TOURETTE SYNDROME
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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
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
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
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
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
Co-occurrence with Tourette
Obsessive Compulsive Disorder Learning Disorders Attention-deficit/hyperactivity Disorder
Distractibility Impulsivity Hyperactivity
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
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
Neuroimaging of 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).
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 rowBrain Imaging of Tourette patient in middle rowComparison in bottom row
Looking at the basal ganglia
NeurochemicalsNeurotransmitters Dopamine and Serotonin are implicated
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.)
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
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
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.)
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.eduRetrieved May 2, 2007, from www.ninds.nih.govFrey, 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
