New Insights into Clinical Characteristics of Gilles de la Tourette Syndrome: Findings in 1032 Patients from a Single German Center.
BACKGROUND
Gilles de la Tourette syndrome (TS) is a complex neuropsychiatric disorder defined by the presence of motor and phonic tics, but often associated with psychiatric comorbidities. The main objective of this study was to explore the clinical presentation and comorbidities of TS.


METHODS
We analyzed clinical data obtained from a large sample (n = 1032; 529 children and 503 adults) of patients with tic disorders from one single German TS center assessed by one investigator. Data was collected with the help of an expert-reviewed semi-structured interview, designed to assess tic severity and certain comorbidities. Group comparisons were carried out via independent sample t-tests and chi-square tests.


RESULTS
The main findings of the study are: (1) tic severity is associated with the presence of premonitory urges (PU), copro-, echo-, and paliphenomena and the number of comorbidities, but not age at tic onset; it is higher in patients with comorbid obsessive-compulsive disorder (OCD) than in patients with comorbid attention deficit/hyperactivity disorder (ADHD). (2) PU were found to be highly associated with "not just right experiences" and to emerge much earlier than previously thought alongside with the ability to suppress tics (PU in >60% and suppressibility in >75% at age 8-10 years). (3) Self-injurious behavior (SIB) is highly associated with complex motor tics and coprophenomena, but not with OCD/obsessive-compulsive behavior (OCB). While comorbid ADHD is associated with a lower ability to suppress tics, comorbid depression is associated with sleeping problems.


CONCLUSIONS
Our results demonstrate that tic severity is not influenced by age at onset. From our data, it is suggested that PU represent a specific type of "not just right experience" that is not a prerequisite for tic suppression. Comorbid ADHD reduces patients' ability of successful tic suppression. Our data suggest that SIB belongs to the coprophenomena spectrum and hence should be conceptualized as a complex tic rather than a compulsion. Finally, this study strongly supports the hypothesis that TS+OCD is a more severe form of TS and that comorbid OCD/OCB, depression, and anxiety belong to the TS spectrum, while ADHD should be better conceptualized as a separate problem.
Department of Education, Monash UniversityMelbourne, VIC, Australia; Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical SchoolHannover, Germany.
Tanvi
T
Sambrani
Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School Hannover, Germany.
Ewgeni
E
Jakubovski
Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School Hannover, Germany.
Kirsten R
KR
Müller-Vahl
ADHD; OCD; Tourette syndrome; comorbidities; depression; premonitory urges; self-injurious behavior; tics
Psychiatry Res. 2015 Aug 30;228(3):765-73
26112450
Behav Modif. 2014 Mar;38(2):264-75
24042069
J Neurol Neurosurg Psychiatry. 2011 Dec;82(12):1320-3
21436227
Psychiatr Genet. 2007 Jun;17(3):143-52
17417057
Dev Med Child Neurol. 2003 Oct;45(10):700-3
14515942
J Neuropsychiatry Clin Neurosci. 2012 Fall;24(4):458-62
23224452
JAMA Psychiatry. 2015 Apr;72 (4):325-33
25671412
Compr Psychiatry. 2012 Jul;53(5):525-34
21867997
Neurol Clin. 1997 May;15(2):457-73
9115475
Mov Disord. 2010 Feb 15;25(3):309-14
20063404
J Neurol Neurosurg Psychiatry. 2004 Aug;75(8):1149-55
15258218
Dev Med Child Neurol. 2009 Mar;51(3):218-27
19183216
BMC Psychiatry. 2012 Aug 13;12:109
22888766
Pediatrics. 1998 Jul;102(1 Pt 1):14-9
9651407
Neurol Clin. 1997 May;15(2):395-402
9115469
JAMA. 2010 May 19;303(19):1929-37
20483969
Mov Disord. 2012 Sep 1;27(10):1222-9
22807284
Eur Child Adolesc Psychiatry. 2012 Aug;21(8):451-7
22543961
J Neuropsychiatry Clin Neurosci. 2015 Winter;27(1):33-41
25162416
Pediatr Neurol. 2011 Aug;45(2):100-8
21763950
Dev Med Child Neurol. 2009 Jun;51(6):468-72
19018838
Cleve Clin Q. 1986 Summer;53(2):127-31
3461891
J Neuropsychiatry Clin Neurosci. 2009 Winter;21(1):13-23
19359447
Am J Psychiatry. 2006 Apr;163(4):716-23
16585449
J Affect Disord. 2006 Apr;91(2-3):265-8
16464507
Soc Psychiatry Psychiatr Epidemiol. 2002 Aug;37(8):372-9
12195544
Mov Disord. 2011 Mar;26(4):735-8
21506153
J Neurol Neurosurg Psychiatry. 1996 Feb;60(2):209-12
8708658
Acta Neurol Scand. 2004 Apr;109 (4):255-60
15016007
J Am Acad Child Adolesc Psychiatry. 2008 Jul;47(7):763-72
18520961
J Child Neurol. 2014 Oct;29(10):1383-9
24832397
J Psychosom Res. 2009 Dec;67(6):475-83
19913651
J Neurol Sci. 2011 Nov 15;310(1-2):276-8
21741055
PLoS One. 2010 Sep 24;5(9):e12959
20885982
J Child Psychol Psychiatry. 1994 May;35(4):597-611
8040217
Brain. 2000 Mar;123 Pt 3:425-62
10686169
Dev Med Child Neurol. 2000 Jul;42(7):436-47
10972415
Acta Paediatr. 2005 Nov;94(11):1608-14
16352498
J Am Acad Child Adolesc Psychiatry. 2006 Nov;45(11):1346-53
17075357
Am J Psychiatry. 1993 Jan;150(1):98-102
8417589
Psychiatry Res. 2013 Dec 15;210(2):559-63
23850205
Arch Pediatr Adolesc Med. 2006 Jan;160(1):65-9
16389213