Gilles de la Tourette syndrome

Nature Reviews Disease Primers volume 3, Article number: 16097 (2017) Cite this article

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Abstract

Gilles de la Tourette syndrome (GTS) is a childhood-onset neurodevelopmental disorder that is characterized by several motor and phonic tics. Tics usually develop before 10 years of age, exhibit a waxing and waning course and typically improve with increasing age. A prevalence of approximately 1% is estimated in children and adolescents. The condition can result in considerable social stigma and poor quality of life, especially when tics are severe (for example, with coprolalia (swearing tics) and self-injurious behaviours) or when GTS is accompanied by attention-deficit/hyperactivity disorder, obsessive–compulsive disorder or another neuropsychiatric disorder. The aetiology is complex and multifactorial. GTS is considered to be polygenic, involving multiple common risk variants combined with rare, inherited or de novo mutations. These as well as non-genetic factors (such as perinatal events and immunological factors) are likely to contribute to the heterogeneity of the clinical phenotype, the structural and functional brain anomalies and the neural circuitry involvement. Management usually includes psychoeducation and reassurance, behavioural methods, pharmacotherapy and, rarely, functional neurosurgery. Future research that integrates clinical and neurobiological data, including neuroimaging and genetics, is expected to reveal the pathogenesis of GTS at the neural circuit level, which may lead to targeted interventions.

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Figure 1: Key events in the history of Gilles de la Tourette syndrome.
Figure 2: Course of tic severity in Gilles de la Tourette syndrome.
Figure 3: Genetic architecture of Gilles de la Tourette syndrome and related developmental tic disorders.
Figure 4: CSTC circuit.
Figure 5: Decision tree for the management of Gilles de la Tourette syndrome.
Figure 6: Stylized depiction of quality-of-life domains affected in Gilles de la Tourette syndrome.

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Acknowledgements

The authors acknowledge all their patients and their families for their time, patience and teaching us all more about Gilles de la Tourette syndrome.

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Affiliations

  1. Department of Neuropsychiatry, UCL Division of Psychiatry, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
    • Mary M. Robertson
  2. Department of Psychiatry, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
    • Mary M. Robertson
  3. Infant, Child and Adolescent Psychiatry, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
    • Valsamma Eapen
    •  & Rudi Črnčec
  4. Academic Unit of Child Psychiatry, South Western Sydney Local Health District and Ingham Institute, Liverpool Hospital, Mental Health Centre, Locked Bag 7103, Liverpool, 1871, New South Wales, Australia
    • Valsamma Eapen
    •  & Rudi Črnčec
  5. Department of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    • Harvey S. Singer
  6. Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
    • Davide Martino
  7. Departments of Neurology and Psychiatry, Center for Human Genetics Research, Massachusetts General Hospital, Boston, Massachusetts, USA
    • Jeremiah M. Scharf
  8. Division of Cognitive and Behavioral Neurology, Brigham & Women's Hospital, Boston, Massachusetts, USA
    • Jeremiah M. Scharf
  9. Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
    • Jeremiah M. Scharf
  10. Department of Biological Sciences, Purdue University, West Lafayette, Indiana, USA
    • Peristera Paschou
  11. Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupoli, Greece
    • Peristera Paschou
  12. Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
    • Veit Roessner
  13. Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
    • Douglas W. Woods
  14. Unit of Functional Neurosurgery, UCL Institute of Neurology, London, UK
    • Marwan Hariz
  15. Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
    • Marwan Hariz
  16. Department of Psychiatry and Genetics Institute, University of Florida, Gainesville, Florida, USA
    • Carol A. Mathews
  17. Department of Psychiatry, Pediatrics, and Psychology, Child Study Center, Yale University, New Haven, Connecticut, USA
    • James F. Leckman
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Contributions

Introduction (M.M.R.); Epidemiology (M.M.R.); Mechanisms/ pathophysiology (H.S.S., D.M., P.P. and J.M.S.); Diagnosis, screening and prevention (M.M.R. and J.F.L.); Management (V.R., D.W.W. and M.H.); Quality of life (V.E. and R.Č.); Outlook (J.M.S., C.A.M. and V.E.); Overview of Primer (M.M.R. and V.E.).

Corresponding authors

Correspondence to Mary M. Robertson or Valsamma Eapen.

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Competing interests

J.M.S. has received consulting fees from Nuvelution Pharma. D.W.W. receives royalties from Guilford Press and Oxford University Press and has received funding from the US National Institute of Mental Health (NIMH) through a subcontract with PsycTech. M.H. has received honoraria and travel grants from Medtronic as a speaker. J.F.L. serves on the scientific advisory boards of the Brain and Behavior Research Foundation, the European Multicentre Tics in Children Studies, the National Organization for Rare Diseases, Fondazione Child, and How I Decide. He has also received royalties from John Wiley and Sons, McGraw-Hill and Oxford University Press. M.M.R., V.E., H.S.S., D.M., P.P., V.R., C.A.M. and R.Č. declare no competing interests.

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Robertson, M., Eapen, V., Singer, H. et al. Gilles de la Tourette syndrome. Nat Rev Dis Primers 3, 16097 (2017) doi:10.1038/nrdp.2016.97

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