Elucidating the Nature and Mechanism of Tic Improvement in Tourette Syndrome: A Pilot Study

Background: For unclear reasons, many Tourette syndrome (TS) children report near‐complete tic remission by young adulthood. Immature maturation of brain networks, observed with resting‐state functional MRI (rs‐fc‐MRI) in adolescents and adults with TS, might evolve to a mature pattern in adults who experience tic improvement or remission. We explored the feasibility of testing this hypothesis in our population of young adult TS males, each with prior clinical assessments completed during childhood as part of a separate TS Association Genetics Consortium study. Methods: A total of 10 TS males (off tic suppressing drugs for at least 6 months) aged 19–32 years, mean follow‐up interval 7.5 (2 to 13) years, and 11 neurologically normal controls were enrolled and underwent 3‐Tesla structural and rs‐fc‐MRI sequences. Results: The mean change in Yale Global Tic Severity Scale (YGTSS) was −31.5% (total) and −26.6% (YGTSS motor+vocal). Two subjects reported resolution of tic‐related disability, with drops from mean 45 to 16.5 (YGTSS‐total) and 25 to 11.5 (YGTSS motor+vocal.). Rs‐fc‐MRI revealed significantly increased connectivity between the ipsilateral anterior and mid cingulate cortex and striatum, increased connectivity between local connections, and decreased connectivity between more distant connections; representing an immature connectivity pattern. Discussion: Similar to previous reports, we found immature patterns of functional connectivity in adult TS subjects. Despite a lack of complete tic remission, two subjects exhibited dramatic drops in tic severity that correlated with tic‐related disability improvement. More work is needed to elucidate the mechanism of such dramatic improvement in TS

Temporal Course of the Tourette Syndrome Clinical Triad

Background: Tourette syndrome (TS) is a disorder characterized by childhood onset of motor and phonic tics, often with improvement of tic symptoms by young adult years. The temporal course of tics and commonly comorbid behavioral symptoms is still not well characterized. Methods: In order to clarify the time course of tics and comorbid attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD) in TS, we administered a brief survey regarding the course of symptoms at a single point in time to 53 TS patients aged 13–31 years. Results: Mean age (±SD) at symptom onset was 7.9 (±3.6) years for tics, 7.9 (±3.5) for ADHD, and 9.2 (±5.0) for OCD. Age at peak symptom severity was 12.3 (±4.6) years for tics, 10.8 (±3.8) for ADHD, and 12.6 (±5.5) for OCD. Tics, ADHD, and OCD were reported to be no longer present in 32.0%, 22.8%, and 21.0% of subjects, respectively. Decline in symptom severity began at age 14.7 (±3.7) years for tics, 13.9 (±2.9) for ADHD, and 15.1 (±5.0) for OCD. Remission of symptoms occurred at age 17.4 (±3.8) years for tics, 17.4 (±1.3) for ADHD, and 15.6 (±2.3) for OCD. Discussion: Our data confirm and expand previously reported TS spectrum symptom milestones and may guide design of future research aimed at improving the course of TS. Keywords: Tourette, obsessive compulsive disorder, attention deficit hyperactivity disorder, tic Citation: Shprecher DR, Rubenstein LA, Gannon K, et al. Temporal course of the Tourette syndrome clinical triad. Tremor Other Hyperkinet Mov. 2014; 4. doi: 10.7916/D8HD7SV

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

A theoretical framework for understanding deviant sexual interest and cognitive distortions as overlapping constructs contributing to sexual offending against children

Most current research and theory accepts implicitly or explicitly that there is a relationship between deviant sexual interest and cognitive distortions surrounding sexual contact with children. However the current literature is lacking a framework by which deviant interest and offense supportive or facilitative cognitive structures or processes may interact. Recent advances in the application of indirect measures of cognitive distortions and sexual deviance have indicated a potential utility of such measures as alternatives or adjuncts to existing measures such as penile plethysmography, viewing time tasks and questionnaires. However, without a coherent theory of what these subtle tasks are measuring and how constructs such as offense-supportive schema and deviant sexual interest interact, it will be difficult to make sense of current findings and indeed to agree on best practice for the use of indirect measures in clinical assessment. This article discusses the cognitive structures and processes involved in both cognitive distortions and deviant sexual interest and explores how they might overlap and interact in facilitating and maintaining offending behavior

A morphometric analysis of auditory brain regions in congenitally deaf adults

We investigated whether variation in auditory experience in humans during development alters the macroscopic neuroanatomy of primary or auditory association cortices. Volumetric analyses were based on MRI data from 25 congenitally deaf subjects and 25 hearing subjects, all right-handed. The groups were matched for gender and age. Gray and white matter volumes were determined for the temporal lobe, superior temporal gyrus, Heschl's gyrus (HG), and the planum temporale. Deaf and hearing subjects did not differ in the total volume or the gray matter volume of HG, which suggests that auditory deafferentation does not lead to cell loss within primary auditory cortex in humans. However, deaf subjects had significantly larger gray matter–white matter ratios than hearing subjects in HG, with deaf subjects exhibiting significantly less white matter in both left and right HG. Deaf subjects also had higher gray matter–white matter ratios in the rest of the superior temporal gyrus, but this pattern was not observed for the temporal lobe as a whole. These findings suggest that auditory deprivation from birth results in less myelination and/or fewer fibers projecting to and from auditory cortices. Finally, the volumes of planum temporale and HG were significantly larger in the left hemisphere for both groups, suggesting that leftward asymmetries within “auditory” cortices do not arise from experience with auditory processing