221/299. carbon monoxide poisoning with features of Gilles de la Tourette's syndrome. A previously healthy 58-year-old man had severe carbon monoxide poisoning. Following a comatose state, tics of the head, coprolalia, fits of shouting, and abnormal vocal utterances developed. In addition to the signs of diffuse encephalopathy, he had some of the features associated with idiopathic Gilles de la Tourette's syndrome. The computed tomographic scan showed ventricular enlargement and low-density areas in the basal ganglia. ( info) |
222/299. A case report of pathological rule-governed syllable intrusion. A detailed analysis of a unique speech disturbance, marked by the frequent appearance in the speech stream of a meaningless intrusive syllable, is presented. Following a lengthy thoracic surgery, an American English speaking patient began to speak with non-English prosodic patterns, which evolved to a conspicuous intrusion in his speech of the syllable /sis/. This syllable and its variants were attached to words in a manner which conformed to the regular phonological rules in English (for formation of plural, possessive, and third person singular morphemes). The distribution and frequency of the intrusive syllable are described, and possible explanations for the abnormal occurrence of this particular syllable are discussed. ( info) |
223/299. A case of Gilles de la Tourette's syndrome treated with clonazepam. A case of a 13 year-old boy with Gilles de la Tourette's syndrome is described. The patient favorable clinical responded to small daily doses of clonazepam. Improvement of the tics and the abnormal vocalization were observed. ( info) |
224/299. Coincident infantile autism and tourette syndrome: a case report. A 15-year-old boy who had been diagnosed as having infantile autism (IA) at two years of age was found to have tourette syndrome (TS) in adolescence. This case report represents the second coincident finding of IA and TS in an adolescent autistic boy. The implications of a co-occurrence of IA and TS are discussed in the light of our current understanding of abnormalities in neurotransmitter metabolism common to both conditions. ( info) |
225/299. tics and vocalizations in children treated with carbamazepine. Three patients are reported who, following the initiation of carbamazepine therapy for seizure control, either experienced the onset of Tourette's syndrome or a worsening of their tics and vocalizations. Blood levels of carbamazepine were within the therapeutic range, and no patient showed clinical signs of intoxication. tics and vocalizations did not resolve following discontinuation of carbamazepine therapy. carbamazepine may trigger the onset of Tourette's syndrome in susceptible patients. ( info) |
226/299. Tourette's syndrome: update. Tourette's syndrome is a widely misunderstood chronic disorder that develops in childhood and is usually lifelong. It is characterized by waxing and waning of involuntary motor and phonic tics. The features and differential diagnosis are discussed in this paper. The estimated prevalence rate of Tourette's syndrome, 0.05%, implies that this disorder is not rare. The reasons for diagnostic confusion are outlined, and the genetic and neurotransmitter features discussed. The management of Tourette's syndrome has become more effective with the availability of at least two psychoactive drugs, haloperidol and pimozide. Although the cause of this syndrome is thought to be organic, these drugs and their adverse effects are best known to psychiatrists. Psychiatric and multidisciplinary intervention is often necessary because of the frequent association of psychosocial problems, cognitive and learning difficulties, and aggravation of the symptoms by stress. The understanding of Tourette's syndrome will probably increase significantly with the advent of the newer imaging techniques and the rapid progress of research in the neurosciences. ( info) |
227/299. A family with fragile-X syndrome. A family with fragile-X syndrome is reported. One sibling has atypical pervasive developmental disorder and moderate mental retardation. A second sibling has Tourette's syndrome, moderate mental retardation, seizure disorder, and autism. A third sibling has attention deficit disorder, moderate mental retardation, and developmental language disorder, expressive type. The authors believe that this family represents a classic example of the differential outcome of interactions of common biogenetic and environmental influences. We propose that in this family the multipotential outcome is at least influenced by if not caused by a common genetic defect. ( info) |
| There are conflicting data concerning the efficacy of clonidine in TS. Some TS patients, probably 50% or more, experience substantial, long-term symptomatic improvement with minimal side effects. However, their profile of response is often variable, with behavioral symptoms appearing to show the most consistent improvement. Maximal benefit may not be evident for 4 to 6 months. A minority of patients do not respond, and a few worsen on clonidine. The need for additional double-blind trials is clear. Additional metabolic and pharmacologic investigations are needed to understand the determinants of the response of TS patients to clonidine. The response to acute doses of clonidine on sedation, growth hormone release, blood pressure, and plasma MHPG levels may be predictive of eventual therapeutic response. The variable response to clonidine, however, suggests that noradrenergic mechanisms in TS may not be of primary pathogenic importance. The study of interactions between neurochemical systems may help illuminate the pathophysiology of TS and lead the way to improved treatment of this disabling condition. ( info) |
229/299. Deleterious effects of drugs used for hyperactivity on patients with Gilles de la tourette syndrome. Two pediatricians failed to recognize Gilles de la tourette syndrome in a child. The symptoms were exacerbated after the child took both pemoline and methylphenidate. All medications commonly used to treat hyperactivity may cause such exacerbation. Gilles de la tourette syndrome is frequently associated with symptoms characteristic of hyperactivity and often goes unrecognized for long periods of time. The symptoms of the syndrome and the evidence that they are exacerbated by medication used to hyperactivity are briefly reviewed. physicians should be aware of the possibility of Gilles de la tourette syndrome in any hyperactive patient who manifests or has a history of a tic. ( info) |
230/299. Familial aspects of Gilles de la tourette syndrome. The authors present two cases in which Gilles de la tourette syndrome was present in at least two family members: the first case is a mother and her son and the second an uncle and his nephew. the increasing severity of the syndrome from one generation to the next and some similar clinical features in the two cases are noted. The authors also speculate that the incidence of family cases of Tourette syndrome may be underestimated because of the painstaking efforts required to obtain this kind of history. ( info) |