Center makes strides in Tourette’s Syndrome study

The Yale Child Study Center continues to make strides in the study of Tourette’s Syndrome — the symptoms of which are consistently misconceived as a repetition of obscene verbal outbursts — furthering Yale’s more than 25-year investigation of the disease.

According to the Tourette Syndrome Association of America, Tourette’s is an inherited, neurological disorder characterized by repeated and involuntary body movements and uncontrollable vocal sounds. The National Institute of Neurological Disorders and Stroke at the National Institutes of Health reports approximately 100,000 Americans are afflicted with Tourette’s, though the number of patients with a partial manifestation of the disorder may be 200 times larger.

Tourette’s usually involves physical tics, such as blinking eyes repeatedly, arm thrusting, and repeated coughing or throat clearing. The verbal tics involving obscenities, referred to as coprolalia, only affects about 15 percent of the total amount of people that suffer from Tourette’s, according to the TSA Web site.

Yale has long been at the forefront of research on Tourette’s and other childhood neurological disorders, YCSC director Alan Kazdin said.

“There is no other place in the world that is like this,” Kazdin said. “We’re leading the world in the underpinnings of TS as well as treatment research and advancements.”

Child Psychiatry professor James Leckman, hailed as a “world leader” in the study of Tourette’s by Kazdin, focuses his research on gene interaction and human central nervous system development, as well as the symptomology of Tourette’s, and its correlation with obsessive compulsive disorder. In his studies, Leckman covers most aspects of Tourette’s, including genetics, neurobiology and risk factors.

“We’ve discovered that genes are involved in TS, and currently we are working on whether or not a single gene or multiple genes are behind TS,” Leckman said. “We have also been studying the course of symptoms and how to assess their severity in TS.”

Leckman said he has seen significant correlation between the development of Tourette’s and early brain development as a result of a decreased amount of oxygen supplied to the brain during child labor and delivery.

Additionally, research has been conducted using brain imaging as a method to predict the onset of Tourette’s and obsessive compulsive disorder. The symptoms generally first appear when patients are between four and six.

Delving deeper into the idea that brain imaging analysis can give deeper insight into the understanding of Tourette’s, Michael Bloch MED ’04, now a fellow at the center, wrote his thesis on a follow up study on patients seen for Tourette’s and obsessive compulsive disorder at the YCSC about 10 years ago. The purpose of the study was to examine the continuation of tics in adulthood, now that most of these patients are between the ages of 18 and 20.

The use of imaging revealed there was a reduction in the caudate brain volume, which is in the basal ganglia region of the brain, in patients who had worse tics in adulthood and were more likely to develop obsessive complusive disorder later on in life.

“Although these findings are not immediately clinically utilized, it does say which children will go on to develop worse tics and OCD in the future,” Bloch said.

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