Katie Ditter Chem 412 March 5, 2001

Transcription

1 Tourette Syndrome: What Makes em Tic Katie Ditter Chem 412 March 5, 2001

2 Discovery Discovered by a french neurologist in 1885 Autosomal dominant neurological disorder Characterized by motor and vocal tics Affects 1 in 100 individuals in some way 3 in 4 affected are male

3 Diagnosis: DSM III Onset between ages 2 and 15 Recurrent, involuntary, repetative, rapid, purposeless motor movements affecting multiple muscle groups Vocal tics Suppress movement voluntarily for minutes to hours Variation in the intensity of symptoms over weeks and months

4 Symptoms: Echolalia mirror speech of others Palilalia repeat ones own words Echopraxia mimicking of other people s actions Coprolalia involuntary utterances of swear words

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8 Grades of Severity Grade 1: 15% Mild: meet criteria for diagnosis, but no medical treatment age of onset: 7.36 years Grade 2: 60% Moderate: requires treatment age of onset: 6.77 years Grade 3: 25% Severe: significant interference with individuals life age of onset: 5.81 years

9 Related disorders OCD--Cannot control compulsions ADHD--Hyperactivity Lesch-Nyhan Syndrome--Self mutilation Parkinson's Disease--tremors panic/phobic/schizoid/sleep/reading disorders alcoholism in men overeating in women

10 Possible Causes: Cholinergic deficiency Treatment medications increase affinity for acetylcholine to bind to receptors

11 Possible Causes: Tryptophan Oxygenase mutation Tryptophan Tryptophan oxygenase Serotonin N CH 2 CH + NH 3 N CH 2 CH 2 + NH 3 COOH OH Treatment: Selective Serotonin reuptake inhibitors

12 How SSRIs and MAOIs work Neurotransmitters: norepinepherine serotonin

13 Possible Causes: Dopamine pathway Dopamine is a precursor to the neurotransmitter norepinephrine Increase in Dopamine causes disinhibition of the limbic system OH OH CH 2 CH 2 NH 3 Dopamine Dopamine beta-hydroxylase OH OH CH CH 2 NH 3 OH norepinephrine Treatment medications block dopamine ion channels

14 The Limbic System Info output: senses, sight, smell, hearing, touching, taste, pain, temperature, sexual feelings Data: memory Response: what to do Action Action: motor system, endocrine system, bodily functions

15 Environmental onset factors Increase Increase tics: anxiety, emotional trauma, social gatherings Decrease symptoms Decrease symptoms: visit to doctor s office, relaxed reading, talking to friends

16 Treatments Tics: Neuroleptics: Haldol alpha-adrenergic meds: Tenex, Catepres OCD: SSRI: Prozac, Luvox, Paxil, Zoloft ADHD: Ritalin tricyclins: Anafranil improve attention, impulsivity, hyperactivity and concentration

17 References: 1. Bruun, Bruun. A Mind of its Own Oxford University Press, New York Chouinard S, Ford B. Adult onset tic disorders. J Neurol Neurosurg Psychiatry. 68(6): June Comings, D. Tourette Syndrome and Human Behavior Hope Press, Duare, Cali Gaffney GR, Ottinger B. http: // Medical Treatment of Tourette Syndrome. Virtual Hospital. May Miranda M, Menendez P, David P, Troncoso M, Hernandez M, Chana P. [Tics disease (Gilles de la Tourette syndrome): clinical characteristics of 70 patients]. Rev Med Chil 127(12): Dec Morris HR, Thacker AJ, Newman PK, Lees AJ. Sign Language Tics in a Prelingually Deaf Man. Mov Disord 15(2): March Muller N, Riedel M, Straube A, Gunther W, Wilske B. Increased anti-streptococcal antibodies in patients with Tourette's syndrome. Psychiatry Res 24;94(1):43-9 Apr Nielsen SF, Nielsen EO, Olsen GM, Liljefors T, Peters D. Novel Potent Ligands for the Central Nicotinic Acetylcholine Receptor: Synthesis, Receptor Binding, and 3D-QSAR Analysis. J. Med Chem. 43, Stone T, Darlington G. Pills Potions Poisons: How Drugs Work Oxford Press http: // Gilles De La Tourette Syndrome; GTS Online Mendelian Inheritance in Man TRYPTOPHAN 2,3- DIOXYGENASE; TDO2 Online Mendelian Inheritance in Man Pharmacognosy and How Drugs Work Class Notes; Dr. Scott Hartsel 2001.