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08-02-04 a Closer Look at the History and Genetics of Tourette Syndrome Salud Mental 2008;31:103-110 History and genetics of Tourette syndrome A closer look at the history and genetics of Tourette syndrome Adriana Díaz-Anzaldúa,1 Guy A. Rouleau2 Artículo original SUMMARY functioning of the patients. With respect to the age of onset, the ICD- 10 Classification of Mental and Behavioural Disorders describes the Tourette syndrome (TS) was named after Georges Albert Edouard onset almost always in childhood or adolescence, and in this way it Brutus Gilles de la Tourette, who made its first formal description at would no longer exclude cases with later onset. Numerous studies the end of the 19th century. Nevertheless, some evidence indicates the confirmed in the 20th century that genetics plays an important role in disorder may have been recognised at least two thousand years ago. the etiology of TS. Family studies proved that the disease runs in Tic like behaviours were recorded by Aretaeus of Cappadocia and families. First-degree relatives of TS patients are indeed in greater several centuries later by Sprenger and Kraemer, followed by other risk for TS than the general population. Twin and adoption studies descriptions. The English writer Samuel Johnson, author of the first demonstrated that genes have an important role in the etiology of TS, English Language Dictionary, showed repetitive body twitches, facial and as much as 90% of the vulnerability to this syndrome could be grimaces, barks and grunts, among other tics. He was observed in affected by genes. In addition, environmental, epigenetic and even situations such as going in or out at a door using a certain number of stochastic factors may affect the susceptibility to TS. steps, from a certain point, which indicated he had also obsessive- At the molecular level, linkage in families and association in compulsive behaviour. There was some evidence of features of TS as unrelated TS subjects have been the main methods used to search for well as co-morbid conditions such as hyperactivity, obsessive- vulnerability genes. Sequencing of almost the entire human genome compulsive behaviour or rage attacks in other famous artists and world made it possible to assess the gene expression of thousands of genes leaders. Some authors have even proposed that the creative, on a single chip; recent studies reported a preliminary specific profile determined, competitive, and persistent nature of certain people may in the blood of TS patients. If confirmed, this finding could be useful in be related to the presence of TS. the identification of genetic factors related with TS. Clinicians have observed that some patients are particularly Given the multi-factorial nature of TS, a thorough clinical sensitive to the feelings and experiences of others, and more prone to description in large samples should be considered; besides association, outside stimuli. In this way, empathy could be a common quality in linkage and sequencing studies, possible gene-gene and gene- these patients. In 1825, Jean Marc Gaspard Itard made the first known environment interactions would also need to be analysed, as well as medical description of TS based on two cases, one of which was later epigenetic factors, and gene expression patterns. followed by Jean-Martin Charcot. In 1885 Gilles de la Tourette put together information from previous fragmented reports and wrote a Key words: Tourette syndrome, Gilles de la Tourette syndrome, complete and formal description, thus establishing a novel clinical Georges Gilles de la Tourette, genetics of Tourette syndrome, tic entity. Behavioural abnormalities such as obsessions, compulsions, disorder. inattentiveness and hyperactivity, commonly observed in TS patients, were considered mental tics at the time. Current diagnostic criteria are very similar to Gilles de la Tourette’s description. TS is characterized RESUMEN by the presence of multiple motor and one or more vocal tics. In this disorder, tics are not caused by the direct physiologic effects of a El síndrome de Gilles de la Tourette (SGT) se nombró asi en honor de substance or a general medical condition. Tic symptomatology is Georges Albert Edouard Brutus Gilles de la Tourette, alumno de persistent for over a year, and in this period, tics are not absent for Charcot, quien realizó la primera descripción formal de esta entidad more than three consecutive months. clínica a finales del siglo XIX. Sin embargo, hay evidencias que indican There is no exact consensus between the DSM-IV and the Tourette que probablemente el trastorno se había identificado de alguna Syndrome Classification Study Group of whether the age of onset manera desde hace por lo menos dos mil años. Areteo de Capadocia should be prior to 18 or 21 years of age, how cases of onset after 21 registró conductas similares a los tics, también descritas por Sprenger years should be diagnosed, and if marked distress or significant y Kraemer en el siglo XV y más adelante por otros. El escritor inglés impairment caused by tics is necessary to define the condition as Samuel Johnson, autor del primer Diccionario de la Lengua Inglesa, definite TS. However, the text revision of the DSM-IV (TR) no longer mostraba contorsiones en todo el cuerpo, muecas, ladridos y gruñidos, specifies that TS symptoms have to cause distress or impair the entre otros tics. Se le observaba entrando o saliendo por una puerta 1 Departamento de Genética, Instituto Nacional de Psiquiatría Ramón de la Fuente, Calz. México-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, 14370, México, D. F. E-mail Adriana Díaz Anzaldúa [email protected], Fax: 5513-3722. 2 Guy A. Rouleau, M.D., Ph.D., F.R.C.P.(C). Centre for the Study of Brain Diseases,CHUM Research Centre Notre Dame Hospital, J.A. de Sève Pavillion, Room Y-3633, 1560 Sherbrooke Street East, Montreal, QC H2L 4M1, Canada. Recibido: 9 de octubre de 2007. Aceptado: 5 de diciembre de 2007. Vol. 31, No. 2, marzo-abril 2008 103 Díaz Anzaldúa y Rouleau con un número determinado de pasos a partir de un punto dado, lo incapacidad en el funcionamiento diario de los pacientes. En cuanto cual indica que también presentaba conducta obsesivo- compulsiva. a la edad de inicio, si la Clasificación de los Trastornos Mentales y de Además, otros artistas y líderes mundiales han presentado la Conducta (CIE-10) describe que la edad de inicio casi siempre es características del SGT y de padecimientos comórbidos como el en la niñez o adolescencia, de esta manera ya no excluye la posibilidad trastorno por déficit de atención e hiperactividad, el trastorno obsesivo- de edades de inicio más avanzadas. compulsivo o ataques de ira. Un grupo de autores ha llegado a Gracias a diversos estudios, durante el siglo XX se pudo confirmar considerar que la naturaleza creativa, determinada, competitiva y que la genética es decisiva en la etiología del SGT. Por medio de estudios persistente en ciertas personas podría relacionarse con el SGT. Algunos en familias se confirmó que el trastorno se concentra particularmente especialistas del área médica han observado que ciertos pacientes en ciertas familias. Los parientes en primer grado de un paciente con con SGT son particularmente sensibles a los sentimientos y SGT se encuentran en mayor riesgo de presentar el trastorno que la experiencias de otras personas y más propensos a los estímulos población en general. Estudios realizados en pares de gemelos y externos. Por lo tanto, la empatía podría ser una cualidad común en personas adoptadas confirmaron que los genes tienen un peso estos pacientes. importante en el aumento de la susceptibilidad al SGT. Se ha estimado En 1825, Jean Marc Gaspard Itard realizó la primera descripción que hasta 90% de la vulnerabilidad al trastorno podría estar afectada médica conocida del SGT, basándose en dos casos, uno de los cuales por los genes. Aunados a estos factores hereditarios que dependen fue estudiado más adelante por Charcot. En 1885, Gilles de la Tourette directamente de la secuencia del ADN de nuestras células nucleadas, reunió fragmentos de información de reportes previos y redactó una se encuentran otros factores que afectan en cierto grado la susceptibilidad descripción formal y completa del trastorno, con lo que estableció al SGT, como los de tipo ambiental, epigenético o aleatorio. una nueva entidad clínica. Las anormalidades del tipo de obsesiones, A nivel molecular, los principales diseños para el estudio del compulsiones, inatención e hiperactividad se consideraban tics SGT y la búsqueda de genes de susceptibilidad han sido el enlace mentales en esa época. Los criterios diagnósticos actuales del SGT genético (linkage) en familias y los estudios de asociación en pacientes son muy similares a los publicados por Gilles de la Tourette. El SGT no emparentados. La secuenciación de prácticamente todo el genoma se caracteriza sobre todo por la presencia de dos o más tics motores humano ha permitido, entre otras cosas, identificar la expresión de y uno o más tics fónicos. En este trastorno, los tics no son causados miles de genes en un solo chip. De acuerdo con estudios preliminares por el efecto fisiológico directo de una droga o por una affeción recientes, podría haber un patrón específico de expresión en sangre médica general. La sintomatología de los tics persiste por más de un de pacientes con SGT. Si esto se llegara a confirmar, los hallazgos año y en este periodo los tics no se ausentan por más de tres meses podrían emplearse para facilitar la identificación de factores genéticos consecutivos. de riesgo para el SGT. Tomando en cuenta la naturaleza multifactorial No hay un consenso preciso entre el DSM-IV y el Grupo de Estudio del SGT, se requiere además de estudios de enlace genético, de la Clasificación del Síndrome de Gilles de la Tourette en relación asociación y secuenciación, análisis sobre interacciones de tipo gen- con la edad de inicio: si debe ser antes de los 18 o los 21 años, cómo gen y gen-ambiente, así como la identificación de factores epigenéticos deben considerarse casos de inicio posterior a los 21 años y si para y de niveles de expresión genética en el SGT.
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