Review article
Imaging evidence for anatomical disturbances and neuroplastic compensation in persons with Tourette syndrome

https://doi.org/10.1016/j.jpsychores.2009.07.005Get rights and content

Abstract

Background

Tourette syndrome (TS) is a disorder of chronic motor and vocal tics that begins in childhood.

Methods

A systematic Medline search was conducted to identify existing anatomical imaging studies in persons with TS.

Results

Thirty studies were identified, and their methods and findings were reviewed. Findings of reduced caudate volumes across the life span and thinning of sensorimotor cortices that is proportional with tic severity in children with TS implicate these regions in the genesis of tics. Hypertrophy of limbic and prefrontal cortices and a smaller corpus callosum accompany fewer symptoms in children with TS, likely representing an activity-dependent plasticity within these regions that help to modulate tic severity.

Conclusion

Although existing studies differ with respect to sample size, gender composition, quality of clinical characterization, pulse sequences, and methods of image analysis, the preponderance of evidence suggests that disturbances in the development of the motor portions of cortical–subcortical circuits likely predispose to the development TS and that neuroplastic changes in control systems of the brain help to modulate the severity of symptom expression. These findings from cross-sectional studies require confirmation in more representative populations within longitudinal studies.

Section snippets

Methods

We have elected to limit this review to anatomical magnetic resonance imaging (MRI) studies of TS. This imaging modality provides excellent tissue contrast at high spatial resolution, thus permitting precise measurement of even of small structures in the brain. We performed a Medline search with the following search terms: (anatomical MR OR MRI OR Neuroimaging) AND (TS OR Tourette syndrome OR tics OR tic disorder) (n=408). We selected for review all original studies that used anatomical MRI to

Basal ganglia

Several lines of evidence suggest that the basal ganglia are a likely site for the generation of tics. Motor portions of the basal ganglia control the velocity and direction of movement, and a loss of behavioral control for scaling of those two features of otherwise normal movements is innate to tics [17]. The stereotyped, repetitive nature of tics are also akin to motor or vocal habits [18], which derive primarily from the striatum [19]. Children and adults with TS are impaired in

Discussion

Findings from anatomical imaging studies have helped to improve our understanding of the pathophysiology of TS and the neurobiological determinants of the clinical course of this disorder. First, the basal ganglia and motor cortex portions of cortical–subcortical circuits are recognized as the likely origin of tic behaviors, with a smaller caudate nucleus present in children [32], [33], [45] and adults [33], and a thinning of the sensorimotor and motor cortices documented in children [54]. The

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    This work was supported in part by National Institute of Mental Health grants (MHK02-74677, MH59139, and MH068318), the Suzanne Crosby Murphy Endowment at Columbia University College of Physicians and Surgeons, and by a grant from the MoodNet, Health Authorities of West Norway.

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