Tackle your Tics, a brief intensive group-based exposure treatment for young people with tics: results of a randomised controlled trial

PP12.13 – 2362: The influence of motor and vocal tic severity on children's quality of life

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

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.

ObjectiveBehaviour therapy (BT) for Tourette’s disorder (TD) and persistent (chronic) motor or vocal tic disorder (PTD) is rarely available. We evaluated the feasibility of adapting two existing BT protocols for...

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

Effectiveness of Low-Frequency Pallidal Deep Brain Stimulation at 65 Hz in Tourette Syndrome

Double-Blind, Crossover Study of Clonidine and Levetiracetam in Tourette Syndrome

P.1.171 Magnesium in mild depressive disorders

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.

Randomized, Sham-Controlled Trial of Real-Time Functional Magnetic Resonance Imaging Neurofeedback for Tics in Adolescents With Tourette Syndrome

To evaluate the efficacy and safety of aripiprazole in the treatment of children with Tourette syndrome. A prospective, multi-center, controlled clinical trial was conducted in 195 children aged 5-17 years with Tourette syndrome. The patients were assigned to two groups: aripiprazole group (n=98) and tiapride group (n=97), with the treatment dosage of 5-25 mg/d and 100-500 mg/d, respectively. After 12 weeks treatment, the clinical efficacy was assessed by the Yale Global Tic Severity Scale (YGTSS) score, and adverse reactions were observed by side effects symptoms scale, blood biochemical indexes, and electrocardiography. Significant pre- and post-treatment differences were ascertained for motor tic, phonic tic, function damage and total scores of YGTSS in the both groups from the second week of treatment (P<0.0001). Compared with the tiapride group, the aripiprazole group showed a more significantly decreased function damage score of YGTSS by the second week of treatment (P<0.05). After 12 weeks treatment, total scores of YGTSS in the aripiprazole group decreased from 53.74±15.71 at baseline to 24.36±16.38, while in the tiapride group from 51.66±13.63 to 23.26±15.31. The mean reduction scores of YGTSS were 29.38 in the aripiprazole group and 28.40 in the tiapride group at the end of treatment, and the clinical response rates were 60.21% and 63.92%, respectively. There were no significant differences between the 2 groups (P>0.05). The incidence of adverse reactions was similar in the aripiprazole and tiapride groups, with 29.6% and 27.8% respectively. There were no significant differences in the incidence of adverse reactions between aripiprazole and tiapride groups and no severe adverse events were found in either group. The results showed that aripiprazole showed similar therapeutic effect to tiapride in treatment of children with Tourette syndrome. Aripiprazole was safe and well tolerated in Chinese population, and can be considered as a new valid option for the treatment of tic disorders.

Gilles de la Tourette syndrome (GTS) is characterized by motor and vocal tics and often associated with obsessive-compulsive disorder (OCD). Responses to intermittent/continuous theta-burst stimulation (iTBS/cTBS), which probe long-term potentiation (LTP)-/depression (LTD)-like plasticity in the primary motor cortex (M1), are reduced in GTS. ITBS-/cTBS-induced M1 plasticity can be affected by brain-derived neurotrophic factor (BDNF) polymorphism. We investigated whether the BDNF polymorphism influences iTBS-/cTBS-induced LTP-/LTD-like M1 plasticity in 50 GTS patients and in 50 age- and sex-matched healthy subjects. In GTS patients, motor and psychiatric (OCD) symptom severity was rated using the Yale Global Tic Severity Scale (YGTSS) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). We compared M1 iTBS-/cTBS-induced plasticity in healthy subjects and in patients with GTS. We also compared responses to TBS according to BDNF polymorphism (Val/Val vs Met carriers) in patients and controls. Fourteen healthy subjects and 13 GTS patients were Met carriers. When considering the whole group of controls, as expected, iTBS increased whereas cTBS decreased MEPs. Differently, iTBS/cTBS failed to induce LTP-/LTD-like plasticity in patients with GTS. When comparing responses to TBS according to BDNF polymorphism, in healthy subjects, Met carriers showed reduced MEP changes compared with Val/Val individuals. Conversely, in patients with GTS, responses to iTBS/cTBS were comparable in Val/Val individuals and Met carriers. YGTSS and Y-BOCS scores were comparable in Met carriers and in Val/Val subjects. We conclude that iTBS and cTBS failed to induce LTP-/LTD-like plasticity in patients with GTS, and this was not affected by BDNF genotype.

Objective To evaluate outcome of High-frequency deep brain stimulation (DBS) of the globus pallidus internus (GPi) for severe Gilles de la Tourette syndrome (GTS). Methods 10 cases of GTS who were resistant to at least 6 months of standard and innovative treatments, as well as to psychobehavioural techniques, underwent DBS. DBS was placed bilaterally globus pallidus internus (GPi).Patients were evaluated after surgery, using Yale Global Tic Severity Scale (YRTSS) from 2 months to 24 months. Results All patients responded well to DBS, although to differing degrees (28.2% ～ 80.0%).The duration of follow-up assessments ranged from 2 to 24 months. Except for two erosions and/or infections cases, there were no serious permanent adverse effects. Conclusion DBS is a useful and safe treatment for severe GTS. The results of ours and previous DBS reports suggest that the GPi may be a good DBS target for GTS. Key words: Gilles de la Tourette syndrome; Deep brain stimulation; Globus pallidus internus

Blink reflex abnormalities in Tourette syndrome.

Background: Behaviour therapy (BT) for Tourette syndrome (TS) and chronic tic disorder (CTD) is effective but rarely available. To increase its availability, we developed a therapist- and parent-guided Internet-delivered BT programme for young people with TS/CTD, named BIP TIC. Preliminary results from a pilot study suggest that BIP TIC is a feasible and highly acceptable treatment. We now plan to evaluate BIP TIC in a full-scale randomised controlled trial in Sweden to determine its clinical efficacy, long-term durability, and cost-effectiveness. This poster outlines the trial protocol. Methods: We plan to conduct a single-blind parallel-group randomised controlled superiority trial, where participants (N=220) are randomised to either 10 weeks of BIP TIC (therapist- and parent-guided Internet-delivered exposure and response prevention) or a control condition (therapist- and parent-guided Internet-delivered education on tics). The trial will be coordinated at a single site in Stockholm, Sweden, but will recruit nationally. Eligibility criteria will include a diagnosis of TS/CTD, age between 9 and 17 years, and stable medication for tics, if on medication. Participants are assessed at post-treatment and at 3, 6, and 12 months follow-up. The primary outcome will be tic severity as measured by the Total Tic Severity Score of the Yale Global Tic Severity Scale at the 3-month follow-up, which will be assessed by raters blind to the treatment condition. A full health economic evaluation will be conducted. Data will be analysed using a pre-specified intention-to-treat statistical analysis plan. Results and Conclusions: Recruitment started in April 2019. If BIP TIC is superior to tic education alone, as well as cost-effective, we will aim to implement it in routine clinical care in Sweden.