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A medical overview of Tourette syndrome∗
Published in Carlotta Zanaboni Dina, Mauro Porta, James F. Leckman, Understanding Tourette Syndrome, 2019
Carlotta Zanaboni Dina, Mauro Porta
Both motor and sound tics are anticipated by the so-called premonitory urge or premonitory sensation (Cohen & Leckman, 1992): a physical/psychological urgency, which signals the tic arrival. It is present in 90% of cases (Leckman et al, 1993), and it is perceived after 10 years of age (Leckman et al, 1998). Premonitory urge, even if not always present or perceived, is a crucial element for the TS diagnosis. Patients describe the physical urge, being located in the same body area of tics or in others, as: discomfort/incompletenessa need to movea sense of pressurea sense of cold or warma tinglea ticklea shiver
Hyperkinetic Movement Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Morales-Briceno Hugo, Victor S.C. Fung, Annu Aggarwal, Philip Thompson
Positive signs in PMD:51Tremor: Tremor pauses with contralateral ballistic movements.Entrainment of tremor rhythm by moving another body part.Entrainment of rhythm by external cues.Tremor fully suppressed with mental distraction.Variability of tremor frequency.Tonic coactivation of antagonist muscles at tremor onset.Myoclonus: Entrainment to external rhythmic cue.Movement fully suppressed with mental distraction.Prominent axial jerks.Variability in jerk distribution and frequency.Dystonia: Fixed dystonia at onset (frequently hand or foot).Lack of overflow phenomenon.Variable resistance to passive movements.Tics: Variable character.Interference with speech or voluntary actions.Absence of premonitory urge.Lack of voluntary transient suppressibility.
The therapeutic effect of habit reversal training for Tourette syndrome: a meta-analysis of randomized control trials
Published in Expert Review of Neurotherapeutics, 2020
Liping Yu, Ying Li, Jishui Zhang, Chunmei Yan, Fang Wen, Junjuan Yan, Fang Wang, Jingran Liu, Yonghua Cui
Interestingly, many patients with tic disorders report a sensation or urge before the execution of a tic, which is often called a premonitory urge [40]. One of the components of HRT, awareness training, focuses on minimizing premonitory urges and promotes early detection of tics [9]. Awareness training is also a fundamental component of HRT in children with tic disorders [41]. However, most other RCTs that have tested the efficacy of HRT have only reported YGTSS scores, while neglecting premonitory urges. Recently, two studies about HRT reported that the premonitory urge was used as a secondary outcome and a predictor for the efficacy of HRT [42,43]. In future studies on HRT, we should pay more attention to the changes in PU, which might be another important indicator of the efficacy of HRT. Thus, in future studies for HRT, premonitory urge should be assessed regularly in clinical assessments.
Evidence-based treatment of Tourette’s disorder and chronic tic disorders
Published in Expert Review of Neurotherapeutics, 2019
Joey Ka-Yee Essoe, Marco A. Grados, Harvey S. Singer, Nicholas S. Myers, Joseph F. McGuire
Behavioral interventions for TD are based on the neurobehavioral model for tics [19,28]. This model acknowledges the genetic, biological, and neurological basis of tics, but suggests that internal and external factors influence the expression of tics. For instance, most patients experience an aversive somatosensory sensation called a premonitory urge that precede tics and cause distress (92% in adults [14]; 79% in children [16]). Patients with TD report that premonitory urges are reduced by the expression of tics [14], which has been confirmed in several experimental studies [29–31]. Consequently, tic expression becomes negatively reinforced due to the reduction in the aversive premonitory urge, which makes this pattern more likely to occur when a premonitory urge is experienced again. This same relationship holds true for external factors as well. Individuals with TD may have difficulty managing tics during certain undesirable activities (e.g. completing homework assignments) [23,32,33]. This can result in the disruption, early discontinuation, and/or avoidance of the activities. As these undesired activities are avoided or discontinued early, the expression of tics in these situations becomes negatively reinforced. Behavioral interventions such as habit reversal training (HRT), the comprehensive behavioral intervention for tics (CBIT), and exposure with response prevention (ERP) aim to interrupt this reinforcement pattern using different therapeutic approaches. Below, we provide a brief description of each behavioral treatment approach and describe the short- and long-term outcomes in clinical trials.
Neural correlates of prediction violations in boys with Tourette syndrome: Evidence from harmonic expectancy
Published in The World Journal of Biological Psychiatry, 2018
Judith Buse, Christian Beste, Veit Roessner
The Yale Global Tic Severity Scale (YGTSS; Leckman et al. 1989) was obtained from all boys with TS to determine the current symptom severity. Premonitory urges were assessed with the Premonitory Urge for Tics Scale (PUTS; Woods et al. 2005). In order to assess subclinical symptoms of obsessive-compulsive disorder (OCD), the participants completed the Obsessive-Compulsive Inventory (OCI-R; Foa et al. 2002; German version by Gönner et al. 2007), as well as the Zwangsinventar für Kinder und Jugendliche (ZWIK; Goletz and Döpfner 2011), a German questionnaire to dimensionally assess paediatric OC symptoms. Attention deficits hyperactivity disorder (ADHD) symptoms were assessed with the parent-rated (FBB)-ADHD scale of the comprehensive diagnostic system for mental disorders in childhood and adolescence (DISYPS II; Döpfner et al. (2008)). Additionally, attentional problems were obtained by the inattention subscale of the Child Behaviour Checklist (CBCL; Achenbach 1991). The demographics and clinical characteristics of the sample are presented in Table 1.