Comorbidity in Tourette Syndrome: lifetime prevalence and risks

March 3, 2015 by  
Filed under Featured, Research

Finally we have a study that provides us with some analysis of comorbidity in Tourette Syndrome (TS)  based on a large sample size.

The Tourette Syndrome Association International Consortium for Genetics has published a report that looked at lifetime prevalence, clinical associations, ages of highest risk, and etiology of psychiatric comorbidity in 1,374 individuals with TS who were compared to 1,142 TS-unaffected family members.

Some of the key findings include:

  • The lifetime prevalence of any psychiatric comorbidity among individuals with TS was 85.7%;
  • 57.7% of individuals with TS had 2 or more psychiatric disorders.
  • 72.1% of individuals with TS met DSM-IV-TR diagnostic criteria for OCD or ADHD.
  • Other disorders, including mood, anxiety, and disruptive behavior, each occurred in approximately 30% of the participants.
  • The age of greatest risk for the onset of most comorbid psychiatric disorders was between 4 and 10 years, with the exception of eating and substance use disorders, which began in adolescence.
  • TS was associated with increased risk of anxiety and decreased risk of substance use disorders  independent from comorbid OCD and ADHD; however, high rates of mood disorders among participants with TS (29.8%) may be accounted for by comorbid OCD.
  • Parental history of ADHD was associated with a higher burden of non-OCD, non-ADHD comorbid psychiatric disorders.
  • Genetic correlations between TS and mood, anxiety, and disruptive behavior disorders may be accounted for by ADHD and, for mood disorders, by OCD.

Looking at their findings, there’s really nothing surprising in the rates of comorbidity nor the possibility that some comorbidity may be better accounted for by the presence of ADHD or OCD than by TS itself.

Referencce:
Hirschtritt ME, Lee PC, Pauls DL, Dion Y, Grados MA, Illmann C, King RA, Sandor P, McMahon WM, Lyon GJ, Cath DC, Kurlan R, Robertson MM, Osiecki L, Scharf JM, Mathews CA; for the Tourette Syndrome Association International Consortium for Genetics. Lifetime Prevalence, Age of Risk, and Genetic Relationships of Comorbid Psychiatric Disorders in Tourette Syndrome. JAMA Psychiatry. 2015 Feb 11. doi: 10.1001/jamapsychiatry.2014.2650. [Epub ahead of print]

Tourette Syndrome World Congress – London, June 24-26, 2015

March 2, 2015 by  
Filed under Event, Featured

The Tourette Syndrome Association (TSA), the European Society for the Study of Tourette Syndrome (ESSTS), Tourettes Action-UK (TA), along with other partners, are proud to present the 1st World Congress on Tourette Syndrome and Tic Disorders. As we join efforts to identify the cause(s) and work towards the development of improved treatments for Tic Disorders and associated conditions, new frontiers and global collaboration will be established.

The objective of this meeting is to provide a forum for disseminating current advances in all areas of TS within relevant scientific and medical communities. We anticipate that this Congress will also act as a catalyst for the synthesis of new ideas that will ultimately enhance our understanding of the disorder and result in the development of new treatments for TS, Tic Disorders and associated conditions. Cross-disciplinary communication will further promote the Congress’s goal of advancing our knowledge of TS by establishing new global networks for basic and clinical scientists.

The Tourette World Congress program will feature internationally renowned experts and speakers who will present the latest information on all aspects of TS, Tic Disorders and related conditions. Plenary sessions, poster sessions and scheduled discussions on controversial topics on Tic Disorders will be included. Several workshops and training programs will be held during the Congress.

TARGET AUDIENCE

The Tourette World Congress is targeted at scientists, clinicians and other professionals at all levels and who are interested in any area of research and drug development in TS, Tic Disorders and related conditions.

Researchers and care providers from academic, industry, healthcare, non-profit and governmental organizations are invited to participate in the meeting.

Allied health care professionals and those working in the areas of complementary and alternative treatments are welcome to join the Congress.

For more information on the conference and registration, visit the www.touretteworldcongress.org web site.

Temporal course of the tourette syndrome clinical triad.

October 25, 2014 by  
Filed under Research

A recently published study looks at the sequence in which tics, ADHD, and OCD emerges in development. In contrast to earlier studies that suggested that ADHD symptoms are usually evident earlier than tic symptoms, this study found that both emerged at around the same time. Because this is a retrospective survey, the accuracy of the findings depends, in part, on how accurate the participants’ memories are. Then, too, the survey does not ask the patients’ parents what their recall is of how symptoms emerged and when. Here’s the abstract:

BACKGROUND: Tourette syndrome (TS) is a disorder characterized by childhood onset of motor and phonic tics, often with improvement of tic symptoms by young adult years. The temporal course of tics and commonly comorbid behavioral symptoms is still not well characterized.
METHODS: In order to clarify the time course of tics and comorbid attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD) in TS, we administered a brief survey regarding the course of symptoms at a single point in time to 53 TS patients aged 13-31 years.
RESULTS: Mean age (±SD) at symptom onset was 7.9 (±3.6) years for tics, 7.9 (±3.5) for ADHD, and 9.2 (±5.0) for OCD. Age at peak symptom severity was 12.3 (±4.6) years for tics, 10.8 (±3.8) for ADHD, and 12.6 (±5.5) for OCD. Tics, ADHD, and OCD were reported to be no longer present in 32.0%, 22.8%, and 21.0% of subjects, respectively. Decline in symptom severity began at age 14.7 (±3.7) years for tics, 13.9 (±2.9) for ADHD, and 15.1 (±5.0) for OCD. Remission of symptoms occurred at age 17.4 (±3.8) years for tics, 17.4 (±1.3) for ADHD, and 15.6 (±2.3) for OCD.
DISCUSSION: Our data confirm and expand previously reported TS spectrum symptom milestones and may guide design of future research aimed at improving the course of TS.

Reference:
Shprecher DR1, Rubenstein LA2, Gannon K1, Frank SA3, Kurlan R4.. Temporal course of the tourette syndrome clinical triad. Tremor Other Hyperkinet Mov (N Y). 2014 Sep 26;4:243. doi: 10.7916/D8HD7SV6. eCollection 2014.

You can access the full article for free here.

Intensive outpatient comprehensive behavioral intervention for tics

October 25, 2014 by  
Filed under Research

A new study attempted to evaluate whether CBIT (Comprehensive Behavioral Intervention for Tics) could be provided intensively on an outpatient basis. Although the study reports only two cases and the study lacks important research controls, the results are promising and bear further investigation. Here’s the abstract:

Recent randomized clinical trials have established the efficacy of Comprehensive Behavioral Intervention for Tics (CBIT) in treating children and adults with Tourette syndrome and persistent tic disorders. However, the standard CBIT protocol uses a weekly outpatient treatment format (i.e., 8 sessions over 10 wk), which may be inconvenient or impractical for some patients, particularly patients, who are required to travel long distances in order to receive care. In contrast, an intensive outpatient program may increase accessibility to evidence-based behavioral treatments for Tourette syndrome and other persistent tic disorders by eliminating the necessity of repeated travel. This case series evaluated the use of an intensive outpatient program CBIT (IOP CBIT) for the treatment of 2 preadolescent males (ages 10 and 14 years) with Tourette syndrome. The IOP CBIT treatment protocol included several hours of daily treatment over a 4-d period. Both children evidenced notable reductions in their tics and maintained treatment gains at follow-up. Moreover, both patients and their parents expressed treatment satisfaction with the IOP CBIT format. This case series addresses an important research gap in the behavioral treatment of tic disorders literature. The patients’ treatment outcomes indicate that IOP CBIT is a promising treatment that warrants more systematic investigation.

Reference:

Blount TH, Lockhart AL, Garcia RV, Raj JJ, Peterson AL Intensive outpatient comprehensive behavioral intervention for tics: A case series. World J Clin Cases. 2014 Oct 16;2(10):569-77. doi: 10.12998/wjcc.v2.i10.569.

You can access the full article for free here.

NY: New Research Program for Children and Adolescents with Tourette’s Disorder

October 21, 2014 by  
Filed under Research

New Research Program for Children and Adolescents with Tourette’s Disorder

Tourette’s Syndrome is a neurological disorder involving motor tics (eye-blinking, mouth movements, head jerks, shoulder shrugs and arm/leg jerks) and/or vocal tics (fast meaningless sounds or noises, grunting, barks, shouting out single words or sentences, or repeating words) that start in childhood and persist over time.

Patients with mild symptoms of Tourette’s Syndrome are treated with behavioral techniques, but more troublesome cases require the use of drugs. Also, the diagnosis and treatment of Tourette’s Syndrome is complicated due to additional conditions including attention deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, and depression. These problems often require patients with Tourette’s to receive other medicines as well.

While the exact cause of Tourette’s Syndrome is unknown, disturbances in the chemicals controlling the nerves in the brain (neurotransmitters) are thought to play a major role. . Your child is invited to take part in a new clinical research program sponsored by Psyadon Pharmaceuticals which is using PSYRX101, a synthetic drug, where the active ingredient is Ecopipam, that acts as to stop the actions of one of these neurotransmitters and to help relieve the symptoms of Tourette’s.

Dr. Cathy Budman’s practice, in collaboration with the Feinstein Institute for Medical Research, is seeking those with a diagnosis of Tourette’s Syndrome and are willing to participate in this novel approach at treating tics in children and adolescents.

You CAN participate if you:

  • Have Tourette’s Syndrome
  • Exhibit both motor and vocal tics
  • Are male or female, ages 7 through 17
  • Weigh over 20kg (45lbs)

You CANNOT participate if you:

  • Have a history of schizophrenia, bipolar disorder, or other psychotic disorders
  • Have a history of attempted suicide
  • Have had a major depressive episode in the past 2 years
  • Have a history of seizures
  • Have had a myocardial infarction within the past 6 months
  • Is a Female who is pregnant or lactating

If your child is currently taking some medicines for their Tourette’s, they may need to stop taking them before they can take part since these other drugs may complicate the test. Please speak with Dr. Budman about what this will mean for your child. If you or someone you know would be interested in participating in this clinical trial, please call: Bibu Jacob, research coordinator, at 516-562-1012 or e-mail at bjacob3@NSHS.edu.

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