A Review and Update on Tourette Syndrome: Where Is the Field Headed?
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Tourette syndrome (TS) is a childhood onset neurologic disorder with manifestations including multiple motor and phonic tics, and in most cases a variety of behavioral comorbidities such as attention deficit hyperactivity disorder, obsessive compulsive disorder, and other impulse control disorders. Although it is considered a hereditary disorder, likely modified by environmental factors, genetic studies have yet to uncover relevant causative genes and there is no animal model that mimics the broad clinical phenomenology of TS. There has been a marked increase in the number of neurophysiological, neuroimaging, and other studies on TS. The findings from these studies, however, have been difficult to interpret because of small sample sizes, variability of symptoms across patients, and comorbidities. Although anti-dopaminergic drugs are the most widely used medications in the treatment of TS, there has been increasing interest in other drugs, behavioral therapies, and surgical approaches including deep brain stimulation. Herein, we review the current literature and discuss the complexities of TS and the challenges in understanding its pathophysiology and in selecting the most appropriate treatment. We also offer an expert’s view of where the field of TS may be headed.
KeywordsTourette syndrome Tic disorders Neurodevelopmental disorders Movement disorders
We would like to acknowledge the support of the TSA Center of Excellence located at the University of Florida Center for Movement Disorders and Neurorestoration. We would also like to acknowledge the following grant support NIH R34MH080764 (Okun), NIH R211NS072897 (Okun), and UF CTSI NIH KL2 Scholarship (Gunduz). The authors would also like to sincerely thank Drs. Don Gilbert, Tamara Hershey, Joseph Jankovic, Carol Mathews, Jon Mink, and Doug Woods for their insightful comments on this manuscript.
Aysegul Gunduz planned the outline of the manuscript, performed the literature search, drafted the text, designed the tables and figures, and approved the manuscript. Michael S. Okun planned the outline of the manuscript, contributed to and edited the text, contributed to the tables and figures, and approved the manuscript.
Compliance with Ethical Standards
The authors were not paid to write this article by a pharmaceutical company or other agency.
Conflict of Interest
Aysegul Gunduz has received research grants from the Michael J. Fox Foundation, UF Clinical and Translational Sciences Institute, and DARPA. The institution and not Dr. Gunduz receives grants from Medtronic, and Dr. Gunduz has financial interest in these grants.
Michael S. Okun serves as a consultant for the National Parkinson Foundation and has received research grants from NIH, NPF, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. Dr. Okun has previously received honoraria, but in the past >60 months has received no support from industry. Dr. Okun has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients, and Cambridge (movement disorders books). Dr. Okun is an associate editor for New England Journal of Medicine Journal Watch Neurology. Dr. Okun has participated in CME and educational activities on movement disorders (in the last 36 months) sponsored by PeerView, Prime, Quantia, Henry Stewart, and by Vanderbilt University. The institution and not Dr. Okun receives grants from Medtronic, Abbvie, and ANS/St. Jude, and the PI has no financial interest in these grants. Dr. Okun has participated as a site PI and/or co-I for several NIH, foundation, and industry-sponsored trials over the years but has not received honoraria.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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