Sensitivity to external stimulation in Tourette syndrome

One common observation in working with children and adults with Tourette syndrome (TS) is that they often have what appears to be a heightened sensitivity to the environment.  An interesting study was published in the October 28 issue of Movement Disorders that looks at this issue. Here’s the Abstract:

… In this study (1) we defined the patients’ experience of sensitivity to external stimuli in detail, and (2) we tested 2 hypotheses regarding its origin. First, we interviewed in depth and administered a lengthy questionnaire to adult Tourette patients (n = 19) and age-matched healthy volunteers (n = 19). Eighty percent of patients described heightened sensitivity to external stimuli, with examples among all 5 sensory modalities. Bothersome stimuli were characterized as faint, repetitive or constant, and nonsalient, whereas intense stimuli were well tolerated. We then determined whether the sensitivity could be the result of an increased ability to detect faint stimuli. After measuring the threshold of detection for olfactory and tactile stimuli among the patients and healthy volunteers, we found no significant differences between them for either sensory modality. These results indicate that patients’ perceived sensitivity derives from altered central processing rather than enhanced peripheral detection. Last, we assessed one aspect of processing: the perception of intensity. When subjects rated the intensity of near-threshold tactile and olfactory stimuli, there was a surprising difference: Tourette patients more frequently used the lowest range of the scale than did healthy volunteers. Future research is necessary to define the anatomical and physiological basis of the patients’ experience of heightened sensitivity.

So what does this mean? It seems that individuals with TS do not have an enhanced ability to detect mild sensory stimulation and recognize it as mild – they are just more bothered by it?  If so, that might help explain some of the distractibility and irritation individuals with TS often report. Imagine if you were sitting in a classroom and the soft thumping of a motor in a nearby room was driving you crazy – even though no one else seemed to be bothered by it…

I have occasionally recommended that parents of my young patients take them to an occupational therapist for a sensory integration evaluation. This study, while raising as many questions as it answers, offers some confirmation to my thinking that we need to pay much more attention to the sensory aspects of TS – both the internal urges (prodromes) and the heightened reactivity to external stimuli.

Of Tics and Compulsions: Brain Imaging Teases Apart Tourette’s and Obsessive-Compulsive Disorder

Anyone who has parented, taught, or treated individuals with both Tourette syndrome (TS) and Obsessive-Compulsive Disorder (OCD) knows how difficult it can be at times to tease out whether something is a complex tic or a compulsion.  Can brain imaging help us?  Melinda Wenner Moyer writes in the September issue Scientific American:

… Now a new study published in Neurology may help scientists further understand how the disorders overlap and differ by revealing several key differences in the brain activity of Tourette’s patients with and without OCD.

Andrew Feigin and his colleagues at North Shore LIJ Health System in Manhasset, N.Y., scanned the brains of 12 unmedicated Tourette’s patients—some of whom also had OCD—and 12 healthy subjects using positron-emission tomography, which reveals patterns of brain activity. Compared with healthy controls, those who had Tourette’s exhibited more activity in the premotor cortex and cerebellum, regions that handle motor control, and less activity in the striatum and orbitofrontal cortex, areas involved in decision making and learning. These findings support the idea that the symptoms of the disorder may arise from the brain’s inability to suppress abnormal actions using decision-making skills.

When the researchers compared the Tourette’s patients who had OCD with those who did not, they found that the patients who had both disorders exhibited greater activity in the primary motor cortex and precuneus, an area that plays a role in self-awareness. Previous research has suggested that in patients who suffer from both disorders, OCD might show up more in the form of compulsions than obsessions, and these findings support that idea: the increased activity of the precuneus may reflect individuals’ efforts and ability to resist obsessive thought, and the motor cortex may be more active because OCD is manifesting itself more physically than mentally.

 

The full article is only available to those who subscribe to or have access to Scientific American

New Documentary on Tourette Syndrome to Premier Thursday, September 15th

The Brad Cohen Tourette Foundation sent out this announcement:

Different is the New Normal will premier on Thursday, September 15th at 8pm (EST) on THIRTEEN (WNET, public television in NY) and then again on Saturday, September 17th at 3:30am (EST)

It will air on Tuesday, September 20th at 10 pm (EST) on NJTV (public television in NJ) then again Thursday, September 22nd at 4 am (EST), Sunday, September 25th at 5 am (EST) ) and Sunday, September 25th at 11 pm (EST), Tuesday, September 27th at 10:30 pm (EST) on WLIW21 (public television in metropolitan and suburban NYC and NJ)

After the broadcast, it will be on this website for a limited time: http://watch.thirteen.org/

The one hour film is about the life of Chicago native Ariel Small, a teen with Tourette Syndrome who inspires others living with TS to be the best they can be. American Idol star James Durbin makes an appearance as he discusses how he has overcome TS himself. This show is informational, educational, and an honest portrayal of what life is like for someone with TS. Follow one kids journey to be normal and accepted by others and how he became empowered to educate the world about TS.

“Different Is the New Normal captures the pain and frustration many parents and their children experience,” said Neal Shapiro, WNET’s President and CEO. “Ariel’s inspirational story provides an uplifting perspective to this often misunderstood disorder, and will inspire everyone who watches this film to think about people as individuals, not as labels.”

Just like my story, Ariel Small will show America that just because a person has TS, we don’t have to allow TS to win. This inspirational show is nicely done and without a doubt will help others understand what living with TS is all about. I give it two thumbs up and after viewing it, I think you do the same.

Join Me at an All-Day Workshop for Educators & Parents on December 5th

I’ll be conducting an all-day workshop for educators on Monday, December 5, 2011 at the Grappone Conference Center in Concord, New Hampshire. The event is sponsored by the University of New Hampshire Institute on Disability and is geared to regular and special education teachers, school psychologists and social workers, behavior specialists, occupational therapists, administrators, and parents.

Description:

Neurological disorders that emerge in childhood often have significant impact on students’ academic, behavioral, and social-emotional functioning. Participants will learn about the cardinal features of Tourette’s Syndrome, Obsessive-Compulsive Disorder, Attention Deficit Hyperactivity Disorder, Executive Dysfunction, Mood Disorders such as Depression and Bipolar Disorder, and the memory deficits, sensory issues and “storms” that sometimes accompany them. Strategies and assistive technology to accommodate symptom interference in activities such as handwriting, homework, math calculation, and written expression and big projects will be described. Pitfalls in behavioral interventions, and simple social skills and problem-solving interventions will also be identified.

For more information on the workshop and registration information, download the brochure or register online at www.iod.unh.edu.

Hope to see you there!

 

Behavior therapy for tics in children may have other long-term beneficial effects

Finding effective non-medication treatments for Tourette’s and other disorders is undeniably important. The emergence of Comprehensive Behavior Intervention Tics, a form of behavior therapy, has increased the clinician’s toolbox by offering another way to help patients reduce tics. A recent research study by Drs. Douglas Woods, John Piacentini, and their colleagues suggests that not only may the treatment ameliorate tics, but for those children and teens who do respond to the treatment, there may be long-term benefit in terms of overall psychosocial functioning. Here’s the Abstract of the study:

Children (n = 126) ages 9 to 17 years with chronic tic or Tourette disorder were randomly assigned to receive either behavior therapy or a control treatment over 10 weeks. This study examined acute effects of behavior therapy on secondary psychiatric symptoms and psychosocial functioning and long-term effects on these measures for behavior therapy responders only. Baseline and end point assessments conducted by a masked independent evaluator assessed several secondary psychiatric symptoms and measures of psychosocial functioning. Responders to behavior therapy at the end of the acute phase were reassessed at 3-month and 6-month follow-up. Children in the behavior therapy and control conditions did not differentially improve on secondary psychiatric or psychosocial outcome measures at the end of the acute phase. At 6-month posttreatment, positive response to behavior therapy was associated with decreased anxiety, disruptive behavior, and family strain and improved social functioning. Behavior therapy is a tic-specific treatment for children with tic disorders.

The study is:

J Child Neurol. 2011 May 9.
Behavior Therapy for Tics in Children: Acute and Long-Term Effects on Psychiatric and Psychosocial Functioning.
Woods DW, Piacentini JC, Scahill L, Peterson AL, Wilhelm S, Chang S, Deckersbach T, McGuire J, Specht M, Conelea CA, Rozenman M, Dzuria J, Liu H, Levi-Pearl S, Walkup JT.

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