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 when 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).^[13]

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.

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.

Treatment & Management

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Author

Shikha Verma, MD, FAPA Senior Adolescent Psychiatrist, Medical Director of Northern California Evolve Treatment Centers; Assistant Professor, Department of Psychiatry and Behavioral Health, Chicago Medical School at Rosalind Franklin University of Medicine and Science

Shikha Verma, MD, FAPA is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Association of Physicians of Indian Origin, American Psychiatric Association, Autism Speaks, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

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.

Acknowledgements

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