004;28(2):397-400. [Medline].

  60. Biswal B, Ulmer JL, Krippendorf RL, et al. Abnormal cerebral activation associated with a motor task in Tourette syndrome. AJNR Am J Neuroradiol. Sep 1998;19(8):1509-12. [Medline].

  61. Serrien DJ, Nirkko AC, Loher TJ, et al. Movement control of manipulative tasks in patients with Gilles de la Tourette syndrome. Brain. Feb 2002;125(Pt 2):290-300. [Medline].

  62. Rauch SL, Whalen PJ, Curran T, et al. Probing striato-thalamic function in obsessive-compulsive disorder and Tourette syndrome using neuroimaging methods. Adv Neurol. 2001;85:207-24. [Medline].

  63. Swerdlow NR, Karban B, Ploum Y, et al. Tactile prepuff inhibition of startle in children with Tourette's syndrome: in search of an "fMRI-friendly" startle paradigm. Biol Psychiatry. Oct 15 2001;50(8):578-85. [Medline].

  64. Laplane D, Widlocher D, Pillon B, et al. [Obsessional-type compulsive behavior caused by bilateral circumscribed pallidostriatal necrosis. Encephalopathy caused by a wasp sting]. Rev Neurol (Paris). 1981;137(4):269-76. [Medline].

  65. Laplane D. [Obsessive-compulsive disorders caused by basal ganglia diseases]. Rev Neurol (Paris). Aug-Sep 1994;150(8-9):594-8. [Medline].

  66. Peterson BS, Staib L, Scahill L, et al. Regional brain and ventricular volumes in Tourette syndrome. Arch Gen Psychiatry. May 2001;58(5):427-40. [Medline].

  67. Peterson BS, Thomas P, Kane MJ, et al. Basal Ganglia volumes in patients with Gilles de la Tourette syndrome. Arch Gen Psychiatry. Apr 2003;60(4):415-24. [Medline].

  68. Bloch MH, Leckman JF, Zhu H, et al. Caudate volumes in childhood predict symptom severity in adults with Tourette syndrome. Neurology. Oct 25 2005;65(8):1253-8. [Medline].

  69. Fredericksen KA, Cutting LE, Kates WR, et al. Disproportionate increases of white matter in right frontal lobe in Tourette syndrome. Neurology. Jan 8 2002;58(1):85-9. [Medline].

  70. Hong KE, Ock SM, Kang MH, et al. The segmented regional volumes of the cerebrum and cerebellum in boys with Tourette syndrome. J Korean Med Sci. Aug 2002;17(4):530-6. [Medline].

  71. Hyde TM, Stacey ME, Coppola R, et al. Cerebral morphometric abnormalities in Tourette's syndrome: a quantitative MRI study of monozygotic twins. Neurology. Jun 1995;45(6):1176-82. [Medline].

  72. Peterson BS, Gore JC, Riddle MA, et al. Abnormal magnetic resonance imaging T2 relaxation time asymmetries in Tourette's syndrome. Psychiatry Res. Dec 1994;55(4):205-21. [Medline].

  73. Giedd JN, Rapoport JL, Leonard HL, et al. Case study: acute basal ganglia enlargement and obsessive-compulsive symptoms in an adolescent boy. J Am Acad Child Adolesc Psychiatry. Jul 1996;35(7):913-5. [Medline].

  74. Castellanos FX, Giedd JN, Hamburger SD, et al. Brain morphometry in Tourette's syndrome: the influence of comorbid attention-deficit/hyperactivity disorder. Neurology. Dec 1996;47(6):1581-3. [Medline].

  75. Peterson BS, Leckman JF, Tucker D, et al. Preliminary findings of antistreptococcal antibody titers and basal ganglia volumes in tic, obsessive-compulsive, and attention deficit/hyperactivity disorders. Arch Gen Psychiatry. Apr 2000;57(4):364-72. [Medline].

  76. Hallett M. Neurophysiology of tics. Adv Neurol. 2001;85:237-44. [Medline].

  77. Johannes S, Wieringa BM, Nager W, et al. Tourette syndrome and obsessive-compulsive disorder: event-related brain potentials show similar mechanisms [correction of mechansims] of frontal inhibition but dissimilar target evaluation processes. Behav Neurol. 2003;14(1-2):9-17. [Medline].

  78. Johannes S, Wieringa BM, Nager W, et al. Excessive action monitoring in Tourette syndrome. J Neurol. Aug 2002;249(8):961-6. [Medline].

  79. O'Connor K, Lavoie ME, Robert M. Preparation and motor potentials in chronic tic and Tourette syndromes. Brain Cogn. Jun-Jul 2001;46(1-2):224-6. [Medline].

  80. Ziemann U, Paulus W, Rothenberger A. Decreased motor inhibition in Tourette's disorder: evidence from transcranial magnetic stimulation. Am J Psychiatry. Sep 1997;154(9):1277-84. [Medline].

  81. Moll GH, Heinrich H, Trott GE, et al. Children with comorbid attention-deficit-hyperactivity disorder and tic disorder: evidence for additive inhibitory deficits within the motor system. Ann Neurol. Mar 2001;49(3):393-6. [Medline].

  82. Gilbert DL, Bansal AS, Sethuraman G, et al. Association of cortical disinhibition with tic, ADHD, and OCD severity in Tourette syndrome. Mov Disord. Apr 2004;19(4):416-25. [Medline].

  83. Gilbert DL, Sallee FR, Zhang J, et al. Transcranial magnetic stimulation-evoked cortical inhibition: a consistent marker of attention-deficit/hyperactivity disorder scores in tourette syndrome. Biol Psychiatry. Jun 15 2005;57(12):1597-600. [Medline].

  84. Orth M, Amann B, Robertson MM, et al. Excitability of motor cortex inhibitory circuits in Tourette syndrome before and after single dose nicotine. Brain. Jun 2005;128(Pt 6):1292-300. [Medline].

  85. Como PG. Neuropsychological function in Tourette syndrome. Adv Neurol. 2001;85:103-11. [Medline].

  86. Keri S, Szlobodnyik C, Benedek G, et al. Probabilistic classification learning in Tourette syndrome. Neuropsychologia. 2002;40(8):1356-62. [Medline].

  87. Marsh R, Alexander GM, Packard MG, et al. Habit learning in Tourette syndrome: a translational neuroscience approach to a developmental psychopathology. Arch Gen Psychiatry. Dec 2004;61(12):1259-68. [Medline].

  88. Marsh R, Alexander GM, Packard MG, et al. Perceptual-motor skill learning in Gilles de la Tourette syndrome. Evidence for multiple procedural learning and memory systems. Neuropsychologia. 2005;43(10):1456-65. [Medline].

  89. LeVasseur AL, Flanagan JR, Riopelle RJ, Munoz DP. Control of volitional and reflexive saccades in Tourette's syndrome. Brain. Oct 2001;124(Pt 10):2045-58. [Medline].

  90. Leckman JF, Katsovich L, Kawikova I, et al. Increased serum levels of interleukin-12 and tumor necrosis factor-alpha in Tourette's syndrome. Biol Psychiatry. Mar 15 2005;57(6):667-73. [Medline].

  91. Tang Y, Gilbert DL, Glauser TA, et al. Blood gene expression profiling of neurologic diseases: a pilot microarray study. Arch Neurol. Feb 2005;62(2):210-5. [Medline].

  92. Hong JJ, Loiselle CR, Yoon DY, et al. Microarray analysis in Tourette syndrome postmortem putamen. J Neurol Sci. Oct 15 2004;225(1-2):57-64. [Medline].

  93. Alexander GM, Peterson BS. Testing the prenatal hormone hypothesis of tic-related disorders: gender identity and gender role behavior. Dev Psychopathol. 2004;16(2):407-20. [Medline].

  94. Peterson BS, Leckman JF. The temporal dynamics of tics in Gilles de la Tourette syndrome. Biol Psychiatry. Dec 15 1998;44(12):1337-48. [Medline].

  95. Jankovic J. Stereotypies. In: Marsden CD, Fahn S, eds. Movement Disorders 3. Boston: Mass. Butterworth-Heinemann;1994:503-17.

  96. Mink JW. Basal ganglia dysfunction in Tourette's syndrome: a new hypothesis. Pediatr Neurol. Sep 2001;25(3):190-8. [Medline].

  97. Mink JW. Neurobiology of basal ganglia circuits in Tourette syndrome: faulty inhibition of unwanted motor patterns?. Adv Neurol. 2001;85:113-22. [Medline].

  98. Mink JW. The basal ganglia: focused selection and inhibition of competing motor programs. Prog Neurobiol. Nov 1996;50(4):381-425. [Medline].

  99. Flaherty AW, Graybiel AM. Input-output organization of the sensorimotor striatum in the squirrel monkey. J Neurosci. Feb 1994;14(2):599-610. [Medline].

  100. Price RA, Kidd KK, Cohen DJ, et al. A twin study of Tourette syndrome. Arch Gen Psychiatry. Aug 1985;42(8):815-20. [Medline].

  101. Devor EJ. Untying the gordian knot: the genetics of Tourette syndrome. J Nerv Ment Dis. Nov 1990;178(11):669-79. [Medline].

  102. Pauls DL. Issues in genetic linkage studies of Tourette syndrome. Phenotypic spectrum and genetic model parameters. Adv Neurol. 1992;58:151-7. [Medline].

  103. State MW, Pauls DL, Leckman JF. Tourette's syndrome and related disorders. Child Adolesc Psychiatr Clin N Am. Apr 2001;10(2):317-31, ix. [Medline].

  104. Pauls D. Genome scans in sibpairs and trios: new data. Presented at: 4th International Scientific Symposium on Tourette Syndrome; June 25-27, 2004; Cleveland, OH.

  105. Crane J, Fagerness J, Osiecki L, Gunnell B, Stewart SE, Pauls DL, et al. Family-based genetic association study of DLGAP3 in Tourette Syndrome. Am J Med Genet B Neuropsychiatr Genet. Jan 2011;156(1):108-14. [Medline]. [Full Text].

  106. State MW, Greally JM, Cuker A, et al. Epigenetic abnormalities associated with a chromosome 18(q21-q22) inversion and a Gilles de la Tourette syndrome phenotype. Proc Natl Acad Sci U S A. Apr 15 2003;100(8):4684-9. [Medline].

  107. Abelson JF, Kwan KY, O'Roak BJ, et al. Sequence variants in SLITRK1 are associated with Tourette's syndrome. Science. Oct 14 2005;310(5746):317-20. [Medline].

  108. Hyde TM, Aaronson BA, Randolph C, et al. Relationship of birth weight to the phenotypic expression of Gilles de la Tourette's syndrome in monozygotic twins. Neurology. Mar 1992;42(3 Pt 1):652-8. [Medline].

  109. Kirvan CA, Swedo SE, Heuser JS, Cunningham MW. Mimicry and autoantibody-mediated neuronal cell signaling in Sydenham chorea. Nat Med. Jul 2003;9(7):914-20. [Medline].

  110. Snider LA, Swedo SE. Post-streptococcal autoimmune disorders of the central nervous system. Curr Opin Neurol. Jun 2003;16(3):359-65. [Medline].

  111. Swedo SE, Leonard HL, Rapoport JL. The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) subgroup: separating fact from fiction. Pediatrics. Apr 2004;113(4):907-11. [Medline].

  112. Asbahr FR, Ramos RT, Negrao AB, Gentil V. Case series: increased vulnerability to obsessive-compulsive symptoms with repeated episodes of Sydenham chorea. J Am Acad Child Adolesc Psychiatry. Dec 1999;38(12):1522-5. [Medline].

  113. Mell LK, Davis RL, Owens D, et al. Association between streptococcal infection and obsessive-compulsive disorder, Tourette's syndrome, and tic disorder. Pediatrics. Jul 2005;116(1):56-60. [Medline].

  114. Murphy TK, Benson N, Zaytoun A, et al. Progress toward analysis of D8/17 binding to B cells in children with obsessive compulsive disorder and/or chronic tic disorder. J Neuroimmunol. Nov 1 2001;120(1-2):146-51. [Medline].

  115. Church AJ, Dale RC, Lees AJ, et al. Tourette's syndrome: a cross sectional study to examine the PANDAS hypothesis. J Neurol Neurosurg Psychiatry. May 2003;74(5):602-7. [Medline].

  116. Kiessling LS, Marcotte AC, Culpepper L. Antineuronal antibodies in movement disorders. Pediatrics. Jul 1993;92(1):39-43. [Medline].

  117. Pavone P, Bianchini R, Parano E, et al. Anti-brain antibodies in PANDAS versus uncomplicated streptococcal infection. Pediatr Neurol. Feb 2004;30(2):107-10. [Medline].

  118. Wendlandt JT, Grus FH, Hansen BH, Singer HS. Striatal antibodies in children with Tourette's syndrome: multivariate discriminant analysis of IgG repertoires. J Neuroimmunol. Sep 3 2001;119(1):106-13. [Medline].

  119. Kurlan R, Kaplan EL. The pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) etiology for tics and obsessive-compulsive symptoms: hypothesis or entity? Practical considerations for the clinician. Pediatrics. Apr 2004;113(4):883-6. [Medline].

  120. Kurlan R. The PANDAS hypothesis: losing its bite?. Mov Disord. Apr 2004;19(4):371-4. [Medline].

  121. Muller N, Riedel M, Blendinger C, et al. Mycoplasma pneumoniae infection and Tourette's syndrome. Psychiatry Res. Dec 15 2004;129(2):119-25. [Medline].

  122. Perlmutter SJ, Leitman SF, Garvey MA, et al. Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood. Lancet. Oct 2 1999;354(9185):1153-8. [Medline].

  123. Loiselle CR, Lee O, Moran TH, Singer HS. Striatal microinfusion of Tourette syndrome and PANDAS sera: failure to induce behavioral changes. Mov Disord. Apr 2004;19(4):390-6. [Medline].

  124. Singer HS, Loiselle CR, Lee O, et al. Anti-basal ganglia antibodies in PANDAS. Mov Disord. Apr 2004;19(4):406-15. [Medline].

  125. Singer HS, Hong JJ, Yoon DY, et al. Serum autoantibodies do not differentiate PANDAS and Tourette syndrome from controls. Neurology. Dec 13 2005;65(11):1701-7. [Medline].

  126. Prevalence of diagnosed Tourette syndrome in persons aged 6-17 years - United States, 2007. MMWR Morb Mortal Wkly Rep. Jun 5 2009;58(21):581-5. [Medline]. [Full Text].

  127. Robertson MM. The prevalence and epidemiology of Gilles de la Tourette syndrome. Part 1: the epidemiological and prevalence studies. J Psychosom Res. Nov 2008;65(5):461-72. [Medline].

  128. Robertson MM. The prevalence and epidemiology of Gilles de la Tourette syndrome. Part 2: tentative explanations for differing prevalence figures in GTS, including the possible effects of psychopathology, aetiology, cultural differences, and differing phenotypes. J Psychosom Res. Nov 2008;65(5):473-86. [Medline].

  129. Hebebrand J, Klug B, Fimmers R, et al. Rates for tic disorders and obsessive compulsive symptomatology in families of children and adolescents with Gilles de la Tourette syndrome. J Psychiatr Res. Sep-Oct 1997;31(5):519-30. [Medline].

  130. Leckman JF. Phenomenology of tics and natural history of tic disorders. Brain Dev. Dec 2003;25 Suppl 1:S24-8. [Medline].

  131. Carter AS, O'Donnell DA, Schultz RT, et al. Social and emotional adjustment in children affected with Gilles de la Tourette's syndrome: associations with ADHD and family functioning. Attention Deficit Hyperactivity Disorder. J Child Psychol Psychiatry. Feb 2000;41(2):215-23. [Medline].

  132. Martinez D, Slifstein M, Broft A, et al. Imaging human mesolimbic dopamine transmission with positron emission tomography. Part II: amphetamine-induced dopamine release in the functional subdivisions of the striatum. J Cereb Blood Flow Metab. Mar 2003;23(3):285-300. [Medline].

  133. Cath DC, Spinhoven P, Hoogduin CA, et al. Repetitive behaviors in Tourette's syndrome and OCD with and without tics: what are the differences?. Psychiatry Res. Mar 25 2001;101(2):171-85. [Medline].

  134. Robertson MM, Gourdie A. Familial Tourette's syndrome in a large British pedigree. Associated psychopathology, severity, and potential for linkage analysis. Br J Psychiatry. Apr 1990;156:515-21. [Medline].

  135. Burd L, Freeman RD, Klug MG, et al. Tourette Syndrome and learning disabilities. BMC Pediatr. Sep 1 2005;5:34. [Medline].

  136. Albin R. Neurobiology of basal ganglia and TS: neurotransmitters and neurochemistry overview. Presented at: 4th International Scientific Symposium on Tourette Syndrome;. June 25-27, 2004; Cleveland, Ohio.

  137. Woods DW, Watson TS, Wolfe E, et al. Analyzing the influence of tic-related talk on vocal and motor tics in children with Tourette's syndrome. J Appl Behav Anal. Fall 2001;34(3):353-6. [Medline].

  138. Meidinger AL, Miltenberger RG, Himle M, et al. An investigation of tic suppression and the rebound effect in Tourette's disorder. Behav Modif. Sep 2005;29(5):716-45. [Medline].

  139. Kwak C, Dat Vuong K, Jankovic J. Premonitory sensory phenomenon in Tourette's syndrome. Mov Disord. Dec 2003;18(12):1530-3. [Medline].

  140. Coffey BJ, Miguel EC, Biederman J, et al. Tourette's disorder with and without obsessive-compulsive disorder in adults: are they different?. J Nerv Ment Dis. Apr 1998;186(4):201-6. [Medline].

  141. Leckman JF, Walker DE, Goodman WK, Pauls DL, Cohen DJ. "Just right" perceptions associated with compulsive behavior in Tourette's syndrome. Am J Psychiatry. May 1994;151(5):675-80. [Medline].

  142. Miguel EC, do Rosario-Campos MC, Prado HS, et al. Sensory phenomena in obsessive-compulsive disorder and Tourette's disorder. J Clin Psychiatry. Feb 2000;61(2):150-6; quiz 157. [Medline].

  143. Scahill LD, Leckman JF, Marek KL. Sensory phenomena in Tourette's syndrome. Adv Neurol. 1995;65:273-80. [Medline].

  144. Bliss J. Sensory experiences of Gilles de la Tourette syndrome. Arch Gen Psychiatry. Dec 1980;37(12):1343-7. [Medline].

  145. Chappell P, Leckman J, Goodman W, et al. Elevated cerebrospinal fluid corticotropin-releasing factor in Tourette's syndrome: comparison to obsessive compulsive disorder and normal controls. Biol Psychiatry. May 1 1996;39(9):776-83. [Medline].

  146. Morris HR, Thacker AJ, Newman PK, Lees AJ. Sign language tics in a prelingually deaf man. Mov Disord. Mar 2000;15(2):318-20. [Medline].

  147. Chabane N, Delorme R, Millet B, et al. Early-onset obsessive-compulsive disorder: a subgroup with a specific clinical and familial pattern?. J Child Psychol Psychiatry. Aug 2005;46(8):881-7. [Medline].

  148. do Rosario-Campos MC, Leckman JF, Curi M, et al. A family study of early-onset obsessive-compulsive disorder. Am J Med Genet B Neuropsychiatr Genet. Jul 5 2005;136(1):92-7. [Medline].

  149. Miguel EC. Co-morbid OCD. Presented at: 4th International Scientific Symposium on Tourette Syndrome; June 25-27, 2004; Cleveland, OH.

  150. Block MH. Presentation at: 4th International Scientific Symposium on Tourette Syndrome. June 25-27, 2004; Cleveland, OH.

  151. Bockner S. Gilles de la Tourette's disease. J Ment Sci. Oct 1959;105:1078-81. [Medline].

  152. Kurlan R, Trinidad KS. Treatment of tics. In: Kurlan R, ed. Treatment of Movement Disorders. Philadelphia, PA:. JB Lippincott;1995: 365-406.

  153. McCracken JT, Suddath R, Chang S, Thakur S, Piacentini J. Effectiveness and tolerability of open label olanzapine in children and adolescents with Tourette syndrome. J Child Adolesc Psychopharmacol. Oct 2008;18(5):501-8. [Medline].

  154. Bruggeman R, van der Linden C, Buitelaar JK, et al. Risperidone versus pimozide in Tourette's disorder: a comparative double-blind parallel-group study. J Clin Psychiatry. Jan 2001;62(1):50-6. [Medline].

  155. Onofrj M, Paci C, D'Andreamatteo G, Toma L. Olanzapine in severe Gilles de la Tourette syndrome: a 52-week double-blind cross-over study vs. low-dose pimozide. J Neurol. Jun 2000;247(6):443-6. [Medline].

  156. Sallee FR, Kurlan R, Goetz CG, et al. Ziprasidone treatment of children and adolescents with Tourette's syndrome: a pilot study. J Am Acad Child Adolesc Psychiatry. Mar 2000;39(3):292-9. [Medline].

  157. Caine ED, Polinsky RJ, Kartzinel R, Ebert MH. The trial use of clozapine for abnormal involuntary movement disorders. Am J Psychiatry. Mar 1979;136(3):317-20. [Medline].

  158. Murphy TK, Bengtson MA, Soto O, et al. Case series on the use of aripiprazole for Tourette syndrome. Int J Neuropsychopharmacol. Sep 2005;8(3):489-90. [Medline].

  159. Seo WS, Sung HM, Sea HS, Bai DS. Aripiprazole treatment of children and adolescents with Tourette disorder or chronic tic disorder. J Child Adolesc Psychopharmacol. Apr 2008;18(2):197-205. [Medline].

  160. Acosta MT, Castellanos FX. Use of the "inverse neuroleptic" metoclopramide in Tourette syndrome: an open case series. J Child Adolesc Psychopharmacol. Spring 2004;14(1):123-8. [Medline].

  161. [Best Evidence] Nicolson R, Craven-Thuss B, Smith J, et al. A randomized, double-blind, placebo-controlled trial of metoclopramide for the treatment of Tourette's disorder. J Am Acad Child Adolesc Psychiatry. Jul 2005;44(7):640-6. [Medline].

  162. Gilbert DL, Sethuraman G, Sine L, et al. Tourette's syndrome improvement with pergolide in a randomized, double-blind, crossover trial. Neurology. Mar 28 2000;54(6):1310-5. [Medline].

  163. Black KJ, Hartlein JM, Schlaggar BL. Levodopa treatment for tics: preliminary report. J Neuropsychiatry Clin Neurosci. 14:102.

  164. Azrin NH, Nunn RG, Frantz SE. Habit reversal vs. negative practice treatment of nervous tics. Behav Res Ther. 1980;11:169-78.

  165. Azrin NH, Peterson AL. Habit reversal for the treatment of Tourette syndrome. Behav Res Ther. 1988;26(4):347-51. [Medline].

  166. Wilhelm S, Deckersbach T, Coffey BJ, et al. Habit reversal versus supportive psychotherapy for Tourette's disorder: a randomized controlled trial. Am J Psychiatry. Jun 2003;160(6):1175-7. [Medline].

  167. Deckersbach T, Rauch S, Buhlmann U, et al. Habit reversal versus supportive psychotherapy in Tourette's disorder: A randomized controlled trial and predictors of treatment response. Behav Res Ther. Oct 28 2005;[Medline].

  168. Black KJ. Habit Reversal Therapy for Tourette Syndrome. Available at http://www.nil.wustl.edu/labs/kevin/move/HRT.htm. Accessed August 31, 2009.

  169. Miltenberger RG, Fuqua RW, Woods DW. Applying behavior analysis to clinical problems: review and analysis of habit reversal. J Appl Behav Anal. Fall 1998;31(3):447-69. [Medline].

  170. Jenkins BG, Chen YI, Sanchez Pernaute R, et al. Mapping dopaminergic function in normal and MPTP treated monkeys with pharmacologic MRI and PET. Presented at: Annual Meeting of the Society of Neuroscience; November 10-15, 2001; San Diego, CA.

  171. Woods DW, Hook SS, Spellman DF, Friman PC. Case study: Exposure and response prevention for an adolescent with Tourette's syndrome and OCD. J Am Acad Child Adolesc Psychiatry. Jul 2000;39(7):904-7. [Medline].

  172. Scahill L, Chappell PB, Kim YS, et al. A placebo-controlled study of guanfacine in the treatment of children with tic disorders and attention deficit hyperactivity disorder. Am J Psychiatry. Jul 2001;158(7):1067-74. [Medline].

  173. The Tourette's Syndrome Study Group. Treatment of ADHD in children with tics: a randomized controlled trial. Neurology. Feb 26 2002;58(4):527-36. [Medline].

  174. Spencer T, Biederman J, Coffey B, et al. A double-blind comparison of desipramine and placebo in children and adolescents with chronic tic disorder and comorbid attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. Jul 2002;59(7):649-56. [Medline].

  175. Allen AJ, Kurlan RM, Gilbert DL, et al. Atomoxetine treatment in children and adolescents with ADHD and comorbid tic disorders. Neurology. Dec 27 2005;65(12):1941-9. [Medline].

  176. Marras C, Andrews D, Sime E, Lang AE. Botulinum toxin for simple motor tics: a randomized, double-blind, controlled clinical trial. Neurology. Mar 13 2001;56(5):605-10. [Medline].

  177. Jankovic J, Beach J. Long-term effects of tetrabenazine in hyperkinetic movement disorders. Neurology. Feb 1997;48(2):358-62. [Medline].

  178. U.S. Food and Drug Administration. FDA Approves First Drug for Treatment of Chorea in Huntington's Disease. FDA. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116936.htm. Accessed August 31, 2009.

  179. Singer HS, Wendlandt J, Krieger M, Giuliano J. Baclofen treatment in Tourette syndrome: a double-blind, placebo-controlled, crossover trial. Neurology. Mar 13 2001;56(5):599-604. [Medline].

  180. Awaad Y, Michon AM, Minarik S, et al. Use of levetiracetam to treat tics in children and adolescents with Tourette syndrome. Mov Disord. Jun 2005;20(6):714-8. [Medline].

  181. Hedderick EF, Morris CM, Singer HS. Double-blind, crossover study of clonidine and levetiracetam in Tourette syndrome. Pediatr Neurol. Jun 2009;40(6):420-5. [Medline].

  182. Smith-Hicks CL, Bridges DD, Paynter NP, Singer HS. A double blind randomized placebo control trial of levetiracetam in Tourette syndrome. Mov Disord. Sep 15 2007;22(12):1764-70. [Medline].

  183. Bruun RD, Budman CL. Paroxetine treatment of episodic rages associated with Tourette's disorder. J Clin Psychiatry. Nov 1998;59(11):581-4. [Medline].

  184. Iancu I, Kotler M, Bleich A, Lepkifker E. Clomipramine efficacy for Tourette syndrome and major depression: a case study. Biol Psychiatry. Sep 15 1995;38(6):407-9. [Medline].

  185. Kurlan R, Como PG, Deeley C, et al. A pilot controlled study of fluoxetine for obsessive-compulsive symptoms in children with Tourette's syndrome. Clin Neuropharmacol. Apr 1993;16(2):167-72. [Medline].

  186. Scahill L, Riddle MA, King RA, et al. Fluoxetine has no marked effect on tic symptoms in patients with Tourette's syndrome: a double-blind placebo-controlled study. J Child Adolesc Psychopharmacol. Summer 1997;7(2):75-85. [Medline].

  187. Chappell PB, Leckman JF, Riddle MA, et al. Neuroendocrine and behavioral effects of naloxone in Tourette syndrome. Adv Neurol. 1992;58:253-62. [Medline].

  188. Erenberg G, Lederman RJ. Naltrexone and Tourette's syndrome. Ann Neurol. May 1992;31(5):574. [Medline].

  189. van Wattum PJ, Chappell PB, Zelterman D, et al. Patterns of response to acute naloxone infusion in Tourette's syndrome. Mov Disord. Nov 2000;15(6):1252-4. [Medline].

  190. Chappell PB, Leckman JF, Scahill LD, et al. Neuroendocrine and behavioral effects of the selective kappa agonist spiradoline in Tourette's syndrome: a pilot study. Psychiatry Res. Jun 1993;47(3):267-80. [Medline].

  191. McConville BJ, Norman AB, Fogelson MH, Erenberg G. Sequential use of opioid antagonists and agonists in Tourette's syndrome. Lancet. Mar 5 1994;343(8897):601. [Medline].

  192. Silver AA, Shytle RD, Philipp MK, et al. Transdermal nicotine and haloperidol in Tourette's disorder: a double-blind placebo-controlled study. J Clin Psychiatry. Sep 2001;62(9):707-14. [Medline].

  193. Silver AA, Shytle RD, Sheehan KH, Sheehan DV, Ramos A, Sanberg PR. Multicenter, double-blind, placebo-controlled study of mecamylamine monotherapy for Tourette's disorder. J Am Acad Child Adolesc Psychiatry. Sep 2001;40(9):1103-10. [Medline].

  194. Orth M, Kirby R, Richardson MP, et al. Subthreshold rTMS over pre-motor cortex has no effect on tics in patients with Gilles de la Tourette syndrome. Clin Neurophysiol. Apr 2005;116(4):764-8. [Medline].

  195. Hembree EA, Riggs DS, Kozak MJ, et al. Long-term efficacy of exposure and ritual prevention therapy and serotonergic medications for obsessive-compulsive disorder. CNS Spectr. May 2003;8(5):363-71, 381. [Medline].

  196. McDougle CJ, Goodman WK, Leckman JF, et al. Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder. A double-blind, placebo-controlled study in patients with and without tics. Arch Gen Psychiatry. Apr 1994;51(4):302-8. [Medline].

  197. Miguel EC, Shavitt RG, Ferrao YA, et al. How to treat OCD in patients with Tourette syndrome. J Psychosom Res. Jul 2003;55(1):49-57. [Medline].

  198. Castellanos FX, Giedd JN, Elia J, et al. Controlled stimulant treatment of ADHD and comorbid Tourette's syndrome: effects of stimulant and dose. J Am Acad Child Adolesc Psychiatry. May 1997;36(5):589-96. [Medline].

  199. Biederman J, Wilens T, Mick E, et al. Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder. Pediatrics. Aug 1999;104(2):e20. [Medline].

  200. Kurlan R. Tourette's syndrome: are stimulants safe?. Curr Neurol Neurosci Rep. Jul 2003;3(4):285-8. [Medline].

  201. Gadow KD, Nolan EE, Sverd J. Methylphenidate in hyperactive boys with comorbid tic disorder: II. Short-term behavioral effects in school settings. J Am Acad Child Adolesc Psychiatry. May 1992;31(3):462-71. [Medline].

  202. Gadow KD, Sverd J, Sprafkin J, et al. Long-term methylphenidate therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder. Arch Gen Psychiatry. Apr 1999;56(4):330-6. [Medline].

  203. Sverd J, Gadow KD, Paolicelli LM. Methylphenidate treatment of attention-deficit hyperactivity disorder in boys with Tourette's syndrome. J Am Acad Child Adolesc Psychiatry. Jul 1989;28(4):574-9; discussion 580-2. [Medline].

  204. Feigin A, Kurlan R, McDermott MP, et al. A controlled trial of deprenyl in children with Tourette's syndrome and attention deficit hyperactivity disorder. Neurology. Apr 1996;46(4):965-8. [Medline].

  205. Spencer T, Biederman J, Steingard R, Wilens T. Bupropion exacerbates tics in children with attention-deficit hyperactivity disorder and Tourette's syndrome. J Am Acad Child Adolesc Psychiatry. Jan 1993;32(1):211-4. [Medline].

  206. Donovan SJ, Stewart JW, Nunes EV, et al. Divalproex treatment for youth with explosive temper and mood lability: a double-blind, placebo-controlled crossover design. Am J Psychiatry. May 2000;157(5):818-20. [Medline].

  207. Budman C, Coffey BJ, Shechter R, Schrock M, Wieland N, Spirgel A, et al. Aripiprazole in children and adolescents with Tourette disorder with and without explosive outbursts. J Child Adolesc Psychopharmacol. Oct 2008;18(5):509-15. [Medline].

  208. Ackermans L, Duits A, van der Linden C, et al. Double-blind clinical trial of thalamic stimulation in patients with Tourette syndrome. Brain. Mar 2011;134:832-44. [Medline].

  209. Woods DW, Marcks BA. Controlled evaluation of an educational intervention used to modify peer attitudes and behavior toward persons with Tourette's Syndrome. Behav Modif. Nov 2005;29(6):900-12. [Medline].

 
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Tourette syndrome and other tic disorders. Schematic of the hypothetical reorganization of the basal ganglia output in tic disorders, with excitatory projections (open arrows) and inhibitory projections (solid arrows). Line thickness represents the relative magnitude of activity. When a discrete set of striatal neurons becomes active inappropriately (right), aberrant inhibition of a discrete set of internal segment of globus pallidus (GPi) neurons occurs. The abnormally inhibited GPi neurons disinhibit thalamocortical mechanisms involved in a specific unwanted competing motor pattern, resulting in a stereotyped involuntary movement.
Tourette syndrome and other tic disorders. Segregated anatomy of the frontal-subcortical circuits: dorsolateral (blue), lateral orbitofrontal (green), and anterior cingulate (red) circuits in the striatum (top), pallidum (center), and mediodorsal thalamus (bottom).
Tourette syndrome and other tic disorders. Graphic shows the relative likelihood of lifetime sensory tics in a given region, as based on self-report of patients with Tourette syndrome. Overt tics are distributed similarly.
Tourette syndrome and other tic disorders. Immunologic response found in patients with Sydenham chorea is also found in patients with Tourette syndrome and obsessive-compulsive disorder. Points on the graph represent percent expression of D8/17 antigen on circulating B lymphocytes.
Tourette syndrome and other tic disorders. In a randomized controlled trial of habit reversal therapy (HRT), results differed significantly from those of a control therapy (massed practice; P < .001, analysis of variance). The HRT group had a 97% reduction in tics at 18-month follow-up, with 80% of patients tic-free.
Table. Symptoms of TS
SymptomDescription/Comment
Sensory hypersensitivityCannot stand to have wrinkly socks, cuts the tags off his or her shirts, refuses all but bland food, or becomes agitated in a visually complex environment
Learning disabilityApproximately 20% in clinical samples, more closely associated with comorbid ADHD than with tics; also associated with male sex, earlier onset, severity, perinatal problems, and lower rates in family members[135]
School phobiaCan be an adverse effect of neuroleptic treatment
Complex socially inappropriate behaviorInsults, racial slurs, and paraphilias (or, more commonly, suppressed urges) are present in a large minority of patients with TS, associated with comorbid ADHD
Rage attacksSudden outbursts lasting approximately 5-30 min, usually in children or teenagers; inconsolable, unremitting violent frustration, commonly after being denied an unreasonable request; often followed by apparently sincere contrition and remorse
Insistence on samenessRefusal to take a different route home or omit a step in a routine, even when hurried; often without a clear obsession or other obsessive-compulsive symptoms
Anxiety and depressionCommon in patient samples but not clearly more common in the general TS population
TS with both OCD and episodes of maniaSurprisingly high rates of mania in patients with TS and OCD shown in at least 2 studies, management frequently difficult
ADHD = attention deficit hyperactivity disorder; OCD = obsessive-compulsive disorder.
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