Tourette Syndrome

1. Tourette Syndrome http://neuropsych.wikispaces.com/applegatej

2. What is Tourette Syndrome? • Neurological disorder • Involuntary body movements and vocal outbursts (tics) • Needs to be present for at least twelve months • Can not be caused by medication • The onset of Tourette Syndrome is prior to age 18

3. History • First case study was completed by Jean-Marc Itard, a French neurologist in 1825. • In 1855, Georges Albert de la Edouard Brutus Gilles de la Tourette detailed accounts of many case studies

4. Symptoms • Movement Tics • Involve head, torso, and upper or lower limb movements that the patient is unable to control • Verbal Tics • Coprolalia • Uttering obscenities • Occurs in only about 10% of people • Various words or sounds including • Clicks, grunts, yelps, barks, sniffs, snorts, and coughs

5. Symptoms… • Begin in early childhood • Between age 3 to 8 • Tics gradually worsen in severity and frequency • Adolescence is when they are the most severe • Can be triggered or made worse by stress

6. Prevalence • Occurs in 4 to 5 people out of 10,000 • Higher incidence rate in boys than girls • 1.5 to 3 times more often • 90 percent of individuals with Tourette experience a remission of symptoms in adulthood • 40 percent will become symptom free by age 18

7. Co-occurrence with Tourette • Obsessive Compulsive Disorder • Learning Disorders • Attention-deficit/hyperactivity Disorder • Distractibility • Impulsivity • Hyperactivity

8. NeurobiologyRegions of the brain that may be involved in Tourettes: Basal Ganglia, Striate, Thalamus • Basal Ganglia • Is involved with the control of movement • Has three parts, two of which are thought to be involved with Tourette • Caudate and Putamen • Striate (Primary Visual Cortex) • Sensitive to orientation and movement • The ventral Striate is related to habits and patterns of movement • Thalamus • Receives sensory information from sensory systems • Relay sensory information to specific areas in the cerebral cortex • The ventrolateral nucleus of the Thalamus is thought to be important in Tourette • It projects information from the cerebellum to the primary motor cortex

9. Neurobiology…Motor Cortex, Broca’s Area • Motor Cortex • Made of the Motor Association Cortex and the Primary Motor Cortex • Involved in planning and executing movements (Association Cortex) • Neurons are connected to various parts of the body (Motor Cortex) • Broca’s Area • Contains motor memories needed to articulate sound

10. Neuroimagingof Tourettehttp://www.emedicine.com/neuro/topic664.htm Caption: Tourette syndrome and other tic disorders. Segregated anatomy of the frontal-sub cortical circuits: dorsolateral (blue), lateral orbitofrontal (green), and anterior cingulate (red) circuits in the striatum (top), pallidum (center), and mediodorsal thalamus (bottom).

11. Frey, Kirk, A., Albin, Roger, L. (2006). Neuroimaging of tourette syndrome. Journal of Child Neurology, 21, 672-677 Brain Imaging of control in the first row Brain Imaging of Tourette patient in middle row Comparison in bottom row Looking at the basal ganglia

12. Neurochemicals Neurotransmitters Dopamine and Serotonin are implicated

13. Dopamine • Dopamine is a neurotransmitter involved in many activities including movement • Some studies suggest there is a higher pre-synaptic dopamine function in the caudate nucleus, putamen, and frontal cortex • Other studies suggest there are more Dopamine binding sites in the caudate nucleus • Dopamine is synthesized in four pathways • Nigrostriatal: pathway involved with control of movements and localized in caudate and putamen • Mesocortical: innervates regions of frontal cortex (motor cortex and motor association cortex) • Mesolimbic: deals with the ventral striatum, olfactory tubercle and parts of the limbic system • Tuberinfundibular: involved in parts of the brain that deal with stress (Collins, J & McCabe, P.)

14. Serotonin • Serotonin controls mood, eating, sleeping, and arousal • Serotonin levels of patients with Tourette is lower than those without • Serotonin neurotransmitters bind to receptor cites at a lower ratio • OCD may be the result of low Serotonin levels in those with Tourette Syndrome

15. Treatments • Medications do not eliminate symptoms, but can be used to control them • Medications block the D2 receptors to prevent Dopamine from binding to the cites • Antagonists for Dopamine are used to treat Tourette • Risperidone, Olanzapine, Ziprasidone, Sulpiride, Tiapride • Neuroleptics a the category of medications used to treat Tourette • Haloperidol, Pimozide, Fluphenazine, Trifluoperazine • Blocks post-synaptic dopamine sites

16. Implications for School Psychologists • Approximately 40% of students with Tourette also have a learning disability • Detailed records of behavior is needed to diagnose Tourette because there is no known test to determine it • Stress, excitement and fatigue may make tics worse • Provide information to parents, teachers and the child with Tourette • Provide a support system for children with Tourette, as they may have significant social problems (Collins, J. & McCabe, P.)

17. Works Cited Black, Kevein, J., , , . Tourette syndrome and other tic disorders. (2007, March 30). Retrieved May 19, 2007, from www.emedicine.com/neuro/topic664.htm Collins, J. &McCabe, P. (2004, Nov.) Neurochemical bases of tourette syndrome and implications for school psychologists. NASPCommunique. Retrieved May 20, 2007 from www.nasponline.org/publications/cq/mocq333pedsp_tourette.aspx Retrieved May 2, 2007, from www.faculty.washington.edu Retrieved May 2, 2007, from www.ninds.nih.gov Frey, Kirk, A., Albin, Roger, L. (2006). Neuroimaging of tourette syndrome. Journal of Child Neurology, 21, 672-677. Gerard, Elizabeth, &Pererson, Bradley, S. (2003). Developmental processes and brain imaging studies in tourette syndrome. Journal of Psychomatic Research, 55, 13-22. Harris, Kendra, & Singer, Harvey, S. (2006). Tic disorders: neural circuits, neurochemistry, and neuroimmunology. Journal of Child Neurology, 21, 678-689. Marshall, Ed, Paul. Retrieved May 2, 2007, from www.tourettes-disorder.com