Directed attention in Gilles de la Tourette syndrome

Gilles de la Tourette syndrome (TS) is a basal ganglia (BG) disorder, associated not only with hyperkinetic movements but also with attentional impairments. This experiment sought to ascertain whether overt direct visual attention would influence tactile attentional performance in TS, via the use of a vibrotactile choice reaction time procedure involving biased probabilities of event occurrence. Participants were required to look (i.e., direct gaze) either at the hand receiving the most (expected) vibrations, or the hand less often stimulated (the unexpected), for both crossed and uncrossed arm postures. Contrary to our predictions, gaze did not influence attentional performance in TS patients. Furthermore, patients were found not to be sensitive to distributions of event probability; that is, they did not demonstrate normal expectancy effects like controls. Attentional deficits in TS (as in Parkinson's disease, another BG disorder) may pertain more to difficulties in holding rather than in shifting the focus of attention. Moreover, directing attention towards the unexpected locus in the crossed arm posture improved overall performance in both patients and controls, suggesting that increased task demands (e.g., crossed arm posture), and/or unexpected stimulus location, may be alleviated by directed attention. These impairments may stem from dysfunction in the circuits linking the frontal lobes with the BG.     

Gilles de la Tourette syndrome in India: two cases.

Two cases of Gilles de la Tourette syndrome from India are presented. The symptomatology of Tourette syndrome is the same as that documented in western populations which suggests biological factors in the aetiology of the syndrome.     

The ability to orient attention in Gilles de la Tourette syndrome

Gilles de la Tourette syndrome is characterised by tics, although patients also commonly present with attentional problems. This experiment aimed to ascertain whether TS patients have problems in orienting attention, via the use of a vibrotactile choice reaction time task. Participants were required to push a button in response to a faint vibration delivered to the index finger. Prior to each stimulus vibration, a pre-cue (valid, neutral or invalid) was administered to the finger. The performance benefits and costs participants gained from valid and invalid precues were calculated. Contrary to our prediction TS patients did not show significantly different costs or benefits. Furthermore, both patients and controls showed an equal and increased benefit in the crossed arm posture, compared to the uncrossed. These results suggest TS patients do not generally have problems in orienting attention. In addition, in the tactile modality, both patients and controls may benefit from directed attention when difficulty levels are maximal.     

Dilemmas in diagnosis and treatment of Gilles de la Tourette syndrome.

Gilles de la Tourette syndrome (TS) is a neurological disorder which has an inordinate risk of being diagnosed as psychogenic in nature because of commonly shared behavioral symptomes with syndromes of psychological origin. An overview of TS is presented including its history, symptomatology, and treatment of choice. The problems and pitfalls inherent in the diagnostic process which lead to psychogenic misconceptions are discussed. Treatment considerations include the secondary emotional problems and the negative consequences of the medication for TS. The implications for training professionals are discussed, but the essential point is that without an adequate history of the onset of symptoms, the potential for misdiagnosis is dramatically increased.     

Ambulatory accelerometry to quantify involuntary movements and tics in the syndrome of Gilles de la Tourette

Gilles de la Tourette syndrome is a chronic neuropsychiatric disorder characterizedby recurrent and involuntary tics, in addition to complex behavioral symptoms. Objective quantification of the nonspecific movements in Tourette patients can contribute much to understanding the pathophysiology of this disease. We used three accelerometersto characterizehead movement patterns and to objectively quantify head motility in the lateral, sagittal, and transversal planes in 9 Tourette patients and 14 controls during periods of rest, conversation, and watching a videotape with an entertaining program. Characteristic head movement patterns can be documented by means of accelerometry. Head motility levels in the lateral, sagittal, and transversal planes were significantly higher in the patients than in the controls during all the procedures. The patients and the controls showed a similar significant increase in head motility during conversation, but not during video watching. This first study shows that for both standardized and ambulatory research, accelerometry may provide an objective tool by which to quantify the severity and temporal dynamics of tics or nonspecific movements.     

Cerebellar neurophysiology in Gilles de la Tourette syndrome and its role as a target for therapeutic intervention

Therapy resistance of approximately one‐third of patients with Gilles de la Tourette syndrome (GTS) requires consideration of alternative therapeutic interventions. The article demonstrates the role of the cerebellum in neuropsychiatric disorders and GTS in particular, specifically its role in functions relating to motor and cognitive symptoms. Certain circuits in the cerebellum have been shown to undergo learning‐induced changes during conditioning, with cells in the cortex of the cerebellum appearing to decrease their activity whilst those in deep nuclei seem to do the inverse. Evidence exists showing that abnormal excitability of the motor cortex via the cerebellum could be expected to participate in motor tics in GTS possibly due to aberrations in certain structures of involved circuits. The role of the cerebellum in learning and plasticity processes renders it a strategic and valuable structure to consider for brain stimulation when investigating potential treatment options for neuropsychiatric disorders such as GTS. This article puts forth the concept of using non‐invasive and invasive brain stimulation techniques as a novel platform for non‐pharmacological neuromodulation of GTS symptoms.     

Short therapy of a child with Gilles de la Tourette's Syndrome*

This paper describes a three-hour intervention with a family whose younger son, aged four, was brought for consultation for Gilles de la Tourette's syndrome. The theoretical elaboration of the intervention is discussed so as to elucidate the therapeutic effect of the session leading to the lasting eradication of the symptoms.     

Freud and Gilles de la Tourette. Speculations regarding the diagnosis of Mrs. Emmy von N

The author reviews the case of Emmy von N. and provides a historical overview of the Gilles-de-la-Tourette syndrome (tic convulsif) referring also to recent studies of this illness. She revises Freud's diagnosis of hysteria in favour of the Gilles-de-la-Tourette syndrome.     

Syntactic and semantic correlates of verbal tics in Gilles de la Tourette's syndrome: a quantitative case study.

A two-hour sample of the speech of a patient suffering from Gilles de la Tourette's syndrome was analyzed. Coprolalic verbal tics are a major symptom of this disorder. In contrast to findings with other speech dysfluencies, verbal tics in Gilles de la Tourette's syndrome tend to occur at points of low information or uncertainty in sentences. They were found to be especially probable before conjunctions and pronouns. Sentences containing verbal tics exhibited more primary process and less secondary process content than sentences not containing tics. Tic sentence words were connotatively less potent, less active, less evaluatively negative, and more aggressive than words in nontic sentences. A neurolinguistic model of the syndrome is proposed: Necessity for grammatical coordination elicits the tic because of overactivity of subcortical centers that mediate this operation. Semantic determinants of the tic hypothetically operate by influencing cortical arousal which in turn triggers the subcortical centers.     

Decreased volume of the cerebral ventricles on CT images in Gilles de la Tourette's syndrome

The aim of the present study was to estimate the volume of the ventricular system comprising lateral plus third ventricles in patients with Gilles de la Tourette's syndrome on computed tomographic (CT) scannings using unbiased stereological principles and to compare that volume with a control group. We found a significantly reduced ventricular volume in 24 patients with Gilles de la Tourette's syndrome (GTS) compared with 28 controls.     

Decreased volume of the cerebral ventricles on CT images in Gilles de la Tourette's syndrome

The aim of the present study was to estimate the volume of the ventricular system comprising lateral plus third ventricles in patients with Gilles de la Tourette's syndrome on computed tomographic (CT) scannings using unbiased stereological principles and to compare that volume with a control group. We found a significantly reduced ventricular volume in 24 patients with Gilles de la Tourette's syndrome (GTS) compared with 28 controls.     

Effects of massed practice and cue-controlled relaxation on tic frequency in Gilles de la Tourette's syndrome

The effects of massed practice (MP) and cue-controlled relaxation on tic frequency were assessed in three single-case studies. Measures of tic frequency, subjective tension and fatigue, and physiological arousal were obtained throughout treatment.MP failed to produce any reduction in tic frequency in the three Gilles de la Tourette's syndrome patients studied. Cue-controlled relaxation resulted in a moderate decrease in tic frequency in only one patient.Tic frequency was related to physiological arousal, as assessed by skin conductance response frequency. No evidence was obtained in support of the suggestion that ticquers demonstrate a deficit in their habituation to sensory stimulation.     

Thermal sensitivity in Tourette syndrome: preliminary report

The effects of heat on tic symptoms were studied in a sample of 78 adults with Tourette syndrome. 62 men and 16 women completed a survey concerning the type, onset, and course of their tics. 10 adult male subjects also participated in a thermal challenge during which ambient temperature was raised from 22 degrees C to 35 degrees C following a control period. Of the 78, 24% or 19 reported increased tics upon exposure to heat. Compared to the remaining 59 subjects, there were no differences in sex distribution, current age, or overall course of illness. In the thermal challenge, there was general increase in tics that was correlated with sweat rate (r = .55, p = .001). This effect was prominent in 5 of 10 subjects (rs = .29 to .63). There were no mean differences in current age, age of onset, or current severity of symptoms between the five subjects of each group. Tic symptoms in a subgroup of patients with Tourette syndrome may be sensitive to heat. Abnormal heat regulation is not a likely explanation for the observed increase in tics. The increase may be due to normal heat-loss mechanisms through dopaminergic pathways.     

Tardive dystonia--a case report on therapy and metaphylaxis

The article deals with a case of tardive dystonia describing grave complications as result of long-term recidive-fluphenacindepot-treatment; therapy and metaphylaxy-problematic are being discussed as well.