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Neurologic disorders in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Robert Burger, Terry Rolan, David Lardizabal, Upinder Dhand, Aarti Sarwal, Pradeep Sahota
Tourette’s syndrome is also quite common, and since it begins in childhood, this disorder will be frequently seen in the obstetric population. Tourette’s syndrome involves the combination of motor and vocal tics, which evolve and fluctuate over time. A tic is a brief un-voluntary movement or sound that can include throat clearing, coughing, sighing, or making sounds or words. The tics can be suppressed voluntarily but take a great deal of effort from the patient to do so. For this reason, they are called un-voluntary rather than involuntary. Patients with Tourette’s syndrome also frequently have attention deficit disorder and obsessive–compulsive disorder. The tics typically respond to dopamine receptor blockade, and haloperidol is a very effective treatment. As discussed previously, this medication is felt to be the safest choice for the fetus (80).
Tic Disorders and Tourette Syndrome
Published in Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper, Child and Adolescent Mental Health, 2021
Valerie Brandt, Samuele Cortese
Despite strong evidence for the heritability of tics, genetic studies have had difficulties pinning down the genes that are involved in tics disorders. It appears that the genetic component of tic disorders is complex, including rare (high-impact) and common (low-impact) genetic variants; it probably involves a number of genes (polygenetic) and environmental factors (Yu et al., 2019), as well as epigenetic factors (Muller-Vahl, Loeber, Kotsiari, Muller-Engling and Frieling, 2017). A meta-analysis showed that genes that have been associated with risk for tic disorders in genome-wide association studies (GWAS) are commonly expressed in the dorsolateral prefrontal cortex and that TS and the other tic disorders are likely on the same spectrum, sharing polygenetic risk (Yu et al., 2019). However, it has to be noted that results of candidate gene studies could not be replicated (Abdulkadir et al., 2018) and that GWAS have had difficulties providing genome-wide significant findings, possibly due to relatively small sample sizes (Fernandez, State and Pittenger, 2018). It is expected that genetic studies will render significant findings in the coming years.
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
Simple transient tics of childhood: Simple tics (motor or vocal).Persist for several months but resolve before 1 year.Common (∼10% school-age children).
Long-term central nervous system (CNS) consequences of COVID-19 in children
Published in Expert Review of Neurotherapeutics, 2023
Saskia Howe de la Torre, Valeria Parlatini, Samuele Cortese
Tics are sudden repeated twitches, movements, or sounds. Several cases of tics have been reported in children following COVID-19 infection. For instance, a survey of 510 children with long COVID identified tics in 9.2% of cases, with no differences among age groups [53]. Persistence was reported in 10.6% of them after 7 months [53]. Motor and ocular tics have been observed more frequently than vocal tics [51,63]. Largely, individuals with new onset tics experienced full recovery, however, both motor and ocular tics persisted after three months in several cases [60,63]. Considering the pathogenetic mechanisms, tics have been associated with fronto-striatal dopaminergic abnormalities [125]. ACE2 is co-expressed and co-regulated with Dopa Decarboxylase (DDC), an enzyme involved in the biosynthesis of dopamine [126]. As ACE2 is highly expressed on dopaminergic neurons, it has been suggested that SARS-CoV-2 may induce a defective expression of ACE2, which may be paralleled by a DDC dysfunction, resulting in altered dopamine levels [126]. Nevertheless, pandemic-related psychosocial stressors may also play a role, as an increase in new onset tics has also been identified in children and adolescents in the general population [127].
Current and emerging pharmacotherapeutic strategies for Tourette syndrome
Published in Expert Opinion on Pharmacotherapy, 2022
Tics are defined as sudden, repetitive, nonrhythmic movements (motor tics) or sounds (vocal tics) [1]. Tic expression has been described as the willful capitulation to an irresistible sensory urge, commonly referred to as premonitory urge [2,3]. Tic disorders are currently classified as both neurodevelopmental conditions and hyperkinetic movement disorders. Tourette syndrome (TS) is a chronic tic disorder characterized by the presence of multiple motor tics plus at least one vocal tic, with onset before 18 years of age [1]. The prevalence of TS has been estimated to be around 0.5–0.8%, with males being three to four times more likely to be affected than females [4–6]. Patients most commonly present with simple motor tics affecting their face and neck (e.g. eye blinking, mouth pulling, facial grimacing, neck tensing) and simple vocal tics such as sniffing, grunting, coughing, and throat clearing. Complex motor tics are movements involving multiple muscular districts, whereas complex vocal tics are entire words, including repeated words (palilalia), other people’s words (echolalia), and swear words (coprolalia) [7].
Aripiprazole for the treatment of Tourette syndrome
Published in Expert Review of Neurotherapeutics, 2021
Joanna H. Cox, Andrea E. Cavanna
There is no known cure for TS, and not all children and adults with TS require treatment. However, for those with more severe or disabling tics, or where their tics have a significant impact on health-related quality of life, a number of different treatments are available. The range of approaches to the treatment of TS encompasses pharmacotherapy, behavioral and psychological therapies, as well as neurosurgical interventions in selected cases. It is often appropriate to take a ‘watchful waiting’ approach, especially if patients are able to manage their symptoms without detriment to their education, occupation, social functioning, or quality of life. As young patients with TS approach adulthood, variable degrees of improvement in tic severity are often reported, with a minority of patients reporting persistent or unchanged tics into adulthood [11]. Where tics are severe or disabling, or are having a significant impact on functioning and health-related quality of life, medication can be used to reduce tic severity. A number of agents from different pharmacological classes have been recommended for the treatment of TS, the most commonly used being antidopaminergic drugs and alpha-2 agonists [28,29].