An Online Mindfulness-Based Group Intervention for Tics: A Pilot Randomized Controlled Trial.

Individuals with Tourette syndrome (TS) often report that they express tics as a means of alleviating the experience of unpleasant sensations. These sensations are perceived as an urge to act and are referred to as premonitory urges. Premonitory urges have been the focus of recent efforts to develop interventions to reduce tic expression in those with TS. The aim of this study was to examine the contribution of brain γ-aminobutyric acid (GABA) and glutamate levels of the right primary sensorimotor cortex (SM1), supplementary motor area (SMA), and insular cortex (insula) to tic and urge severity in children with TS. Edited magnetic resonance spectroscopy was used to assess GABA+ (GABA + macromolecules) and Glx (glutamate + glutamine) of the right SM1, SMA, and insula in 68 children with TS (MAge = 10.59, SDAge = 1.33) and 41 typically developing control subjects (MAge = 10.26, SDAge = 2.21). We first compared GABA+ and Glx levels of these brain regions between groups. We then explored the association between regional GABA+ and Glx levels with urge and tic severity. GABA+ and Glx of the right SM1, SMA, and insula were comparable between the children with TS and typically developing control subjects. In children with TS, lower levels of SMA GABA+ were associated with more severe and more frequent premonitory urges. Neither GABA+ nor Glx levels were associated with tic severity. These results broadly support the role of GABAergic neurotransmission within the SMA in the experience of premonitory urges in children with TS. © 2021 International Parkinson and Movement Disorder Society.

BackgroundIndividuals with Tourette Syndrome and Persistent Tic Disorders (collectively TS) often experience premonitory urges—aversive physical sensations that precede tics and are temporarily relieved by tic expression. The relationship between tics and premonitory urges plays a key role in the neurobehavioral treatment model of TS, which underlies first-line treatments such as the Comprehensive Behavioral Intervention for Tics (CBIT). Despite the efficacy of CBIT and related behavioral therapies, less than 40% of adults with TS respond to these treatments. Further examination of the relationship between premonitory urges, tic severity, and tic impairment can provide new insights into therapeutic targets to optimize behavioral treatment outcomes. This study examined whether urge intolerance—difficulty tolerating premonitory urges—predicted tic severity and tic-related impairment among adults with TS.MethodsParticipants were 80 adults with TS. Assessments characterized premonitory urge, distress tolerance, tic severity, and tic impairment. We used structural equation modeling (SEM) to examine the construct of urge intolerance—comprised of premonitory urge ratings and distress tolerance ratings. We first evaluated a measurement model of urge intolerance through bifactor modeling, including tests of the incremental value of subfactors that reflect premonitory urge severity and distress tolerance within the model. We then evaluated a structural model where we predicted clinician-rated tic severity and tic impairment by the latent variable of urge intolerance established in our measurement model.ResultsAnalyses supported a bifactor measurement model of urge intolerance among adults with TS. Consistent with theoretical models, higher levels of urge intolerance predicted greater levels of clinician-rated tic severity and tic impairment.ConclusionThis investigation supports the construct of urge intolerance among adults with TS and distinguishes it from subcomponents of urge severity and distress tolerance. Given its predictive relationship with tic severity and tic impairment, urge intolerance represents a promising treatment target to improve therapeutic outcomes in adults with TS.

Previous studies have investigated differences in the volumes of subcortical structures (e.g., caudate nucleus, putamen, thalamus, amygdala, and hippocampus) between individuals with and without Tourette syndrome (TS), as well as the relationships between these volumes and tic symptom severity. These volumes may also predict clinical outcome in Provisional Tic Disorder (PTD), but that hypothesis has never been tested. This study aimed to examine whether the volumes of subcortical structures measured shortly after tic onset can predict tic symptom severity at one-year post-tic onset, when TS can first be diagnosed. We obtained T1-weighted structural MRI scans from 41 children with PTD (25 with prospective motion correction (vNavs)) whose tics had begun less than 9 months (mean 4.04 months) prior to the first study visit (baseline). We re-examined them at the 12-month anniversary of their first tic (follow-up), assessing tic severity using the Yale Global Tic Severity Scale. We quantified the volumes of subcortical structures using volBrain software. Baseline hippocampal volume was correlated with tic severity at the 12-month follow-up, with a larger hippocampus at baseline predicting worse tic severity at follow-up. The volumes of other subcortical structures did not significantly predict tic severity at follow-up. Hippocampal volume may be an important marker in predicting prognosis in Provisional Tic Disorder.

Tics can have a serious impact on the quality of life of children and their families. Behavioural therapy is an evidence-based first line treatment for tic disorders. This randomised controlled trial studied the efficacy of a brief, condensed group-based programme for children with tics (Dutch Trial Registry NL8052, 27 September 2019). Tackle your Tics is a four-day group treatment, including exposure and response prevention and supporting components, delivered by therapists and ‘experts by experience’. We collected outcome measures at baseline (T1), directly post-treatment (T2), and at three- and 6-months follow-up (T3, T4) including tic severity (primary outcome measure), tic-related impairment, quality of life, tic-related cognitions, emotional/behavioural functioning, family functioning, treatment satisfaction and adherence. Outcomes directly post-treatment improved in both the treatment group (n = 52) and waiting list (n = 54), but showed no statistically significant differences between the conditions (differential change over time T1-T2) on tic severity (Yale Global Tic Severity Scale), quality of life (Gilles de la Tourette Syndrome Quality of Life Scale), tic-related cognitions and family functioning. At longer term (T3), again no between-group difference was found on tic severity, but tic-related impairment, quality of life and emotional/behavioural functioning significantly improved in the treatment group compared to the waiting list. Mean treatment satisfaction scores were favourable for both children and parents. Directly posttreatment, Tackle your Tics showed no superior effect compared to waiting list. However, on longer term this brief four-day group treatment was effective in improving tic-related impairment, quality of life and emotional/behavioural functioning.

Gilles de la Tourette syndrome is a neurodevelopmental disorder characterized by the presence of motor and vocal tics. We hypothesized that patients with this syndrome would present an aberrant pattern of cortical formation, which could potentially reflect global alterations of brain development. Using 3 Tesla structural neuroimaging, we compared sulcal depth, opening, and length and thickness of sulcal gray matter in 52 adult patients and 52 matched controls. Cortical sulci were automatically reconstructed and identified over the whole brain, using BrainVisa software. We focused on frontal, parietal, and temporal cortical regions, in which abnormal structure and functional activity were identified in previous neuroimaging studies. Partial correlation analysis with age, sex, and treatment as covariables of noninterest was performed amongst relevant clinical and neuroimaging variables in patients. Patients with Gilles de la Tourette syndrome showed lower depth and reduced thickness of gray matter in the pre- and post-central as well as superior, inferior, and internal frontal sulci. In patients with associated obsessive-compulsive disorder, additional structural changes were found in temporal, insular, and olfactory sulci. Crucially, severity of tics and of obsessive-compulsive disorder measured by Yale Global Tic severity scale and Yale-Brown Obsessive-Compulsive scale, respectively, correlated with structural sulcal changes in sensorimotor, temporal, dorsolateral prefrontal, and middle cingulate cortical areas. Patients with Gilles de la Tourette syndrome displayed an abnormal structural pattern of cortical sulci, which correlated with severity of clinical symptoms. Our results provide further evidence of abnormal brain development in GTS.

Long-term Outcomes of Behavior Therapy for Youth With Tourette Disorder.

Remote delivery of a mindfulness-based intervention for adults with tics: Protocol of a randomized controlled trial.

Tourette's Syndrome

Gilles de la Tourette syndrome (GTS) and depression are both common disorders. It has been suggested that depression occurs in 13%-76% GTS patients. Despite this, there are few studies into the specific relationships and correlates between the two disorders. There is only some consensus as to the precise relationship between the two disorders. We undertook the study to investigate the relationship between depressive symptomatology and the core clinical features of GTS in a well-characterized clinical population of youth with this disorder. Our aim was to verify the association between depression and comorbid obsessive-compulsive disorder and explore further other potential associations highlighted in some, but not all, of the studies focused on this topic. Our results demonstrated that (1) the GTS patients were significantly older than the controls, (2) the GTS patients were significantly more depressed than controls, (3) depression was associated with tic severity, (4) the Diagnostic Confidence Index scores were higher in GTS patients without depression, (5) anxiety, attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and behavioral problems were significantly associated with depression, and (6) finally, patients with GTS and depression have a positive family history of depression. However, obsessionality (CY-BOCS) did not differentiate between depressed and not depressed GTS patients. Depression is common in patients with GTS and occurs significantly more in GTS than in controls. Depression is significantly associated with GTS factors such as tic severity, comorbidity with ADHD, and the presence of coexistent anxiety, CDs, and behavior problems. Depression is importantly significantly associated with a positive family history of depression. Intriguingly, depression in our sample was not related to obsessionality.

Tic-related impairment drives treatment decisions for Tourette syndrome and related tic disorders. The clinical features most strongly associated with impairment remain unclear. The aim of this analysis is to identify clinical predictors of tic-related impairment in children and adults with tic disorders in a prospective longitudinal study. Participants were drawn from the Calgary Tic Registries, undergoing prospective structured assessments. Baseline demographic and psychiatric data, psychotropic medication use, Yale Global Tic Severity Scale (YGTSS) dimension scores, and the number of different tics (NDT) were analyzed. Predictors of impairment were examined using Spearman's correlations, univariate associate screening with false discovery rate correction, least absolute shrinkage and selection operator (LASSO) regression with ordinary least squares refitting, and linear mixed-effects (LME) models to evaluate within-person changes over time. The sample included 496 participants (848 total assessments). Motor tic interference showed the strongest correlation with impairment (ρ = 0.50), followed by motor tic intensity and frequency. The NDTs correlated with impairment more strongly than most individual YGTSS dimensions. In LASSO regression, seven predictors remained significant: motor tic interference, frequency and complexity, phonic tic interference, older age, female sex, and absence of autism. The LME models analyzed data from all participants with at least one follow-up visit. LME models showed that increases in total tic score predicted higher impairment and that impairment decreased modestly over time. Motor tic interference is the most robust predictor of tic-related impairment. Older age and female sex further contribute to functional burden. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Brain functional connectivity in chronic tic disorders and Gilles de la Tourette syndrome.

<sec><st>Objective</st> Gilles de la Tourette syndrome (GTS) is a chronic neurodevelopmental disorder characterised by multiple motor and phonic tics and behavioural problems. Patients with GTS of all ages often report a poor health-related quality of life (HR-QOL). Although the diagnosis of GTS is usually established in childhood, little is known about factors that predict the long-term well-being of these patients, especially in the presence of co-morbid behavioural problems. We set out to prospectively investigate the childhood predictors of HR-QOL in adult patients with GTS. </sec> <sec><st>Method</st> 46 patients with GTS aged 6–16 years underwent a standardised clinical assessment of both tics and behavioural symptoms at a specialist GTS clinic. The same patients were re-assessed as adults (>16 years of age), with a mean follow-up period of 13 years (range 3–25 years), when they completed the Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL), a disease-specific measure of HR-QOL. </sec> <sec><st>Results</st> Multiple linear regression analysis identified tic severity, premonitory urges and family history of GTS as childhood predictors of poorer HR-QOL in adults with GTS. Specifically, tic severity significantly predicted poor outcome across physical, psychological and cognitive domains of the GTS-QOL, reflecting its widespread effect on HR-QOL. </sec> <sec><st>Conclusion</st> Young patients with severe tics associated with characteristic premonitory urges and a family history of tic disorders appear to be at higher risk for poorer HR-QOL as adults. Further prospective research into HR-QOL in GTS is required in order to inform long-term strategic resource allocation. </sec>

Objective To explore the association of dietary behavior of children with Tourette syndrome(TS) and tic symptoms. Methods 207 TS children and their 264 corresponding controls, who visited our hospital during the period of November 2008 to October 2010, were investigated with children’s dietary behavior questionnaire, under the guidance of professional staff, and the TS tic symptom severity was also evaluated according to The Yale Global Tic Severity Scale (YGTSS). Kruskal-Wallis H rank-sum test was applied for univariate analysis and multinominal logistic regression for further multivariate analysis, with values of odds ratio (OR) and population attributable risk (PAR) obtained to demonstrate the relation strength between dietary behavior and tic symptom severity. Results Results of univariate analysis showed that western fast meal, barbecues, cream food, cold food, and spicy food were related to TS tic symptom severity (P<0.05). Results of multivariate analysis demonstrated that western fast meal, fruits and vegetables, cream food and spicy food were risk factors for mild TS compared with control group, with OR and 95%CI of 3.282(1.922, 5.064), 2.239(1.298, 3.861), 2.341(1.355, 4.046), 2.118(1.327, 3.380) and their corresponding PAR of 0.306, 0.464, 0.169, 0.250 respectively. As to moderate and severe TS, the risk factors included western fast meal, fruits and vegetables, and spicy food, with their respective OR and 95%CI of 2.581(1.322, 5.038), 2.364(1.166, 4.795), 1.822(1.014, 2.272) and PAR of 0.234, 0.487, 0.197. Conclusion Dietary behavior, especially western fast meal, fruits and vegetables, cream food and spicy food, are considered to be associated with TS tic symptom severity. Therefore it’s obligatory to rectify undesirable dietary behaviors for TS children. Key words: Tourette syndrome; Dietary behavior; Univariate analysis; Multivariate analysis

Life events and Tourette syndrome

P.1.171 Magnesium in mild depressive disorders