Pediatric Tourette Syndrome Workup

  • Author: Jason S Hawley, MD; Chief Editor: Eduardo Dunayevich, MD   more...
 
Updated: Feb 7, 2012
 

Approach Considerations

Tourette syndrome (TS) is a clinical diagnosis; therefore, no specific laboratory or genetic tests exist to help establish the diagnosis. Routine community based neuroimaging studies (CT and MRI) are normal in patients with TS. The keys to diagnosis are recognition and an index of suspicion.

Neuroimaging studies performed on a research basis have yielded subtle abnormalities that may give clues to understanding the pathophysiology of TS. Children and adults with TS have reduced caudate volumes compared with controls. Moreover, recent studies have suggested that the degree of volume reduction within the caudate nucleus correlates with the severity of tics and obsessive-compulsive disorder (OCD).[12]

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Functional Magnetic Resonance Imaging

Event-related functional MRI studies of patients with tics have indicated that paralimbic and sensory association areas are critically implicated in tic generation, similar to movements triggered internally by unpleasant sensations, as has been shown for pain or itching.

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Positron-Emission Tomography

Positron-emission tomography (PET) studies have also shown increased activity in sensomotor, paralimbic, language, and frontal subcortical regions. This activity was event-related to motor and phonic tics, as well as the compulsions to perform these behaviors.

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Contributor Information and Disclosures
Author

Jason S Hawley, MD  Chief of Neurology, Carl R Darnall Army Medical Center

Jason S Hawley, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Chief Editor

Eduardo Dunayevich, MD  Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories

Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

Additional Contributors

Sharette K Gray, MD Chief of Outpatient Psychiatry, Carl R Darnall Army Medical Center

Sharette K Gray, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Mark E Landau, MD Neurology Program Director, National Capital Consortium, Associate Professor, Uniformed Services University of the Health Science, Neurophysiology Section, Department of Neurology, Walter Reed Army Medical Center

Mark E Landau, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Jennifer S Morse, MD Associate Medical Director, Optum Health

Jennifer S Morse, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, Aerospace Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Emad Soliman, MD, MSc Consulting Staff, Department of Neurology, St John's Riverside Hospital

Emad Soliman, MD, MSc is a member of the following medical societies: American Academy of Neurology and American Medical Association

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

References

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  2. Bohlhalter S, Goldfine A, Matteson S, Garraux G, Hanakawa T, Kansaku K, et al. Neural correlates of tic generation in Tourette syndrome: an event-related functional MRI study. Brain. Aug 2006;129:2029-37. [Medline].

  3. Singer HS. Tourette's syndrome: from behaviour to biology. Lancet Neurol. Mar 2005;4(3):149-59. [Medline].

  4. Comella CL. Gilles de la Tourette's syndrome and other tic disorders. CONTINUUM: Lifelong Learning in Neurology. June 2004;10 (3):128-41.

  5. Alsobrook JP 2nd, Pauls DL. The genetics of Tourette syndrome. Neurol Clin. May 1997;15(2):381-93. [Medline].

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

  7. Simonic I, Nyholt DR, Gericke GS, Gordon D, Matsumoto N, Ledbetter DH, et al. Further evidence for linkage of Gilles de la Tourette syndrome (GTS) susceptibility loci on chromosomes 2p11, 8q22 and 11q23-24 in South African Afrikaners. Am J Med Genet. Mar 8 2001;105(2):163-7. [Medline].

  8. Tanner CM, Goldman SM. Epidemiology of Tourette syndrome. Neurol Clin. May 1997;15(2):395-402. [Medline].

  9. Kadesjo B, Gillberg C. Tourette's disorder: epidemiology and comorbidity in primary school children. J Am Acad Child Adolesc Psychiatry. May 2000;39(5):548-55. [Medline].

  10. Scharf JM, Miller LL, Mathews CA, Ben-Shlomo Y. Prevalence of tourette syndrome and chronic tics in the population-based avon longitudinal study of parents and children cohort. J Am Acad Child Adolesc Psychiatry. Feb 2012;51(2):192-201.e5. [Medline].

  11. Cheung MY, Shahed J, Jankovic J. Malignant Tourette syndrome. Mov Disord. Sep 15 2007;22(12):1743-50. [Medline].

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

  13. Shavitt RG, Hounie AG, Rosário Campos MC, Miguel EC. Tourette's Syndrome. Psychiatr Clin North Am. Jun 2006;29(2):471-86. [Medline].

  14. Visser-Vandewalle V, Ackermans L, van der Linden C, Temel Y, Tijssen MA, Schruers KR, et al. Deep brain stimulation in Gilles de la Tourette's syndrome. Neurosurgery. Mar 2006;58(3):E590. [Medline].

 
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