Family functioning mediation in tic severity and quality of life for children with Tourette syndrome

BACKGROUND Tourette syndrome(TS)is recognized as a neurodevelopmental disorder profoundly influenced by familial factors,particularly family functioning.However,the relationship among family functioning,tic severity,and quality of life in individuals with TS during childhood and adolescence remains unclear.We hypothesized that family functioning plays a role in the association between the severity of TS and quality of life in children.AIM To determine the role of family functioning in the relationship between TS severity and quality of life.METHODS This study enrolled 139 children(male/female=113/26)with TS.We assessed tic severity using the Yale Global Tic Severity Scale,quality of life via the Tourette Syndrome Quality of Life Scale,and family functioning through the Family Assessment Device.Our analysis focused on correlating these measures and exploring the mediating role of family functioning in the relationship between tic severity and quality of life.Additionally,we examined if this mediating effect varied by gender or the presence of comorbidity.RESULTS We found that family communication dysfunction had a significant mediating effect between tic severity and both psychological symptoms(indirect effect:Β=0.0038,95%confidence interval:0.0006-0.0082)as well as physical and activities of daily living impairment(indirect effect:Β=0.0029,95%confidence interval:0.0004-0.0065).For vocal tic severity,this mediation was found to be even more pronounced.Additionally,in male participants and those without attention deficit hyperactivity disorder,the mediating effect of family communication dysfunction was still evident.CONCLUSION Our study highlights the impact of family functioning on the tic severity and the quality of life in children.This relationship is influenced by gender and comorbid conditions like attention deficit hyperactivity disorder.

Research Progress on Integrated Chinese and Western Medicine Treatment of Tourette Syndrome in Children

Tourette syndrome is a common neuropsychiatric disorder that affects the physical and mental health of children.Early detection,diagnosis,and treatment are crucial to prevent serious impacts on the affected children,their families,and society.In recent years,there has been an increasing trend towards using a combination of methods in the clinical treatment of children with Tourette syndrome.This approach has achieved remarkable results,leading to a reduction in the rate of Tourette syndrome symptoms in children.In recent years,a combination of clinical methods has been used to treat children with Tourette syndrome,resulting in significant improvement in control rates.This article reviews the etiology of infantile Tourette syndrome and the progress made in Chinese and Western medicine treatments,providing a reference for further treatment of the condition.

Clinical characteristics of pediatric patients with treatment-refractory Tourette syndrome:An evidence-based survey in a Chinese population

BACKGROUND Tourette syndrome(TS)is a complex neurodevelopmental condition marked by tics,as well as a variety of psychiatric comorbidities,such as obsessivecompulsive disorders(OCDs),attention deficit hyperactivity disorder(ADHD),anxiety,and self-injurious behavior.TS might progress to treatment-refractory Tourette syndrome(TRTS)in some patients.However,there is no confirmed evidence in pediatric patients with TRTS.AIM To investigate the clinical characteristics of TRTS in a Chinese pediatric sample.METHODS A total of 126 pediatric patients aged 6-12 years with TS were identified,including 64 TRTS and 62 non-TRTS patients.The Yale Global Tic Severity Scale(YGTSS),Premonitory Urge for Tics Scale(PUTS),and Child Behavior Checklist(CBCL)were used to assess these two groups and compared the difference between the TRTS and non-TRTS patients.RESULTS When compared with the non-TRTS group,we found that the age of onset for TRTS was younger(P<0.001),and the duration of illness was longer(P<0.001).TRTS was more often caused by psychosocial(P<0.001)than physiological factors,and coprolalia and inappropriate parenting style were more often present in the TRTS group(P<0.001).The TRTS group showed a higher level of premonitory urge(P<0.001),a lower intelligence quotient(IQ)(P<0.001),and a higher percentage of family history of TS.The TRTS patients demonstrated more problems(P<0.01)in the“Uncommunicative”,“Obsessive-Compulsive”,“Social-Withdrawal”,“Hyperactive”,“Aggressive”,and“Delinquent”subscales in the boys group,and“Social-Withdrawal”(P=0.02)subscale in the girls group.CONCLUSION Pediatric TRTS might show an earlier age of onset age,longer duration of illness,lower IQ,higher premonitory urge,and higher comorbidities with ADHD-related symptoms and OCD-related symptoms.We need to pay more attention to the social communication deficits of TRTS.

Fecal transplantation can alleviate tic severity in a Tourette syndrome mouse model by modulating intestinal flora and promoting serotonin secretion

Background:Tourette syndrome(TS)is a neuropsychiatric disorder with onset in childhood that warrants effective therapies.Gut microbiota can affect central physiology and function via the microbiota-gut-brain axis.Therefore,the gut microbiota plays an important role in some mental illnesses.A small clinical trial showed that fecal microbiota transplantation(FMT)may alleviate TS symptoms in children.Herein,FMT effects and mechanisms were explored in a TS mouse model.Methods:TS mice model(TSMO)(n=80)were established with 3,3'-iminodipropionitrile,and 80 mice were used as controls.Mice were grouped into eight groups and were subjected to FMT with feces from children or mice with or without TS,or were given probiotics.Fecal specimens were collected 3 weeks after FMT.16S rRNA sequencing,behavioral observation,and serum serotonin(5-HT)assay were performed.Differences between groups were analyzed using Mann-Whitney U test and Kolmogorov-Smirnov(KS)tests.Results:A total of 18 discriminative microbial signatures(linear discriminant analysis score>3)that varied significantly between TS and healthy mice(CONH)were identified.A significant increase in Turicibacteraceae and Ruminococcaceae in TSMO after FMT was observed(P<0.05).Compared with non-transplanted TSMO,the symptoms of those transplanted with feces from CONH were alleviated(W=336,P=0.046).In the probiotic and FMT experiments,the serum 5-HT levels significantly increased in TSMO that received probiotics(KS=1.423,P=0.035)and in those transplanted with feces from CONH(W=336.5,P=0.046)compared with TSMO without transplantation.Conclusions:This study suggests that FMT may ameliorate TS by promoting 5-HT secretion,and it provides new insights into the underlying mechanisms of FMT as a treatment for TS.

Association between Tourette Syndrome and the Dopamine D3 Receptor Gene Rs6280

Background：Tourette syndrome （TS） is a complex,heterozygous genetic disorder.The number of molecular genetic studies have investigated several candidate genes,particularly those implicated in the dopamine system.The dopamine D3 receptor （DRD3） gene has been considered as a candidate gene in TS.There was not any report about the association study of TS and DRD3 gene in Han Chinese population.We combined a case-control genetic association analysis and nuclear pedigrees transmission disequilibrium test （TDT） analysis to investigate the association between DRD3 gene rs6280 single nucleotide polymorphisms （SNPs） and TS in a Han Chinese population.Methods：A total of 160 TS patients was diagnosed by the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition.The DRD3 gene rs6280 SNPs were genotyped by TaqMan SNP genotyping assay technique in all subjects.We used a case-control genetic association analysis to compare the difference in genotype and allele frequencies between 160 TS patients and 90 healthy controls.At the same time,we used TDT analysis to identify the DRD3 gene rs6280 transmission disequilibrium among 10l nuclear pedigrees.Results：The genotype and allele frequency of DRD3 gene rs6280 SNPs had no statistical difference between control group （90） and TS group （160） （χ^2 =3.647,P =0.161; χ^2 =0.643,P =0.423） using Chi-squared test.At the basis of the 101 nuclear pedigrees,TDT analysis showed no transmission disequilibrium ofDRD3 gene rs6280 SNPs （χ^2 =0; P =1）.Conclusions：Our findings provide no evidence for an association between DRD3 gene rs6280 and TS in the Han Chinese population.

Deep Brain Stimulation of the Globus Pallidus Internus in Patients with Intractable Tourette Syndrome： A 1-year Follow-up Study

Background： Deep brain stimulation （DBS） has been a promising treatment for patients with refractory Tourette syndrome （TS） for more than a decade. Despite successful DBS treatment of TS in more than 100 patients worldwide, studies with a large patient sample and long-term follow-up assessments are still scarce. Accordingly, we investigated the clinical efficacy and safety of globus pallidus internus （GPi） DBS in the treatment of intractable TS in 24 patients with a 1-year follow-up assessment. Methods： Bilateral/unilateral GPi-DBS was performed in 24 patients with TS. We evaluated symptoms of tics and obsessive-compulsive disorder （OCD） through the Yale Global Tic Severity Scale （YGTSS） and Yale-Brown Obsessive-compulsive Scale （Y-BOCS）. We used the Wechsler Adult Intelligence Scale-Revised in China （WAIS-RC） to evaluate the safety of the treatment. We conducted follow-up assessments of all patients for at least 12 months （12-99 months）. Results： Symptoms of tics and OCD were significantly relieved at a 12-month follow-up assessment. The mean YGTSS score was 74.04 ± 11.52, 49.83 ± 10.91, 32.58 ± 7.97, and 31.21 ± 8.87 at baseline, 3, 6, and 12 months, respectively. The mean YGTSS scores obtained at the follow-up assessments were significantly different from the baseline （P 〈 0.05）. The improvement in motor tics was superior to that in phonic tics. The mean Y-BOCS scores were 21.61 ± 4.97, 18 ± 4.58, 14.39 ± 3.99, and 13.78 ± 4.56 at baseline, 3, 6, and 12 months, respectively （P 〈 0.05）. We observed a remarkable improvement in psychiatric comorbidities, such as OCD and attention-deficit hyperactivity disorder, after the procedure. WAIS-RC scores were comparable before and after the operation. There were no severe postoperative complications. Conclusion： GPi-DBS appears to comprehensively alleviate tic symptoms and psychiatric comorbidities in patients with TS, thus significantly improving patients＇ quality of life.

Clinical Observation on Tourette Syndrome Treated by Different Acupuncture Methods

Objective： To approach a better solution for enhancing the therapeutic results of acupuncture therapy in the treatment of Tourette syndrome, by observing the clinical results of combined scalp with body acupuncture and mono-body acupuncture. Methods： Fifty-seven patients were randomized into a treatment group （31 cases） and a control group （26 cases）. The patients in the treatment group all received combined scalp-body acupuncture treatment, while the patients in the control group were given mono-body acupuncture treatment, for I month as a treatment session. At the end of the third treatment session, the Yale Global Tic Severity Scale （YGTSS） would be compared between pre- and post-treatment. Results： In the treatment group, 2 patients were clinically cured, 4 showed markedly effective, 18 showed effective, and 7 failed, making a total therapeutic rate of 77.4%. In the control group, 0 were clinically cured, 3 showed markedly effective, 9 showed effective, 14 failed, making a total therapeutic rate of 46.2%. There was a significant difference between the two total therapeutic rates （P〈0.05）. Conclusion： The combination of scalp and body acupuncture had a better therapeutic result than the mono-body acupuncture therapy in the treatment of Tourette syndrome.

Clinical Observation on Treatment of Tourette Syndrome by Integrative Medicine

Objective:To explore the clinical efficacy of integrative Chinese and Western medicine in treating Tourette syndrome(TS).Methods:Ninety children with TS were randomized into two groups by randomizing digital table method:the 60 patients in the treated group were treated by Ningdong Granule(宁动颗粒,NDG) plus haloperidol,and the 30 in the control group treated by haloperidol alone.The course for both groups was 6 months.Conditions of the patients were estimated before and after treatment with Yale Global Tic Sev...

Effects of human mesenchymal stem cell transplantation in the bilateral corpus striatum in a rat model of Tourette's syndrome

Tourette＇s syndrome is treated by behavioral or pharmacological therapy.However,patients with malignant Tourette＇s syndrome also exhibit life-threatening symptoms,which are unresponsive to conservative treatments or neurosurgical procedures,such as deep brain stimulation.In recent years,mesenchymal stem cells（MSCs）have shown therapeutic potential in many neurological diseases.Therefore,the present study proposed to use MSC transplantation as a novel therapy for Tourette＇s syndrome.Stereotypic behaviors in Tourette＇s syndrome rats decreased significantly at21 days after human MSCs transplantation into the striatum.Immunohistochemistry analyses revealed survival of transplanted human MSCs and differentiation into neurons and astrocytes in the rat brain.Results suggest that intrastriatal transplantation of human MSCs could provide therapeutic potential for Tourette＇s syndrome.

Clinical Study on Treatment of Tourette's Syndrome with Acupuncture-Chinese Herbs Combination

Objective: To observe the clinical effect on treatment of Tourette's syndrome with combination of acupuncture and Chinese herbs.Method: Sixty cases were randomly divided into acupuncture-Chinese group and western drug group, which have been treated with acupuncture plus modified Tranquilizing Liver-wind Decoction and orally taken holoperidol respectively.Result: Therapeutic effect comparison between the two groups showed a significant difference (P<0.05).Conclusion: Combination of scalp acupuncture and Chinese berbs has good effect in treating Tourette's syndrome, with better result than western drug. Key Words Tourette syndrome - Acupuncture Therapy - Scalp Acupuncture - Drug Therapy (TCD) Author: CHI Xu (1977-), female, masterTranslator: HAN Chou-ping

Treatment of 28 Cases of Tourette's Syndrome by Puncturing Back-Shu Points

Twenty-eight cases of Infantile Tourette＇s syndrome were treated by puncturing Back-Shu points. In 28 cases of the patients, the results showed cure in 6 cases, effect in 21 cases and failure in one case, and the total effective rate in 96.4%.

Psychosurgery:A History from Prefrontal Lobotomy to Deep Brain Stimulation

Neurosurgical treatment for psychiatric disorders features a long and controversial history.This article explores a“spectrum of psychosurgery”,describing how old-fashioned and controversial prefrontal lobotomy gradually evolved into modern day,mainstream scientific deep brain stimulation(DBS).We focus on the rise,fall and possible re-emergence of psychosurgery as a therapeutic intervention today.We journey through historic indiscriminate use of prefrontal lobotomy,which evoked stern criticism from both public and professionals,through to the development of modern day DBS-performed for patients suffering from severe,treatment resistant symptoms of obsessive-compulsive disorder(OCD),epilepsy and movement disorders.We hope this article will provide a basis for understanding the availability of existing treatment options and potential future opportunities,whilst simultaneously challenging any public/professional preconceptions of psychosurgery,which may indirectly be obstructing patient care.Additionally,we carried out a qualitative survey displayed in WordCloud Format,capturing the intellection of 38 mental health professionals working for North West Boroughs NHS Healthcare Foundation Trust,on“psychosurgery”,“prefrontal lobotomy”and“DBS”,which may well reflect wider public opinion.In summary,the article provides a brief,yet comprehensive overview of the controversial history of psychosurgery,present-day practice,and future trends of neurosurgery for psychiatric disorders.

Effects of Ningdong granule on DA,DRD2,and HVA in a rat model of Tourette's syndrome

OBJECTIVE:Ningdong granule is a traditional Chinese medicine preparation for the treatment of Tourette's syndrome.METHODS:Sixty-four rats were randomly assigned to a control group and three experimental groups,respectively.Rat models of Tourette's syndrome were established via intraperitoneal injection of apomorphine(Apo).The rats in the experimental groups were subsequently intragastrically injected with haloperidol at 10 mg/kg(haloperidol group),Ningdong granule at 370 mg/kg(NDG group),and normal saline(0.9%) at 10 mL/kg(Apo group),respectively.Rat behaviors were observed and recorded on a daily basis.After 12 w,all rats were sacrificed,and sera and striatal tissues were harvested.Homovanillic acid levels in sera,as well as dopamine and dopamine D2 receptor mRNA expression in the striatum,were measured to determine possible mechanisms of Ningdong granule on the dopamine system in a rat model of Tourette's syndrome.RESULTS:Following intervention,stereotype actions of the Tourette's syndrome rats were significantly inhibited in the haloperidol and NDG groups,respectively(P<0.01).Homovanillic levels were significantly greater in the haloperidol and NDG groups,respectively(P<0.05).In addition,dopamine levels were significantly less in the NDG group(P<0.01),and DRD2 mRNA expression was significantly reduced in the haloperidol and NDG groups,respectively(P<0.05).CONCLUSION:Results demonstrated that Ningdong granule effectively inhibited stereotype actions and Tourette's syndrome symptoms by promoting dopamine metabolism,reducing dopamine levels in the striatum,increasing homovanillic acid content in sera,and reducing mRNA expression of DRD2 in the striatum.

Observation on the Curative Effect of Acupuncture on Child Tourette＇s Syndrome

To investigate the efficacy of earth-reinforcing and wood-reducing acupuncture tbr child Tourette＇s syndrome. Methods： Forty-five children with Yourette＇s syndrome were randomly allocated, according to a random number table, into an acupuncture group （23 cases） and a Western medicine group （22 cases）. Points Zhongwan （CV 12） and Siguan were selected in co-operation with acupuncture of other routine points in the acupuncture group. Haloperidol was orally administered for routine treatment in the Western medicine group. Results： The cure rate was 65.2% in the acupuncture group and 31.8% in the Western medicine group. There was a significant difference in cure rate between the two groups （P〈0.05）. Conclusion： Earth-reinforcing and wood-reducing acupuncture has an exact curative effect on child Tourette＇s syndrome.

Treatment of 102 Cases of Tourette＇s Syndrome with Acupuncture plus Herbal Medicine

102 cases of Tourette＇s syndrome were divided into three types of the liver and kidney yin deficiency, phlegm and damp blockage and spleen and stomach deficiency. Acupuncture, auricular-plaster therapy, cupping therapy and herbal medicine were combined to treat this syndrome. As a result, 30 cases were satisfactorily effective, 61 cases were improved and 11 cases were ineffective with a total effective rate of 98.2% and no side effects were noticed during treatment.

Clinical observation of tuina manipulations for tic disorders in kids

Objective:To observe the clinical efficacy of tuina manipulations in treating different types of tic disorders(TD).Methods:Eligible TD patients were classified into three types,transient tic disorders(TTD),chronic multiple tic disorders(CMTD)and Tourette syndrome(TS),according to their disease duration and severity.The three types of children were treated with the same tuina manipulations.Changes in the Yale global tic severity scale(YGTSS)score,effective rate for tic,and cervical spine imaging examination results(including asymmetry of the lateral atlanto-dental interval,broadened anterior atlanto-dental interval,C2 spinous process deviation,occipito-atlanto-axial flexion/extension instability)were observed after 1-month and 3-month treatments respectively.Results:The YGTSS score changed significantly after 1-month and 3-month treatments compared with that before treatment(both P<0.01);the effective rate for TD was 46.6%and 86.7%respectively after 1-month and 3-month treatments;there were significant differences comparing the effective rate for tic between different types of TD after 1-month and 3-month treatments(all P<0.05);comparing the effective rate for tic after 1-month treatment with that after 3-month treatment for the same type,the intra-group differences were statistically significant[TTD group(P<0.01),CMTD group(P<0.01),TS group(P<0.05)];the abnormal parameter rates in neck imaging examination after 3-month treatment were significantly different from those before treatment(all P<0.01).Conclusion:Tuina manipulation is effective for TTD,CMTD and TS.It can correct the abnormal alterations of patients'cervical vertebrae,and its efficacy for TTD is most significant.

Correlation between premonitory urges and tic symptoms in a Chinese population with tic disorders

Importance Tics usually start around 4–6 years old and affect about 1%of school‐age children.Premonitory urges(PUs)are sensory phenomena that precede tics and are often described as unpleasant feelings.Recent evidence supports a relationship between PUs and tic severity,but reports are conflicting.In addition,there is no report of PUs in the Chinese population.Objective To investigate the correlation between PUs and tic symptoms in the Chinese population with tic disorders.Methods We recruited 252 Chinese individuals with chronic tic disorders(age 5–16 years).The Yale Global Tic Severity Scale(YGTSS)was used to assess tic symptoms,and the Premonitory Urge for Tics Scale(PUTS)was used to assess PUs.We calculated Spearman correlations between PUTS and YGTSS scores,and constructed a linear regression model to predict the tic symptom severity by PUs.Results There was a significant positive correlation between PU severity(PUTS scores)and motor tic severity,total tic severity,tic‐caused impairment(YGTSS scores)(P<0.05).PU severity was a significant positive predictor of tic symptom severity(standardized beta coefficient=0.174,t=2.786,P=0.006).Interpretation We provide evidence for a correlation between PUs and tic symptoms.PU severity predicts tic symptom severity.Further research on PUs is needed to clarify the shared brain mechanism with tics,and their role in tic expression.A suitable tool to assess PUs in younger children is also needed.