DOCSLIB.ORG

Update on Tourette Disorder

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

7/26/2019 Update on Tourette Disorder REBECCA K. LEHMAN, MD, FAAN ASSOCIATE PROFESSOR OF CLINICAL PEDIATRICS (CHILD NEUROLOGY) PALMETTO HEALTH-UNIVERSITY OF SOUTH CAROLINA MEDICAL GROUP PRISMA HEALTH CHILDREN’S HOSPITAL-MIDLANDS AUGUST 9, 2019 1 Disclosures Financial disclosures: Reimbursement from TAA for travel to MAB meeting and lectures. Participating (Sub-I/PI/Rater) in clinical trials for Neurocrine, Teva, and Emalex. Reimbursed for travel to investigator meetings. No other financial conflicts. All of the treatments for Tourette Disorder are off- label, with the following exceptions: Haloperidol (3 years and older) Pimozide (12 years and older) Aripiprazole (6-18 years) Tetrabenazine (orphan drug designation for children 5- 16 years) 2 1 7/26/2019 Objectives By the end of the lecture, attendees should be able to: Describe the clinical characteristics of tics Define Tourette Disorder (Syndrome) Review the symptom criteria for the diagnosis of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections) Examine the controversies surrounding the diagnosis and treatment of PANDAS List the neuropsychiatric conditions that commonly co-occur with TD Outline the range of management strategies for TD Identify resources that are available for patient education and support 3 What are tics? Movements or vocalizations that are: Sudden Abrupt Transient Repetitive Coordinated (stereotyped) 4 2 7/26/2019 Premonitory Urge Leckman JF, Walker DE, Cohen DJ, 1993. 5 Other Characteristics of Tics • Variable in appearance and frequency over time • Briefly suppressible • Worsened by stress and excitement • Often reduced by focused concentration • May persist in sleep but often abate 6 3 7/26/2019 Classification of Tics Tic Symptom Dimensions Examples Simple motor tics: Sudden, brief, Eye blinking, nose twitching, grimacing, grinning, pouting, meaningless movements mouth opening, head jerking, shoulder shrugging, abdominal or buttock tensing, kicking, finger movements, rapid jerking of any part of the body Complex motor tics: Slower, longer, more Sustained “looks,” facial gestures, biting, touching “purposeful” movements objects/self, thrusting arms, throwing, banging, gestures with hands, gyrating and bending, dystonic postures, copropraxia (obscene gestures) Simple phonic tics: Sudden, meaningless Throat clearing, coughing, sniffing, spitting, screeching, sounds or noises barking, grunting, gurgling, clacking, hissing, sucking, animal noises, and innumerable other sounds Complex phonic tics: Sudden, more Syllables, words or phrases (e.g., “Shut up!,” “Oh, okay.”); “meaningful” utterances speech atypicalities (variations in pitch, volume, etc.); palilalia (repetition of one’s own words) or echolalia (repetition of another’s words or phrases); coprolalia (obscene or inappropriate words or phrases) 7 I Have Tourette’s But Tourette’s Doesn’t Have Me 8 4 7/26/2019 9 Tourette Disorder (Syndrome) A. Both multiple motor and >/= 1 vocal tics have been present at some time during the illness, although not necessarily concurrently. B. The tics occur many times a day (usually in bouts), nearly every day or intermittently throughout a period of >1 year; and during this period, there was never a tic-free period of >3 consecutive months. C. Onset before age 18 years. D. The disturbance is not due to the direct physiological effects of a substance (e.g. stimulants) or a general medical condition (e.g. HD or post-viral encephalitis) 10 5 7/26/2019 Other Tic Disorders • Persistent (Chronic) Motor Tic Disorder • Multiple motor tics • Duration >1 year • Persistent (Chronic) Vocal Tic Disorder • Multiple vocal tics • Duration >1 year 11 Other Tic Disorders Provisional Tic Disorder Single or multiple motor and/or vocal tics Duration >4 weeks but <12 consecutive months Other Specified Tic Disorder, Unspecified Tic Disorder Any tic disorder that does not meet criteria for a specific tic disorder (e.g. tics lasting <4 weeks, onset after age 18) 12 6 7/26/2019 Epidemiology • Boys: girls = 3-4: 1 • Affects all ethnic groups • Prevalence among school-age children: Provisional (transient) tic disorders – 20-25% Chronic tic disorders – ~1% Tourette syndrome – 0.3-0.8% 13 Prevalence of TD Community studies* 0.6% Diagnosed + Not Diagnosed Suggests that ~50% of Ages 0-19 years children with TS are undiagnosed National survey data** 0.3% Diagnosed only Ages 6-17 years *Knight et al (2012), Scharf et al., 2014. **Bitsko et al. (2014), CDC (2009) 14 7 7/26/2019 Leckman, J. F. et al. Pediatrics 1998;102:14-19 Copyright ©1998 American Academy of Pediatrics 15 Take Home Point #1 16 8 7/26/2019 Differential Diagnosis Eye rolling -> Absence seizures Blinking -> Allergy, poor vision, blepharospasm Facial grimacing -> Dystonia Sniffing -> Allergy Scratching -> Scabies, lice, skin disorders Tics during sleep -> Hypnic myoclonus, PLMS, epilepsy, parasomnias Extremely exaggerated tics -> Functional movement disorder Other movement disorders (myoclonus, tremor, chorea, dystonia) Compulsions 17 PANDAS Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (Swedo et al, 1998) OCD and/ or tics Prepubertal onset Episodic (saw-tooth) course Associated with Group A beta-hemolytic Strep infections Association with neurological signs 18 9 7/26/2019 PANS Pediatric Acute-Onset Neuropsychiatric Syndrome (Swedo et al, 2012) Abrupt, dramatic onset OCD or severely restricted food intake Two or more of: Anxiety Emotional lability or depression Irritability, aggression, and/or severely oppositional behavior Behavioral regression Deterioration in school Sensory or motor abnormalities Somatic symptoms, including sleep disturbances, enuresis, and urinary frequency Symptoms not better explained by another neurological or medical disorder 19 Cunningham Panel Antibody Moleculara Upper Hesselmark Upper Limit of Normal Limit of Normal Calcium/ 130 197 Calmodulin Kinase II Anti-Dopamine 8,000 15,200 Receptor 1 Anti-Dopamine 16,000 18,400 Receptor 2 Lysoganglioside 640 1,280 GM01 Antibody Beta-Tubulin 1,000 8,000 Antibody 20 10 7/26/2019 21 Current State of Evidence Guidelines are based on expert consensus Insufficient, high-quality data to support the use of long-term antibiotics, immunomodulation, and/or tonsillectomy Treatment studies have small numbers of subjects Controlled studies have been negative No studies of more specific immunomodulators 22 11 7/26/2019 EMTICS: European Multicentre Tics in Children Studies Longitudinal, observational, prospective study involving 16 sites in Europe Goal: To investigate the association of environmental factors (GAS infection, psychosocial stress) with the onset and course of tics and/or OCD To characterize the immune response to microbial antigens and the hosts immune response regulation in association with onset and exacerbations of tics To increase knowledge of the human gene pathways influencing the pathogenesis of tic disorders To develop prediction models for the risk of onset and exacerbations of tic disorders https://cordis.europa.eu/project/rcn/102102/reporting/en 23 EMTICS Design ONSET cohort At-risk individuals N = 260 children aged 3-10 years who are tic-free at study entry and have a first-degree relative with a chronic tic disorder COURSE cohort Affected individuals N = 715 youth aged 3-16 years with a tic disorder 24 12 7/26/2019 EMTICS Conclusions No indication for a role of new GAS exposures in relation to exacerbations of tic disorders GAS infections are frequent and exposure at some point in childhood is nearly universal Co-occurrence of tic exacerbations and recent new GAS exposures is most likely due to chance Anti-GAS responses in patients with tics did not increase after tic exacerbations Assessing GAS exposure in children with tic disorders is not clinically meaningful Possible altered post-infectious immune response in patients with TD/ OCD 25 26 13 7/26/2019 Take Home Point #2 27 Co-morbid Conditions • ADHD • Anxiety/ OCD • Learning difficulties • Mood disorders • Impulse control disorders • Dysgraphia/ fine motor impairment 28 14 7/26/2019 Treatment of Tics Take Home Point #3: Not all patients require treatment Current treatments do not “cure” tics Think about treating patients whose tics are causing: Pain/injury Social distress Significant disturbance to others in classroom environment No scientific evidence to support the use of dietary interventions Take Home Point #4: Comorbid disorders are often more impairing than the tics themselves and are associated with poorer long-term outcomes. Assess for comorbid disorders and treat most impairing condition first. 29 Take Home Point #5 30 15 7/26/2019 31 Figure 2 . Mean change from Questionnaire-Teacher baseline on the Conners Abbreviated Symptom (ASQ- Teacher) at each evaluation visit for the four treatment groups. Error bars represent 1 SEM. CLON = clonidine; MPH = methylphenidate. Figure 3 . Mean change from baseline on the Yale Global Tic Severity Scale (Y-GTSS) at each evaluation visit for the four treatment groups. Error bars represent 1 SEM. CLON = clonidine; MPH = methylphenidate. (Tourette Syndrome Study Group, 2002) 32 16 7/26/2019 Take Home Point #6 Patients with TD/ CTD are at increased risk of suicide Clinicians must inquire about suicidal thoughts and suicide attempts in people with TS and refer to appropriate resources if present Fernandez del la Cruz L., Rydell M, Runeson B, et al. Suicide in Tourette’s and chronic
Recommended publications
  • Tourette Syndrome: Training for Law Enforcement

    Tourette Syndrome: Training for Law Enforcement

    Tourette Syndrome: Training for Law Enforcement 42-40 Bell Blvd., Suite 205, Bayside, NY 11361 tourette.org 888-4TOURET Understanding Tourette Syndrome & Tic Disorders: The Basics Tourette Syndrome (TS) is a type of Tic Disorder. Tics are involuntary, sudden, rapid repetitive movements and vocalizations. Tics are the defining feature of a group of childhood-onset, neurodevelopmental conditions. There are two types of tics— motor (movements) and vocal (sounds). As seen in the chart below, tics range from head shaking to throat clearing. You may see someone doing more than one tic at a time. It is important to note that you might encounter someone uttering obscenities, racial statements, or socially inappropriate phrases (corprolalia). However, only 1 in 10 individuals present this type of tic. It is also possible that you might encounter someone acting out obscene gestures (copropraxia). These tics, like all others, are involuntary. Types of Tics TYPES SIMPLE COMPLEX Motor Tics SUDDEN, BRIEF MOVEMENTS: MOVEMENTS ARE OFTEN Some Examples: Eye blinking, head shaking, face SLOWER AND MAY SEEM grimacing, shoulder shrugging, PURPOSEFUL IN APPEARANCE: abdominal tensing, or arm jerking Touching, tapping, hopping, squatting, skipping, jumping, or copropraxia (obscene gestures) Vocal Tics SUDDEN SOUNDS OR NOISES: WORDS OR PHRASES THAT Some Examples: Sniffing, coughing, spitting, OFTEN OCCUR OUT OF grunting, throat clearing, CONTEXT: Syllables, words or snorting, animal noises, phrases (“shut up”, “stop that”), squeaking, or shouting coprolalia (uttering of obscen- ities), palilalia (repeating own words), echolalia (repeating others’ words) Tic Challenges in Social Situations Tics can increase in high stress situations, such as being stopped by law enforcement.
  • Neurobiology of the Premonitory Urge in Tourette Syndrome: Pathophysiology and Treatment Implications

    Neurobiology of the Premonitory Urge in Tourette Syndrome: Pathophysiology and Treatment Implications

    View metadata, citation and similar papers at core.ac.uk brought to you by CORE HHS Public Access provided by Aston Publications Explorer Author manuscript Author ManuscriptAuthor Manuscript Author J Neuropsychiatry Manuscript Author Clin Neurosci Manuscript Author . Author manuscript; available in PMC 2017 April 28. Published in final edited form as: J Neuropsychiatry Clin Neurosci. 2017 ; 29(2): 95–104. doi:10.1176/appi.neuropsych.16070141. Neurobiology of the premonitory urge in Tourette syndrome: Pathophysiology and treatment implications Andrea E. Cavanna1,2,3,*, Kevin J Black4, Mark Hallett5, and Valerie Voon6,7,8 1Department of Neuropsychiatry Research Group, BSMHFT and University of Birmingham, Birmingham, UK 2School of Life and Health Sciences, Aston University, Birmingham, UK 3University College London and Institute of Neurology, London, UK 4Departments of Psychiatry, Neurology, Radiology, and Anatomy & Neuroscience, Washington University School of Medicine, St. Louis, MO, USA 5Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA 6Department of Psychiatry, University of Cambridge, Cambridge, UK 7Behavioural and Clinical Neurosciences Institute, Cambridge, UK 8Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK Abstract Motor and vocal tics are relatively common motor manifestations identified as the core features of Tourette syndrome. Although traditional descriptions have focused on objective phenomenological
  • Mozart's Scatological Disorder

    Mozart's Scatological Disorder

    loss in this study, previous work has been descriptive Our study shows that there is a potential for hearing in nature, presenting the numbers of cases of hearing damage in classical musicians and that some form of loss, presumed to have been noise induced orcomparing protection from excessive sound may occasionally be hearing levels with reference populations.'7-8 Both needed. these descriptive methods have shortcomings: the former depends on the definition of noise induced 1 Health and safety at work act 1974. London: HMSO, 1974. 2 Noise at work regulations 1989. London: HMSO, 1989. hearing loss, and the latter depends on identifying a 3 Sataloff RT. Hearing loss in musicians. AmJ Otol 1991;12:122-7. well matched reference population. Neither method of 4 Axelsson A, Lindgren F. Hearing in classical musicians. Acta Otolaryngol 1981; 377(suppl):3-74. presentation is amenable to the necessary statistical 5Burns W, Robinson DW. Audiometry in industry. J7 Soc Occup Med 1973;23: testing. We believe that our method is suitable for 86-91. estimating the risk ofhearing loss in classical musicians 6 Santucci M. Musicians can protect their hearing. Medical Problems ofPerforming Artists 1990;5:136-8. as it does not depend on identifying cases but uses 7 Rabinowitz J, Hausler R, Bristow G, Rey P. Study of the effects of very loud internal comparisons. Unfortunately, the numbers music on musicians in the Orchestra de la Suisse Romande. Medecine et Hygiene 1982;40:1-9. available limited the statistical power, but other 8 Royster JD. Sound exposures and hearing thresholds of symphony orchestra orchestras might be recruited to an extended study.
  • Tourette Syndrome; Is It an Annoying Disorder Or an Inspiring

    Tourette Syndrome; Is It an Annoying Disorder Or an Inspiring

    nd Ado a les ld c i e h n C t f B o e l Journal of Child & Adolescent h a a n v r i Zaky, J Child Adolesc Behav 2017, 5:4 u o o r J Behavior DOI: 10.4172/2375-4494.1000353 ISSN: 2375-4494 Review Article Open Acces Tourette Syndrome; Is It an Annoying Disorder or an Inspiring Companion??!!! Eman Ahmed Zaky* Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt *Corresponding author: Eman Ahmed Zaky, Professor of Pediatrics and Head of Child Psychiatry Unit, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt, Tel :+ 201062978734; E-mail: [email protected] Received date: Jul 10, 2017; Accepted date: Jul 10, 2017; Published date: Jul 17, 2017 Copyright: 2017 © Zaky EA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Tourette syndrome (TS) is a hereditary neurobehavioral disorder which starts early during childhood and manifests with a group of motor and one or more vocal tics for a duration of a year at least. It tends to be a lifelong chronic disorder with many remissions and exacerbations but in general, it is not a degenerative disease and has no negative percussions on intelligence or life span. Cases with TS need proper professional evaluation to exclude any differential diagnoses and detect any comorbidities. Cognitive Behavior Therapy (CBT), medications, and supportive intervention are indicated for cases with significant functional impairment.
  • Tourette's Syndrome

    Tourette's Syndrome

    Tourette’s Syndrome CHRISTOPHER KENNEY, MD; SHENG-HAN KUO, MD; and JOOHI JIMENEZ-SHAHED, MD Baylor College of Medicine, Houston, Texas Tourette’s syndrome is a movement disorder most commonly seen in school-age children. The incidence peaks around preadolescence with one half of cases resolving in early adult- hood. Tourette’s syndrome is the most common cause of tics, which are involuntary or semi- voluntary, sudden, brief, intermittent, repetitive movements (motor tics) or sounds (phonic tics). It is often associated with psychiatric comorbidities, mainly attention-deficit/hyperac- tivity disorder and obsessive-compulsive disorder. Given its diverse presentation, Tourette’s syndrome can mimic many hyperkinetic disorders, making the diagnosis challenging at times. The etiology of this syndrome is thought to be related to basal ganglia dysfunction. Treatment can be behavioral, pharmacologic, or surgical, and is dictated by the most incapacitating symp- toms. Alpha2-adrenergic agonists are the first line of pharmacologic therapy, but dopamine- receptor–blocking drugs are required for multiple, complex tics. Dopamine-receptor–blocking drugs are associated with potential side effects including sedation, weight gain, acute dystonic reactions, and tardive dyskinesia. Appropriate diagnosis and treatment can substantially improve quality of life and psychosocial functioning in affected children. (Am Fam Physician. 2008;77(5):651-658, 659-660. Copyright © 2008 American Academy of Family Physicians.) ▲ Patient information: n 1885, Georges Gilles de la Tourette normal context or in inappropriate situa- A handout on Tourette’s described the major clinical features tions, thus calling attention to the person syndrome, written by the authors of this article, is of the syndrome that now carries his because of their exaggerated, forceful, and provided on p.
  • Did Mozart Suffer from Gilles De La Tourette Syndrome?ଝ

    Did Mozart Suffer from Gilles De La Tourette Syndrome?ଝ

    r e v c o l o m b p s i q u i a t . 2 0 1 7;4 6(2):110–115 www.elsevier.es/rcp Epistemology, philosophy of the mind and bioethics Did Mozart suffer from Gilles de la Tourette syndrome?ଝ a,∗ b Leonardo Palacios-Sánchez , Juan Sebastián Botero-Meneses , c d d Laura Daniela Vergara-Méndez , Natalia Pachón , Arianna Martínez , d Santiago Ramírez a Departamento de Neurología, Universidad del Rosario, Bogotá, Colombia b Grupo de Investigación en Neurociencia (NEUROS), Universidad del Rosario, Bogotá, Colombia c Departamento de Pediatría, Universidad del Rosario, Bogotá, Colombia d Semillero de Investigación en Neurociencia, Bogotá, Colombia a r t i c l e i n f o a b s t r a c t Article history: The personal and private lives of great men and women in history, like writers, painters Received 1 April 2016 and musicians, have been the subject of great interest for many years. A clear example Accepted 4 May 2016 of this is the vast scrutiny is cast over the famous composer, Wolfgang Amadeus Mozart. Available online 3 June 2017 What may have started as curiosity, rapidly evolved into extensive research, as the answers about the musician’s legendary talent may lie in the details of his life (his childhood, his Keywords: relationships, his quirks and his mannerisms). It is usually up to historians, anthropologists or philosophers to delve into the pages of old books, trying to grasp answers and clues. Tourette syndrome Movement disorders However, for some time, physicians have sought their own part in solving the puzzle.
  • Tourette's Syndrome: a Review from a Developmental Perspective

    Tourette's Syndrome: a Review from a Developmental Perspective

    Isr J Psychiatry Relat Sci - Vol. 47 - No 2 (2010) Tourette's Syndrome: A Review from a Developmental Perspective Tamar Steinberg, MD, 1 Robert King, MD, 2 and Alan Apter, MD 1 1 The Harry Freund Neuro-Psychiatric Clinic, Schneider Children's Medical Center, Petah Tikva, Israel 2 Yale Child Study Center, New Haven, Connecticut, U.S.A. izations. Simple motor tics are sudden, fleeting or ABSTRACT fragmentary movements such as blinking, grimacing, head jerking, or shoulder shrugs. Complex motor tics The object of this review is to summarize some of the consist of several simple motor tics occurring in an recent developments in the understanding of Tourette’s orchestrated sequence or semi-purposeful movements, Syndrome which can be regarded as the prototype of a such as touching or tapping; these may also have a more developmental psychopathological entity. The review sustained, twisting, and dystonic character (2). covers the following topics: tics and their developmental Simple phonic tics consist of simple, unarticulated course; sensory phenomena related to tics including sounds such as throat clearing, sniffing, grunting, measurement of these phenomena; pathophysiology squeaking, or coughing. Complex phonic tics consist of of tics and compensatory phenomena and the parallel out-of-context syllables, words, phrases or paroxysmal development of the various psychiatric comorbidities as changes of prosody. they emerge over the life span. Finally there is an attempt Complex tics may involve socially inappropriate or to summarize the major points and future directions. obscene gestures (copropraxia) or utterances (coprola- lia), as well as echo phenomena, such as echolalia or echopraxia (repeating others’ words or gestures), which exemplify the suggestibility of tics.
  • Ziprasidone Monotherapy for Tourette Syndrome with Comorbid ADHD

    Ziprasidone Monotherapy for Tourette Syndrome with Comorbid ADHD

    f Ps al o ych rn ia u tr o y J Journal of Psychiatry Naguy and At-Tajali, J Psychiatry 2015, S1 DOI: 10.4172/2378-5756..S1-002 ISSN: 2378-5756 ShortResearch Communication Article OpenOpen Access Access Ziprasidone Monotherapy for Tourette Syndrome with Comorbid ADHD Ahmed Naguy1* and Ali At-Tajali2 1Child and Adolescent Psychiatrist, Kuwait Centre for Mental Health (KCMH), Kuwait 2General Adult Psychiatrist, Head of Neuromodulation Unit, KCMH, Kuwait Abbreviations: TS: de la Tourette Syndrome; OCD: Obsessive- There is no hard and fast rule, but antipsychotics, especially atypical Compulsive Disorder; PANDAS: Paediatric Autoimmune (AAPs), by and large, produce the most robust results controlling tics Neuropsychiatric Disorders Associated with Streptococcal Infection; when socially-embarrassing or functionally impairing. Nonetheless, ADHD: Attention-Deficit/Hyperactivity Disorder; AAP: Atypical clinicians ’enthusiasm is commonly tempered by the ominous Antipsychotics; ECG: Electrocardiogram; OPD: Outpatient metabolic and/or neurologic syndromes subsequent to antipsychotic Department; HRT: Habit Reversal Therapy; Y-GTSS: Yale-Global use. Pharmacologic options for TS are legion [11] (Table 4). Tic Severity Scale; IQ: Intelligence Quotient; DSST: Digital Symbol Here, we are reporting a case of adolescent TS with comorbid Substitution Test; CPT: Continuous Performance Test. severe ADHD where stimulants were deleterious for tics, atomoxetine (Strattera®) was ineffective addressing ADHD, and clonidine (Catapres®) Short Communication was too soporific
  • The ICD-10 Classification of Mental and Behavioural Disorders : Clinical Descriptions and Diagnostic Guidelines

    The ICD-10 Classification of Mental and Behavioural Disorders : Clinical Descriptions and Diagnostic Guidelines

    ICD-10 ThelCD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines | World Health Organization I Geneva I 1992 Reprinted 1993, 1994, 1995, 1998, 2000, 2002, 2004 WHO Library Cataloguing in Publication Data The ICD-10 classification of mental and behavioural disorders : clinical descriptions and diagnostic guidelines. 1.Mental disorders — classification 2.Mental disorders — diagnosis ISBN 92 4 154422 8 (NLM Classification: WM 15) © World Health Organization 1992 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications — whether for sale or for noncommercial distribution — should be addressed to Publications, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
  • Tourette Syndrome in Children

    Tourette Syndrome in Children

    Focus | Clinical Tourette syndrome in children Valsamma Eapen, Tim Usherwood UP TO 20% OF CHILDREN exhibit rapid jerky peak severity at the age of approximately movements (motor tics) that are made 10–12 years, and typically improve by without conscious intention as part of a adolescence or thereafter.6 Background Gilles de la Tourette syndrome (GTS), developmental phase that often lasts a few 1 characterised by motor and vocal tics, weeks to months. Similarly, involuntary has a prevalence of approximately 1% sounds, vocalisations or noises (vocal or Clinical features in school-aged children. Commonly phonic tics) such as coughing and even In addition to simple motor and vocal/ encountered comorbidities of GTS brief screams or shouts may be observed in phonic tics, complex tics may be present include attention deficit hyperactivity some children for brief periods of time. Tics (Table 1). Some complex tics – such as disorder (ADHD) and obsessive- lasting for a few weeks to months are known spitting, licking, kissing, etc – may be compulsive behaviour/disorder (OCB/ OCD). Genetic factors play an important as ‘transient tic disorder’. When single misunderstood or misinterpreted and part in the aetiology of GTS, and family or multiple motor or vocal tics – but not a may result in the young person getting members may exhibit tics or related combination of both – have been present in trouble, especially if these tics include disorders such as ADHD, OCB or OCD. for more than one year, the term ‘chronic involuntary and inappropriate obscene tic disorder’ is used. When both (multiple) gesturing (copropraxia) or copying the Objective The aim of this article is to present a motor and (one or more) vocal tics have been movements of other people (echopraxia).
  • How Tourette Syndrome Made Me the Teacher I Never Had Free

    How Tourette Syndrome Made Me the Teacher I Never Had Free

    FREE FRONT OF THE CLASS: HOW TOURETTE SYNDROME MADE ME THE TEACHER I NEVER HAD PDF Brad Cohen,Lisa Wysocky | 272 pages | 31 May 2009 | Griffin Publishing | 9780312571399 | English | California, United States Front of the Class: How Tourette Syndrome Made Me the Teacher I Never Had by Brad Cohen Brad Cohen's story starts when he is a young boy and his mother helps doctors to realize that he has Tourette syndrome. With the support from his mother and school principal, Brad is a success story, becoming a Front of the Class: How Tourette Syndrome Made Me the Teacher I Never Had speaker and an award-winning teacher. He constantly gets into trouble with his father Norman and his teachers at school due to his tics. In one class, his teacher calls him to the front to make him apologize to his class for disrupting the class and promise he won't do it again. Determined to find out what is wrong with her son, Ellen seeks medical help. A psychiatrist believes that Brad's tics are the result of his parents' divorce. One lady suggests an exorcism. Ellen takes her search to the library and comes across Tourette syndrome TS in a medical book. She shows this to the psychiatrist, who agrees with the diagnosis, and says that there is no cure. Brad and his mother attend a support group for the first and last time. From then on, Brad aspires to never be like the other members of the support group and to become successful. At the beginning of middle school, Brad is sent to the principal's office for being disruptive.
  • Introducing Your Line up of Speakers for This Year's 40Th Anniversary

    Introducing Your Line up of Speakers for This Year's 40Th Anniversary

    Introducing your line up of speakers for this year’s 40th Anniversary National Conference on Tourette Syndrome Plus… Edmonton, Alberta Fantasyland Hotel September 29 – October 1, 2016 Sarah Hoffman – Deputy Premier and Ministry of Health - Opening Ceremony Brad Cohen – Our Key Note Speaker Brad Cohen is an American motivational speaker, teacher, school administrator, and author who has severe Tourette syndrome (TS). Cohen described his experiences growing up with the condition in his book, Front of the Class: How Tourette Syndrome Made Me the Teacher I Never Had, co-authored with Lisa Wysocky. The book has been made into a Hallmark Hall of Fame TV movie titled Front of the Class.[ During his childhood, Cohen was accused of being a troublemaker in school and was punished by his teachers for the tics and noises caused by TS. He decided to "become the teacher that he never had". After he graduated and received his teaching certificate, 24 elementary schools rejected him before he was hired at Mountain View Elementary School in Cobb County, Georgia. As a new teacher, he was named Georgia's First Class Teacher of the Year. Dr. A. Carroll – “Tourette Syndrome – 130 years later – what do we know now?” Dr. Carroll, Psychiatrist at the Tourette Clinic in Edmonton will provide a brief overview of the history of Tourette Syndrome, understanding genetics, environmental influences, natural course and complimentary and traditional treatments Debra Kryzanowski – “Let Food be your medicine” Debra has a Bachelor of Science in Nursing and has been a Registered Nurse for 30 years in various capacities including teaching, geriatric psychiatry, management, and child psychiatry.