Tourette's Syndrome

Current conceptualizations of TS have been shaped by advances in systems neuroscience and the emerging understanding of the role of the basal ganglia in implicit learning and habit formation. Although the evidence that the same mechanisms are involved in both habit formation and tics is circumstantial, recent progress in neuroanatomy, systems neuroscience, and functional in vivo neuroimaging has set the stage for a major advance in our understanding of TS. Continued success in these areas will lead to the targeting of specific brain circuits for more intensive study. Diagnostic, treatment, and prognostic advances can also be anticipated, e.g., which circuits are involved and to what degree? How does that degree of involvement affect the patient's symptomatic course and outcome? Will it be possible to track treatment response using neuroimaging techniques? And will specific circuit-based therapies using deep-brain stimulation emerge to treat refractory cases (Vandewalle et al. 1999xStereotactic treatment of Gilles de la Tourette syndrome by high frequency stimulation of thalamus. Vandewalle, V, van der Linden, C, Groenewegen, H.J, and Caemaert, J. Lancet. 1999; 353: 724Abstract | Full Text | Full Text PDF | PubMedSee all ReferencesVandewalle et al. 1999)?The identification of susceptibility genes in TS will doubtless point in new therapeutic directions for treatment, as will the characterization of the putative autoimmune mechanisms active in the PANDAS subgroup of patients. Given this potential, TS can be considered a model disorder to study the dynamic interplay of genetic vulnerabilities, epigenetic events, and neurobiological systems active during early brain development. It is likely that the research paradigms utilized in these studies and many of the empirical findings resulting from them will be relevant to other disorders of childhood onset and to our understanding of normal development.‡To whom correspondence should be addressed (e-mail: james.leckman@yale.edu).