Portal de Periódicos da CAPES

THE COURSE AND PROGNOSIS OF TOURETTE SYNDROME

1997; Elsevier BV; Volume: 15; Issue: 2 Linguagem: Inglês

10.1016/s0733-8619(05)70313-3

1557-9875

Ruth D. Bruun, Cathy L. Budman,

Trypanosoma species research and implications

Tourette's syndrome (TS) is an inherited, neuropsychiatric disorder of childhood onset, characterized by motor and vocal tics. Over the past two decades we have made major advances in our understanding of this disorder; however, the natural course remains poorly defined for several reasons. Until the late 1970s, TS was considered to be a rare and esoteric affliction. Even patients with the most flagrant symptoms often were not diagnosed correctly. As a result, observations on the nature of the disorder were based on studies conducted on a relatively small pool of patients with severe, disabling symptoms.31 Increasing interest from the medical community and the media gradually led to recognition of milder cases and earlier diagnoses. With larger patient samples, perceptions of the natural course of TS have changed.3, 4, 5, 11, 15, 25, 27, 32, 33, 36 Most research continues to be conducted at tertiary care medical centers, however, and may still reflect the more severe end of the TS spectrum. There remains a need for community-based prospective studies that include the milder cases. Haloperidol was the first medication demonstrated to be an effective treatment for tics.33 This discovery led to the active pursuit of additional pharmacologic agents. Clonidine, pimozide, and other neuroleptics subsequently became available or were recognized as effective for tic control.35, 36 More recently, significant advances in the understanding of conditions associated with TS, such as attention-deficit disorder (ADD) and obsessive-compulsive disorder (OCD), have expanded the variety of treatments for the TS patients who suffer from these comorbid disorders.10, 27, 36 It is not known, however, which effect these interventions may have on the natural progression of TS. Research in the neurobiology and genetics of TS has revealed mechanisms that may play important etiologic roles in this disorder. These studies also suggest that the potential heterogeneity of TS may contribute to varying clinical courses.8, 10, 14, 28, 29, 30, 35, 36, 38 If so, it is then likely that generalizations about the natural course may not be applicable in certain patient populations. Finally, the clinical criteria used for diagnosing TS have been subject to controversy and changes over the years. Recent revisions of diagnostic criteria established by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) require the disturbance to cause “marked distress of significant impairment in social, occupational, or other important areas of functioning.” Operationally, this may mean that patients who were previously diagnosed with TS no longer meet current criteria. These methodologic problems further complicate the long-term follow-up of TS patients. Despite these problems, several observations on the natural course of TS have been made. One of these authors (Bruun) has followed a large cohort of TS patients from childhood into adulthood, both treated and untreated, for over 20 years. Both authors have encountered many people who receive an initial diagnosis as adults. These patients have provided histories of their symptoms over their life cycle in the absence of treatment interventions, helping us to examine the evolution of TS developmentally.