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Motor cortex excitability and co-morbidity in Gilles de la Tourette Syndrome
  1. Michael Orth (michael.orth{at}
  1. Universitaetskrankenhaus Ulm, Germany
    1. John Rothwell (j.rothwell{at}
    1. Institute of Neurology, United Kingdom


      Background: Gilles de la Tourette syndrome (GTS) is often complicated by comorbid attention-deficit-hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD). We examined whether motor cortex excitability differs between uncomplicated GTS patients and those complicated by ADHD or OCD.

      Methods: We measured motor thresholds, short intra-cortical inhibition (SICI) and intra-cortical facilitation (ICF), and short latency afferent inhibition (SAI) using transcranial magnetic stimulation (TMS) in 29 untreated GTS patients (18 uncomplicated, 6 with co-morbid ADHD, 5 with co-morbid OCD) and 24 healthy subjects. Tic severity was rated with standard clinical scales.

      Results: Patients had slightly higher resting (RMT) and active motor thresholds (AMT). The threshold of SICI and ICF expressed as percentage of each individual’s AMT was similar in controls and GTS patients. Above threshold, GTS patients had less SICI, and more ICF. SICI was similar in all subgroups, but ICF differed significantly between them. Patients with GTS+ADHD had more ICF than controls, uncomplicated GTS patients or GTS+OCD patients; ICF was similar in these other groups. GTS patients as a whole had reduced SAI. Uncomplicated GTS patients or GTS+ADHD patients had less SAI than controls or GTS+OCD patients.

      Conclusions: GTS with ADHD co-morbidity is associated with more extensive changes in the excitability of motor cortex circuits than uncomplicated GTS or GTS+OCD. The extent to which various different neuronal circuits are affected may be relevant for the phenotype of Tourette spectrum disorders.

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