1. Tourette Syndrome (TS) TS is a neurodevelopmental disorder that is characterized by involuntary motor movements and vocalizations called Tics 1 Tics are rapid, repetitive, and stereotyped movements or vocalizations –The quantity and complexity of the tics fluctuate over time TS is a chronic condition that is frequently associated with difficulties in self-esteem, school performance, social acceptance, and family life. TS is chronic and usually emerges between ages 2 to 15 (~50% affected by age 7) 1-2 TS is more common in males than females by a ratio of about 5 to 1. 1-2 TS is not a rare disorder, with the number of children affected estimated to be 7 in 1000. 1-2

2. Other Characteristics of TS Other symptoms associated with TS: 3-4 –speech and conduct problems –mood instability, anxiety, obsessive-compulsive symptoms –impulsivity, distractibility, motor hyperactivity, –learning problems Common Co-morbidities: –ADHD (55%) 5 –Obsessive-Compulsive Disorder (OCD) (20-60%) 6 -8 –Referred to as ‘TS-plus’ –More severe tics, higher the psychiatric co-morbidity Neuropsychological deficits 9

3. Causes of TS Serotonogic & dopaminergic neurotransmitter systems 1 –Tics and comorbidities improve with use of SSRIs and dopamine-receptor blockers TS has been linked to disruption of brain areas: 1,10,11 –Frontal areas –basal ganglia –Caudate Genetics plays a role 1 –Relatives have higher rates of Tics, OCD, and ADHD –High concordance rate in monozygotic twins

4. Prognosis Tics peak between 8 and 12 years 12 Most Tics are gone by adulthood (only 20% still have significant Tics in adulthood) 12 Treatment: 1 –Medications –Behavior Therapy –Counseling –Cognitive therapy –Relaxation theory –Awareness and assertiveness training –Habit reversal training

5. References 1.Kenney C, Kuo S, Jimenez-Shahed J. Tourette's Syndrome. Am Fam Physician. 2008;77:651-658. 2.Hirtz D, Thurman D, Gwinn-Hardy K, Mohamed M, Chaudhuri A, Zalutsky R. How common are the "Common" Neurologic disorders? Neurology. 2007;68:326-337. 3.Lekman J, Yeh C, Lombroso P. Neurobiology of tic disorders, including Tourette's Syndrome. Pediatric Psychopharmacology: Oxford University Press. 2003;164-174. 4.Shapiro A, Shapiro E, Young J, Feinberg T, eds. Gilles de la Tourette Syndrome, 2nd ed. New York: Raven Press;1988. 5.Freeman R. Tic disorders and ADHD: Answers from a world-wide clinical dataset on Tourette Syndrome. Eur Child Adolesc Psychiatry. 2007;16(Suppl 1):15-23. 6.Apter A, Pauls D, Bleich A, et al. An epidemiologic study of Gilles de la Tourette's Syndrome in Israel. Arch Gen Psychiatry. 1993;50:734-738. 7.Cath D, Spinhoven P, van Woerkom T, et al. Gilles de la Tourette's Syndrome with and without obsessive- compulsive disorder compared with obsessive-compulsive disorder without tics: Which symptoms discriminate? J Nerv Ment Dis. 2001;189:219-228. 8.Pitman R, Green R, Jenike M, Mesulam M. Clinical comparison of Tourette's disorder and obsessive- compulsive disorder. Am J Psychiatry. 1987;144:1166-1171. 9.Bornstein R, King G, Carroll A. Neuropsychological abnormalities in Gilles de la Tourette's Syndrome. J Nerv Ment Dis. 1983;171:497-502. 10.Robertson M. Tourette Syndrome, associated conditions and the complexities of treatment. Brain. 2000;123(Pt 3):425-462. 11.Mink JW. Neurobiology of basal ganglia circuits in Tourette Syndrome: Faulty inhibition of unwanted motor patterns? Adv Neurol. 2001;85:113-122. 12.Leckman, JF., Bloch, M., Scahill, L., & King, R. (2006). Tourette Syndrome: The self under siege, Journal of Child Neurology, 21.