Fecal transplantation can alleviate tic severity in a Tourette syndrome mouse model by modulating intestinal flora and promoting serotonin secretion / 中华医学杂志(英文版)

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.

Síndrome de Tourette: Tratamiento farmacológico en pacientes pediátricos, una puesta al día / Tourette's Syndrome: An Update on Pharmacological Treatment in Paediatric Patients

El síndrome de Tourette (ST) se caracteriza por tics motores y fónicos, destacando las dificultades de su manejo farmacológico. El objetivo de este artículo es describir los resultados de una revisión bibliográfica de las alternativas de tratamiento farmacológico existentes en la actualidad para el ST pediátrico. Metodología: Se realizó una búsqueda bibliográfica en base de datos PubMed utilizando los términos meSH "Tourette syndrome", "Tics", "Therapeutics" y "Children" entre los años 1950 y 2020, tras priorización y exclusión se obtuvo un total de 64 artículos. Resultados: Los artículos muestran 21 alternativas terapéuticas, que se detallan en dos niveles según eficacia y efectos adversos. Conclusiones: Existen múltiples alternativas farmacológicas, algunas con efectos adversos que pueden llegar a determinar la imposibilidad de continuar el tratamiento. Esta sigue siendo un área abierta de investigación en la búsqueda de alternativas que disminuyan estos efectos.

Abstract. Introduction: Tourette syndrome (TS) is characterized by motor and phonic tics, and the difficulties of its pharmacological management. The objective of this article is to describe the results of a bibliographic review of the pharmacological treatment alternatives that currently exist for pediatric TS. Methods: A bibliographic search was carried out in the PubMed database using the meSH terms "Tourette syndrome", "Tics", "Therapeutics" and "Children" between 1950 and 2020, after prioritization and exclusion, a total of 64 articles were selected. Results: The articles show 21 therapeutic alternatives, which are categorized into two levels according to efficacy and adverse effects. Conclusions: There are multiple pharmacological alternatives, some with adverse effects that may make it impossible to continue treatment. This continues to be an open area of investigation in the search for alternatives that minimize these side effects.

Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder

Objective: Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). Method: We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. Results: Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. Conclusion: We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.

What does immunology have to do with brain development and neuropsychiatric disorders?

Introduction: Neural development is an enormously complex and dynamic process. From very early in brain development 'immune cells' play a key role in a number of processes including the formation and refinement of neural circuits, as well as sexual differentiation. There is a growing body of evidence that the immune system also plays an important role in the pathobiology of several neurodevelopmental and neuropsychiatric disorders. Objective: The goal of this article is to review the currently available data concerning the role of the 'immune system' in normal brain development, as well as its role in the pathobiology of neurodevelopmental and neuropsychiatric disorders. Methodology: We conducted a traditional literature search using PubMed and recent special issues of journals to locate relevant review articles. Results: The cellular and molecular processes that make up our 'immune system' are crucial to normal brain development and the formation and maintenance of neural circuits. It is also increasingly evident that the immune system and neuroinflammation play important roles in the pathobiology of at least a subset of individuals with Autism Spectrum Disorder (ASD), schizophrenia, obsessive-compulsive disorder, Tourette syndrome and mood disorders, such as depression, as well as autoimmune and neurodegenerative disorders. Emerging evidence also points to the importance of the 'gut-brain axis' and an individual's microbiome, which can impact an individual's somatic and mental well-being. Conclusions: There are multidirectional interconnections across multiple biological systems in our brains and bodies that are mediated in part by the immune system. At present, however, the 'promise' of this field remains greater than the 'deliverables'. Time will tell whether novel interventions will be developed that will make a positive difference in the care of our patients. It is also possible that valid biomarkers will emerge that will guide a more personalized approach to treatment.

Introdução: O desenvolvimento neural é um processo extremamente complexo e dinâmico. Tao pronto se inicia o desenvolvimento do cérebro, as "células imunológicas" desempenham um papel fundamental em vários processos, incluindo a formação e aperfeiçoamento de circuitos neurais, bem como a diferenciação sexual. Há um crescente corpo de evidências de que o sistema imunológico também desempenha um papel importante na fisiopatologia de diversos transtornos neurodesenvolvimentais e neuropsiquiátricos. Objetivo: O objetivo deste artigo é revisar os dados atualmente disponíveis sobre o papel do "sistema imunológico" em relação ao desenvolvimento normal do cérebro, bem como a fisiopatogenia dos transtornos de neurodesenvolvimento e neuropsiquiátricos. Metodologia: Foi realizada uma pesquisa bibliográfica tradicional para localizar artigos de revisão relevantes. Resultados: Os processos celulares e moleculares que compõem o nosso "sistema imunológico" são cruciais para o desenvolvimento normal do cérebro e a formação e manutenção de circuitos neurais. É cada vez mais evidente que o sistema imunológico e neuroinflamação desempenham papéis importantes na etiopatogenia de pelo menos um subconjunto de indivíduos com autismo, esquizofrenia, transtorno obsessivo-compulsivo, síndrome de Tourette, depressão e transtornos do humor, bem como distúrbios autoimunes e neurodegenerativos. Evidências emergentes também apontam para a importância do eixo intestino-cerebral e do microbioma de um indivíduo em relação à sua saúde e bem-estar somático e mental. Conclusões: Existem interconexões multidirecionais entre múltiplos sistemas biológicos em nossos cérebros e corpos que são mediados em parte pelo sistema imunológico. No momento, no entanto, a "promessa" desse campo continua sendo maior do que os "resultados finais". O tempo dirá se novas intervenções serão desenvolvidas que farão uma diferença positiva no cuidado de nossos pacientes. Também é possível que surjam biomarcadores válidos que orientarão uma abordagem mais personalizada ao tratamento.

Beliefs about Tic Disorders and Tourette's Syndrome in South Korea: An Online Panel Survey

OBJECTIVES: This study investigates lay beliefs about the etiology and treatments of tic disorder and Tourette's syndrome, as well as identifying sociodemographic and personality variables affecting these beliefs among South Koreans. METHODS: In total, 673 participants (mean age 41.77±12.03 years) completed an online survey regarding their beliefs about tic disorder and Tourette's syndrome. The factors related to their lay beliefs about the disorders were analyzed, and the correlates were investigated. RESULTS: Results indicated that lay people in South Korea held strong beliefs that the causes of tic disorder and Tourette's syndrome lie within the parenting/psychological and neurological/biological categories, compared to the dietary/environmental one. Among the sociodemographic variables, sex, age, and levels of subjective mental health knowledge were primarily associated with the aforementioned beliefs. Familiarity with tic disorder and Tourette's syndrome was also associated with these beliefs. Among the personality traits investigated, extraversion and conscientiousness had significant influences on the beliefs people had about tic disorder and Tourette's syndrome. CONCLUSION: The results suggest that both policy makers and mental health service providers should adopt a strategic approach for developing and implementing health education interventions about tic disorder and Tourette's syndrome because individual sociodemographic variables, familiarity with the disorders, and personality traits are all associated with the beliefs about these disorders.

Clinical Aspects of Premonitory Urges in Patients with Tourette's Disorder

Most patients with Tourette's disorder experience an uncomfortable sensory phenomenon called the premonitory urge immediately before experiencing tics. It has been suggested that premonitory urges are associated with comorbidities such as obsessive compulsive disorder, anxiety disorders, and attention-deficit/hyperactivity disorder, although these associations have been inconsistent. Most patients experience tics as a result of the premonitory urges, and after the tics occur, most patients report that the premonitory urges are temporarily relieved. As a consequence, several studies have assessed the premonitory urge and its potential therapeutic utility. Based on the concept that the premonitory urge induces tics, behavioral treatments such as Exposure and Response Prevention and Habit Reversal Therapy have been developed. However, it is still unclear whether habituation, the main mechanism of these therapies, is directly related to their effectiveness. Moreover, the observed effects of pharmacological treatments on premonitory urges have been inconsistent.

Professor 's experience in treatment of Tourette syndrome with 's scalp acupuncture / 中国针灸

Professor 's experience in treatment of Tourette syndrome with 's scalp acupuncture were introduced. Professor believes that this disease is in category of tremor in TCM. Pathogenic wind is the key in its pathogenesis and liver, spleen and kidney are closely related. Hence, the treatment focuses on eliminating pathogenic wind and regulating the function of liver, spleen and kidney. The cerebrum is the regulation center in human body. The abnormal somatic function can be adjusted by acupuncture at the scalp area where the cerebral cortical function is projected. 's scalp acupuncture is suitable in treatment of Tourette syndrome. Such scalp acupuncture was introduced in this paper with the typical case reported so as to provide a new approach to clinical treatment.

Progressive Cervical Spondylotic Myelopathy Caused by Tic Disorders in a Young Adult with Tourette Syndrome / 대한신경손상학회지

Involuntary movement of the cervical spine can cause damage to the cervical spinal cord. Cervical myelopathy may occur at an early age in involuntary movement disorders, such as tics. We report the case of a 21-year-old man with Tourette syndrome, who developed progressive quadriparesis, which was more severe in the upper extremities. The patient had abnormal motor tics with hyperflexion and hyperextension of the cervical spine for more than 10 years. High-signal intensity intramedullary lesions were observed at C3-4-5-6 level on T2 weighted magnetic resonance imaging. Examinations were performed for high-signal intensity intramedullary lesions that may occur at a young age, but no other diseases were detected. Botulinum toxin injection to the neck musculature and medication for tic disorders were administered. However, the myelopathy was further aggravated, as the involuntary cervical movement still remained. Therefore, laminoplasty was performed at C3-4-5-6, with posterior fixation at C2-3-4-5-6-7 to alleviate the symptoms. The neurological signs and symptoms improved dramatically. The management of tic disorders should be the first priority during treatment. However, surgical treatment may be necessary, if symptoms worsen after appropriate treatment.

Caracterización cognitiva del trastorno de Tourette con comorbilidad TDAH: un estudio de caso / Cognitive characterization of Tourette disorder with ADHD comorbidity: a case study

El trastorno de Tourette (TT) es un trastorno del neurodesarrollo que aparece en la primera infancia caracterizado por la presencia de tics fónicos y motores que dificultan la socialización y el proceso de aprendizaje escolar. El TT posee una variada comorbilidad que incluye el trastorno por déficit de atención con hiperactividad (TDAH), el trastorno obsesivo compulsivo (TOC), y dificultades de aprendizaje y del comportamiento. Presentamos el caso de un adolescente de 13 años diagnosticado con TT y con TDAH a los 6 y 10 años respectivamente. El paciente ha tenido una escolarización dificultosa y se encuentra con tratamiento médico de clozapina, aripiprazol, haloperidol y litio. Se aplica una batería neuropsicológica para evaluar la atención e inhibición, organización visuoespacial, memoria de trabajo, flexibilidad cognitiva, memoria verbal y memoria no-verbal, con el propósito de describir su perfil cognitivo de funciones ejecutivas y memoria. El estudio reveló que la atención está deteriorada pero que la inhibición se encuentra preservada; esto confirma el diagnóstico de TDAH y establece el subtipo de inatento para el caso en estudio. Las demás funciones ejecutivas evaluadas se encuentran severamente descendidas, situación que es coincidente con el perfil desarrollado por otros autores para el TT con comorbilidad TDAH. Sin embargo, no es claro si la disfuncionalidad ejecutiva se debe al TDAH que presenta, o a factores sociales y culturales derivados de las dificultades de escolarización causadas por el TT.

Tourette's disorder (TD) is a neurodevelopmental disorder that appears in early childhood characterized by the presence of phonic and motor tics that hinder socialization and the school learning process. TD has a varied comorbidity that includes attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), learning and behavioral difficulties. We present the case of a 13-year-old adolescent diagnosed with TD and with ADHD at 6 and 10 years old respectively. The patient has had a difficult schooling and is under medical treatment of clozapine, aripiprazole, haloperidol and lithium. A neuropsychological battery is applied to evaluate the attention and inhibition, visuospatial organization, working memory, cognitive flexibility, verbal memory and non-verbal memory, with the purpose of describing its cognitive profile of executive functions and memory. The study revealed that the attention is impaired but that the inhibition is preserved; This confirms the diagnosis of ADHD and establishes the inattentive subtype for the case under study. The other executive functions evaluated are severely descended, a situation that coincides with the profile developed by other authors for TD with comorbid ADHD. However, it is not clear if the executive dysfunctionality is due to the ADHD it presents, or to social and cultural factors derived from the difficulties of schooling caused by the TD.

Eficacia de la dieta libre de gluten en el síndrome Gilles de la Tourette con enfermedad celíaca. Reporte de caso / Efficacy of the gluten-free diet in the Gilles de la Tourette syndrome with celiac disease. Case Report

RESUMEN Fundamentación: El síndrome Gilles de la Tourette es un proceso neuropsiquiátrico de causa desconocida caracterizado por múltiples tics. Los desórdenes relacionados al gluten cubren múltiples manifestaciones clínicas inmunológicas ante el consumo de gluten; incluyen la enfermedad celíaca y la sensibilidad al gluten no celíaca. Se han publicado casos de síndrome Gilles de la Tourette con sensibilidad al gluten no celíaca, pero ninguno relacionado con la enfermedad celíaca clásica. Reporte de caso: Paciente masculino de 20 años, con diagnóstico de EC desde la infancia y cuadro típico de Tourette diagnosticado recientemente. Mostró excelente respuesta y remisión clínica neurológica y conductual después de establecerse rigurosamente una dieta libre de gluten. Conclusiones: Es necesario incluir entre los grupos de riesgo de sensibilidad al gluten los niños con trastornos neuropsicológicos como los aquí referidos. La enfermedad celíaca clásica debe incluirse entre las posibles asociaciones con el síndrome Gilles de la Tourette. La dieta restrictiva también mejora en estos casos la evolución de ambas enfermedades.

ABSTRACT Background: The Gilles de la Tourette syndrome is a neuropsychiatric process of unknown cause characterized by multiple tics. Disorders related to gluten cover multiple immunological clinical manifestations when eating gluten; they include celiac disease and non-celiac gluten sensitivity. There have been cases of Gilles de la Tourette syndrome with sensitivity to non-celiac gluten, but none related to classic celiac disease. Case report: A 20-year-old male patient, with a CD diagnosis from childhood and typical GTS pattern recently diagnosed. He showed excellent response and clinical neurological and behavioral remission after rigorously establishing a gluten-free diet. Conclusions: Children with neuropsychological disorders such as those referred here need to be included among the risk groups with gluten sensitivity. Classical celiac disease should be included among the possible associations with the Gilles de la Tourette syndrome. The restrictive diet also improves the evolution of both diseases in these cases.

What do Cochrane systematic reviews say about the use of cannabinoids in clinical practice?

ABSTRACT BACKGROUND: The therapeutic effects of cannabinoid compounds have been the center of many investigations. This study provides a synthesis on all Cochrane systematic reviews (SRs) that assessed the use of cannabinoids as a therapeutic approach. DESIGN AND SETTING: Review of SRs, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: A broad search was conducted in the Cochrane Database of Systematic Reviews to retrieve any Cochrane SRs that assessed the efficacy and safety of cannabinoids as a therapeutic approach. The results and key characteristics of all reviews included were summarized and discussed. RESULTS: Eight SRs were included. They assessed the use of cannabinoids for the following types of conditions: neurological (two SRs), psychiatric (two SRs), rheumatological (one SR), infectious (one SR) and oncological (two SRs). There was moderate-quality evidence showing that the use of cannabinoids reduced nausea and vomiting among adults, compared with placebo. Additionally, there was moderate-quality evidence showing that there was no difference between cannabinoids and prochlorperazine regarding the number of participants who reported vomiting, in this same population. CONCLUSIONS: This review identified eight Cochrane systematic reviews that provided evidence of unknown to moderate quality regarding the use of cannabinoids as a therapeutic intervention. Further studies are still imperative for solid conclusions to be reached regarding practical recommendations.

Síndrome de Gilles de la Tourette / Gilles de la Tourette's syndrome

Introducción: El síndrome de la Tourette constituye un trastorno neuropsiquiátrico que puede afectar seriamente la calidad de vida. Objetivo: Describir las características clínicas y el tratamiento del síndrome de la Tourette en un paciente atendido en el Departamento de Salud Mental del Policlínico Universitario Héroes de Girón. Métodos: Se aplicó el método clínico, anamnesis, examen físico general, neurológico y psiquiátrico. Entrevista semiestructurada, pruebas psicológicas proyectivas, exámenes de laboratorio, electrocardiograma, imagineología cerebral (TAC simple de cráneo); estudios neuropsicológicos (Wisconsin) y neurofisiológicos (electroencefalograma). Se revisó la historia clínica del paciente examinado. Resultados: Paciente masculino de 43 años de edad, soltero, no hijos, electricista. Con historia de hiperactividad y dificultad atencional, asociado a tics motores complejos y fonatorios desde los 7 años de edad sin tratamiento, con afectación de su calidad de vida. Al examen clínico se constatan tics mixtos, al examen psiquiátrico distractibilidad, retraimiento, desmotivación, perseveración, rumiaciones, ideas obsesivas, ansiedad, angustia, hipercinesia, compulsiones, rituales, disfemia, coprolalia e insomnio nocturno. En las pruebas psicológicas marcada ansiedad e impulsividad. Los estudios de laboratorio, electrocardiografía y TAC de cráneo no arrojaron resultados patológicos. Wisconsin positivo. Electroencefalograma con irritación cortical en región frontotemporal izquierda. Conclusiones: El síndrome de la Tourette se presenta con frecuencia en la clínica psiquiátrica del adulto como entidad comórbida con el Trastorno por Déficit de Atención e Hiperactividad y el Trastorno obsesivo compulsivo(AU)

Introduction: Tourette's syndrome constitutes a neuropsychiatric disorder that can seriously affect the quality of life. Objective: To describe the clinical characteristics and the treatment of Tourette's syndrome in a patient treated at the Department of Mental Health of Héroes de Girón University Polyclinic. Methods: The clinical method, anamnesis, general physical, neurological and psychiatric examination were applied. Semi-structured interview, projective psychological tests, laboratory tests, electrocardiogram, brain imaging (simple skull CAT scan); neuropsychological (Wisconsin) and neurophysiological studies (Electroencephalogram). The clinical record of the patient examined was reviewed. Results: Male patient aged 43 years, single, without children, electrician. With a history of hyperactivity and attentional difficulty, associated with complex and phonatory motor tics from the age of 7 and without treatment, affecting his quality of life. The clinical examination shows mixed tics, psychiatric examination, distractibility, withdrawal, demotivation, perseveration, ruminations, obsessive ideas, anxiety, anguish, hyperkinesia, compulsions, rituals, dyspnea, coprolalia and nocturnal insomnia. In psychological tests, marked anxiety and impulsivity. The laboratory studies, electrocardiography and CT scan of the skull did not yield pathological results. Wisconsin positive. Electroencephalogram with cortical irritation in the left frontotemporal region. Conclusions: Tourette's syndrome is frequently seen in the psychiatric clinic of the adult as a comorbid entity with attention deficit hyperactivity disorder and obsessive compulsive disorder(AU)

A review on the management of tic disorders in children: psychoeducation and behavioral intervention / 中国当代儿科杂志

Tic disorders (TD) are a group of neurodevelopmental disorders that are characterized by motor and/or vocal tics in children and adolescents. The etiology and pathogenesis of TD remain unclear, and it is believed to be caused by a combination of genetic, biological, psychological, and environmental factors. The major treatment for TD includes psychoeducation, behavioral intervention, and drug treatment. To further explore the management of TD, this article reviews the research advances in psychoeducation and behavioral intervention for patients with TD.

Treatment of Children and Adolescents with Attention Deficit Hyperactivity Disorder and/or Tourette's Disorder with Clonidine Extended Release

We aimed to assess the effectiveness and safety of clonidine extended release (ER) treatment in Korean youth with ADHD and/or Tourette's disorder. We retrospectively reviewed the medical records of 29 children and adolescents treated with clonidine ER. The effectiveness were retrospectively measured at baseline and after 4 and 12 weeks based on the Clinical Global Impression-Severity (CGI-S) and Clinical Global Impression-Improvement (CGI-I) scores. Safety was evaluated at each visit based on spontaneous reports from the subjects or from their parents/guardians. Significant decreases in the CGI-S scores for both ADHD (F=23.478, p < 0.001, partial η2=0.540) and tic symptoms (F=15.137, p < 0.001, partial η2=0.443) were noted over 12 weeks. The most common adverse event was somnolence (n=9, 31.0%) and life-threatening adverse effects were not observed. Our results provide preliminary evidence for the effectiveness and safety of clonidine ER.

Did Mozart suffer from Gilles de la Tourette syndrome? / ¿Mozart padeció síndrome de Gilles de la Tourette?

Abstract The personal and private lives of great men and women in history, like writers, painters and musicians, have been the subject of great interest for many years. A clear example of this is the vast scrutiny is cast over the famous composer, Wolfgang Amadeus Mozart. What may have started as curiosity, rapidly evolved into extensive research, as the answers about the musician's legendary talent may lie in the details of his life (his childhood, his relationships, his quirks and his mannerisms). It is usually up to historians, anthropologists or philosophers to delve into the pages of old books, trying to grasp answers and clues. However, for some time, physicians have sought their own part in solving the puzzle. The long told hypothesis regarding Mozart's diagnosis of Gilles de la Tourette syndrome will be examined. Could all of the peculiarities and oddities of the genius be caused by a neurological disorder? Or was this musical genius just an eccentric brilliant man?

Resumen Por años, la vida privada de los grandes hombres y mujeres de la historia, escritores, pintores y músicos, ha sido objeto de gran interés. Un claro ejemplo de esto es el gran escrutinio que se ha hecho sobre el aclamado compositor Wolfgang Amadeus Mozart. Lo que posiblemente comenzó como simple curiosidad rápidamente se convirtió en una investigación exhaustiva, pues en los detalles de su vida (su infancia, relaciones, mañas y manierimos) podría estar la evidencia de su legendario talento. Usualmente, son los historiadores, antropólogos y filósofos los que se sumergen en las páginas de viejos y ajados libros tratando de encontrar respuestas y pistas; sin embargo, desde algún tiempo, los médicos han reclamado su propio papel en la resolución de estos interrogantes. Este artículo explora la hipótesis sobre el posible diagnóstico de síndrome de Gilles de la Tourette para Mozart. ¿Todas las peculiaridades y rarezas del genio podrían estar causadas por un trastorno neurológico o se trataba solamente de un hombre brillante y excéntrico?

A Systematic Review of the Effectiveness of Medical Cannabis for Psychiatric, Movement and Neurodegenerative Disorders

The discovery of endocannabinoid’s role within the central nervous system and its potential therapeutic benefits have brought forth rising interest in the use of cannabis for medical purposes. The present review aimed to synthesize and evaluate the available evidences on the efficacy of cannabis and its derivatives for psychiatric, neurodegenerative and movement disorders. A systematic search of randomized controlled trials of cannabis and its derivatives were conducted via databases (PubMed, Embase and the Cochrane Central Register of Controlled Trials). A total of 24 reports that evaluated the use of medical cannabis for Alzheimer’s disease, anorexia nervosa, anxiety, dementia, dystonia, Huntington’s disease, Parkinson’s disease, post-traumatic stress disorder (PTSD), psychosis and Tourette syndrome were included in this review. Trial quality was assessed with the Cochrane risk of bias tool. There is a lack of evidence on the therapeutic effects of cannabinoids for amyotrophic lateral sclerosis and dystonia. Although trials with positive findings were identified for anorexia nervosa, anxiety, PTSD, psychotic symptoms, agitation in Alzheimer’s disease and dementia, Huntington’s disease, and Tourette syndrome, and dyskinesia in Parkinson’s disease, definitive conclusion on its efficacy could not be drawn. Evaluation of these low-quality trials, as rated on the Cochrane risk of bias tools, was challenged by methodological issues such as inadequate description of allocation concealment, blinding and underpowered sample size. More adequately powered controlled trials that examine the long and short term efficacy, safety and tolerability of cannabis for medical use, and the mechanisms underpinning the therapeutic potential are warranted.

Comparing Intelligence Test Profiles to Assess Tourette's Disorder with Attention-Deficit Hyperactivity Disorder

OBJECTIVES: The study compared the intelligence test profiles of Tourette's Disorder (TD), attention-deficit hyperactivity disorder (ADHD), and TD with ADHD (TD+ADHD) groups. METHODS: The Korean Wechsler Intelligence Scale for Children-third edition (K-WISC-III) and Korean Wechsler Intelligence Scale for Children-fourth edition (K-WISC-IV) were administered to 13 children and adolescents with TD, 17 children and adolescents with ADHD, and 15 children and adolescents with TD+ADHD. Each parameter was compared among the groups using the Kruskal-Wallis test. RESULTS: The mean scores of the freedom from distractibility/working memory index (FD/WMI) and the digit span and arithmetic subtests of the TD+ADHD group were significantly lower than those of the TD group. CONCLUSION: According to the intelligence test results, the comorbid ADHD+TD group showed a significant decrease in working memory compared to the TD group. These findings are similar to those of previous research on cognitive functions and suggest that the TD+ADHD comorbid and TD alone groups exhibit different endophenotypes. The results also imply that WISC-III and WISC-IV, the most commonly used intelligence tests clinically, are effective in evaluating cognitive functions such as attention. Further research is required to confirm these results.

Atualizações neurocientíficas na Síndrome de Tourette: uma revisão integrativa / Neuroscientific updates in Tourette Syndrome: an integrative review

O presente estudo apresenta uma revisão integrativa sobre a Síndrome de Tourette (ST) que é pouco conhecida por muitos profissionais da saúde. Foi realizada uma revisão integrativa acerca das evidências clínicas e científicas sobre a ST, a fim de esclarecer e nortear a prática clínica direcionada aos portadores dessa doença em diferentes áreas da Saúde. Foi realizada uma busca de artigos científicos em cinco bases de dados nas línguas portuguesa, inglesa e espanhola, seguindo uma análise criteriosa dos artigos selecionados. Todos os artigos selecionados foram publicados na língua inglesa evidenciando o reduzido número de trabalhos sobre a relação ST e intervenção terapêutica nas demais línguas. Os mesmos artigos englobam os aspectos mais atuais da ST, abordando desde a neurofisiologia da síndrome até intervenções como a terapia comportamental e a estimulação cerebral. Foi possível concluir que a ciência caminha cada vez mais em direção a um conhecimento aprofundado sobre a ST, principalmente no que se refere às novas formas de intervenção

This study presents an integrative review of Tourette Syndrome (TS) which little is known by many health professionals. An integrative review of the clinical and scientific evidences about the TS was performed in order to clarify and guide clinical practice directed to patients with this disease in different health areas. A search ofscientific articles was conducted in five databases in Portuguese, English andSpanish languages, following a careful analysis of the selected articles. All articles were published in English showing the small number of studies on the TS and therapeutic intervention ratio in other languages. The same items include the most current aspects of TS, addressing from the neurophysiology of the syndrome tointerventions such as behavioral therapy and brain stimulation. It was possible to conclude that science moves increasingly toward a thorough knowledge of the TS especially with regard to new forms of intervention