Tourette's Syndrome Essay

Question 1

Tourette’s syndrome (TS)

Answer 1

Involves a number of clinical features including verbal and motor tics

Question 2

Tics

Answer 2

the most obvious and distinguishing symptom

brief actions (motor)
vocalisations (verbal)

Question 3

Range in complexity

Answer 3

simple recurrent acts like blinking and coughing, involving one muscle group

complex multiple co-occuring tics or elaborate action sequences, involving multiple motor groups

Question 4

Most common misconception about TS

Answer 4

People with the condition use inappropriate language and blurt out curse words
Often seen on TV and in movies
This is often not the case
Known as coprolalia
1 in 10 people
Complex tic
Hard to suppress/control
Embarrassing/ashamed

Question 5

Tics

Answer 5

Involuntary
Unwilled
Unchosen
Involuntary urge
Voluntarily releasing tic to relieve urge

Question 6

Prevalence, stress, comorbidity

Answer 6

1 in 100 (1%) population
Most find it gets better by late teens/early adulthood
Not understood why
Worse with stress - same as OCD
Comorbid with ADHD and OCD

Question 7

First line of treatment for TS

Answer 7

Habit reversal therapy
Two step process - awareness and competitive response training

Tic occurs, person acknowledges it, tells therapist, therapist gives counter response e.g sit on hand

Psychological intervention first line because physiological mechanism not fully understood

Question 8

Pharmacological treatments second line include

Answer 8

antiepileptics and neuroleptics (control gaba and glutamate balance)

Question 9

Dopamine blockers

Answer 9

haloperidol
risperidone
control tics
SE: weight gain, IRM

Question 10

Experimental techniques

Answer 10

transcranial magnetic stimulation
deep brain stimulation
invasive
not as common

Question 11

Mechanism not fully understood but thought to

Answer 11

primarily include BG

Question 12

in typical motor control

Answer 12

signals encoding motor plans from cortex enter cortico-striatal-thalamo-cortical circuit via putamen

Question 13

in TS dysregulation within basal ganglia

Answer 13

likely compromises inhibitory striatal outflow facilitating direct over indirect pathway activity

Question 14

as consequence, thalamic output to motor cortex

Answer 14

predisposes production of actions not signalled through corticostriatal pathway or weakly signalled

Question 15

postmortem data

Answer 15

revealed key insights into striatal dysfunction in TS with 50% reduction in GABAergic interneurons

Question 16

similar to HD chorea

Answer 16

reduction in GABA interneurons - unwanted movements

Question 17

findings in TS brains consistent with

Answer 17

altered neural migration during development

Question 18

Animal models

Answer 18

injection of GABA antagonist bucucilline into putamen leads to brief recurrent actions that closely resemble human tics

Question 19

potential mechanisms involving dysregulated synaptic communication and architecture include

Answer 19

neurologins
neurexins
GABAergic
glutamatergic AMPA receptor signalling suggested

Question 20

as well as mitochondrial function disturbances

Answer 20

proposed to alter energy balance within BG