Study of Tics in Patients With Tourette's Syndrome and Chronic Motor Tic Disorder

The purpose of this study is to determine the areas of the brain responsible for tics in patients with Tourette's syndrome and chronic motor tic disorder using [15O]H2O. Previous neuroimaging studies have looked at brain activity during tics using functional magnetic resonance imaging (fMRI), and positron emission tomography (PET), but a major drawback of these studies lay in the difficulty distinguishing between the activity in the brain responsible for tic generation versus activity in motor-related structures due to tic movements. We plan to overcome this difficulty in our paradigm using two rest conditions without any movement. One is a state when patients suppress their tics and the second is sleep state, when tics usually cease or are at least very infrequent. 23 adult patients with a DSM-IV-TR (American Psychiatric Association 2000) diagnosis of a tic disorder and frequent tics will be studied. These two rest states will be compared with a condition where tics are allowed to occur spontaneously. The differential activation of brain areas between these three conditions should help to elucidate/define the regions of the brain responsible for generation of tics.

- INCLUSION CRITERIA Patients will have clinically documented Tourette's syndrome or chronic motor tic disorder as defined by DSM-IV-TR and evaluation of tic severity using the Yale Tic Scale. This criterion will be established by preliminary screening in the NINDS Movement Disorders Outpatient Clinic. Regarding co-morbid disorders such as ADHD and OCD, we will accept a mild degree of ADHD and mild to moderate degree of OCD. These disorders will be established by a psychiatrist using below listed scales and criteria. In order to participate in this study, patients will be asked to stop any medication that can influence the central nervous system for 2 weeks prior to exam. Patients taking fluoxetine will be asked to stop it 4 weeks prior to the exam. Stopping the medications for Tourette syndrome or tics, OCD and ADHD may lead to worsening of their symptoms. Any changes to patients' medication must first be discussed with their doctor and only this doctor will be responsible for tapering the medication. Patients will be asked to abstain from alcohol for one week before the study. Patients will be in age ranges 18 to 65. Patients may be male or female. Female patients of child-bearing potential will have a pregnancy test and specific interview prior to the study to ensure that pregnant patients will not participate in the study. Patients will be asked to stop any medication that can influence central nervous system (CNS) for one week prior to exam. Twenty three normal controls will be included; controls will be screened in the NINDS Movement Disorders Outpatient Clinic, and will have neurological and physical examination. Controls with chronic illnesses, taking any medication that affects the CNS will be excluded. EXCLUSION CRITERIA Patients younger than 18 or older than 65 years old will be excluded from the study. We are excluding patients older than 65 years because of possibility of age-related neurological disorders such as stroke and dementia. Patients with MRI findings consistent with brain tumors, strokes, trauma or AVMs will be excluded. Patients with progressive neurological disorders other than TS or chronic motor tic disorder and significant other pathology will be excluded. Patients with a history of significant medical disorders, or requiring chronic treatment with other drugs, which cannot be stopped, will be excluded. Patients with cancer will be excluded. Patients not capable of giving an informed consent will be excluded. Patients who are pregnant will be excluded.

Study Location