Sources of Disability in Tourette Syndrome: Children vs. Adults

Abstract

Background: Tourette syndrome (TS) is a neurodevelopmental disorder characterized by tics and neuropsychiatric co-morbidities like Obsessive Compulsive Disorder (OCD) and Attention Deficit Disorder (ADHD), among others. In many instances tics get better with age but this is not always true regarding the psychiatric co-morbidities. Methods: This manuscript reviews the disease-specific Quality of Life (QOL) instruments used to measure disability in TS and the existing literature on sources of functional impairment in children and adults with TS. Results: Traditionally, disability in TS has been recorded using objective measures. In recent years there has been a development of disease-specific instruments to measure subjectively the impact of the different aspects of TS on the patient's daily function. The differential impact of tics vs. the psychiatric co-morbidities in children with TS is an issue of debate in the existing literature. In adults with TS, the literature is scant, therefore the sources of disability in this group are even less defined compared to children. Discussion: As clinicians, we need to focus on determining the sources of disability in children and adults with TS so we can target our interventions successfully.

Efficacy of a Gluten-Free Diet in the Gilles de la Tourette Syndrome: A Pilot Study

“…Nevertheless, the adults were taking a higher proportion of psychotropics than the children, with significant differences. Our results coincide with those of other authors, in the sense that during childhood the intensity and frequency of tics are usually higher in children than in adults, while OCD usually predominates in adults compared with children, which accounts for the more widespread consumption of psychotropics among adults than children [ 2 , 28 , 29 ].…”

Clinical Features of Tourette Syndrome

“…One-third of patients experience complete remission. 5,39 However, in a subset of patients, tic severity may not improve or may worsen. 5,20,40 Predictors of tic persistence and later tic severity include tic severity, poor fine motor skills, and higher levels of psychosocial stress and depression during childhood.…”

“…18 Severity often peaks 2 years following peak tic severity, and obsessivecompulsive disorder symptoms are more likely to persist into adulthood than tics. 39 In the largest longitudinal study of the natural history of Tourette syndrome over a 10-year follow-up period, the spectrum of psychiatric comorbidities continued to change throughout adolescence, and patients with psychiatric comorbidities were less likely to achieve satisfactory symptom control. 43 The majority of research in Tourette syndrome has focused on pediatric populations, and there are few data on the natural history, quality of life, and function of adults with Tourette syndrome.…”

“…43 The majority of research in Tourette syndrome has focused on pediatric populations, and there are few data on the natural history, quality of life, and function of adults with Tourette syndrome. 39 There is conflicting evidence on whether disability in adults is primarily related to the tics or psychiatric comorbidities, and the existing literature is biased by disproportionate representation of patients with more severe disease among adults who continue to seek medical care. In one study of 31 Tourette syndrome patients who underwent a standard videotaped evaluation during childhood and again as adults, 90% continued to exhibit tics, although a composite measure of tic-related disability was lower in adulthood.…”

Relationship between representation and severity of Gilles de la Tourette syndrome and comorbidities

“…Средний возраст начала тиков 5,6 года с волнообразным течением, максимальной тяжестью в начале второго десятилетия, возможно снижение частоты и тяжести после полового созревания у большей части пациентов (59-85%). Хотя прогноз течения тиков благоприятный с взрослением человека, многие элементы психопатологии могут сохраняться в дальнейшей жизни [14].…”