抽动-秽语综合征儿童巨细胞病毒感染的意义初探

儿童抽动-秽语综合征（Tourette＇s syndrome，TS）近年发病有增多的趋势，严重影响患儿的学习和生活，其发病原因至今未明，病毒感染可能是发病机制之一。人巨细胞病毒（human cytomegalovirus，HCMV）易导致儿童感染，为此我们对86例TS儿童和50例正常儿童进行了外周血淋巴细胞HCMV pp65抗原与血浆HCMV DNA定量检测，以规探讨HCMV感染与儿童TS的关系。     

巨细胞病毒感染与格林巴利综合征

格林-巴利综合征(Guillain-Barre Syn-drome,GBS),是神经系统的一种常见病.约2/3的病人在发病前1～3周有非特异性的呼吸道或胃肠道感染,不少学者提出病毒感染的证据.但同时检测GBS患者血清和脑脊液(CSF)中人巨细胞病毒(HCMV)IgM、IgG抗体,以探讨GBS与HCMV感染关系的研究,在国内尚少见报道.本文将近几年来新疆地区GBS有关HCMV感染的关系报道如下.     

Tourette综合征研究进展

近年来随着对Ｔｏｕｒｅｔｔｅ综合征研究的进展,人们逐渐认识ＴＳ不是单一疾病,此病对于儿童和青少年学习和生活影响较大,其发病机制尚不十分清楚,本文将介绍其流行病学、病因学和治疗等方面的研究进展。     

Tourette综合征的外科治疗

本文介绍外科治疗Ｔｏｕｒｅｔｔｅ综合征的方法，ＴＳ的病理学，ＴＳ和强迫症之间的联系及其外科治疗的神经解剖机理，并对进一步研究提出一些建议。     

巨细胞病毒感染与动脉粥样硬化

<正>动脉粥样硬化(Atherosclerosis,AS)是心脑血管疾病的主要病理基础,其致病的危险因素是国内外学者研究的热点。自从1978年Fabricant用禽类疱疹病毒(Marek’s Disease Her- pesvirus,MDV)在鸡体内成功诱发动脉粥样硬化以来,由于人巨细胞病毒(Human cytomegalovirus,HCMV)与MDV同属疱     

人巨细胞病毒感染与脑梗死的关系

近年来研究表明微生物感染,尤其人巨细胞病毒(HC-MV)感染与脑梗死有关,现就HCMV感染与脑梗死的关系作一综述。1HCMV的分子生物学特点HCMV直径约150~200nm,由内向外依次由核心、衣壳、被膜、包膜组成。核心为双链线性DNA,长180~240kb,G C含量在56%~57%。HCMV DNA在细胞内的转录、表达有一定的时序性,产物可分为立即早期(IE)、早期(E)和晚期(L)3种。宿主细胞因子可激活IE基因转录产物的形成,E基因一般于感染后2~4h开始表达,早期蛋白质是重要的功能蛋白质,有关闭宿主细胞DNA的复制和合成病毒DNA聚合酶,诱导DNA复制,参与病毒…     

110例Tourette综合征的临床与脑电图相关性分析

本文报告１１０例Ｔｏｕｒｅｔｔｅ综合的临床和脑电图资料，结果发现：多发性不自主抽动与不自主发声的严重程度之间无相关性；秽语的出现与抽动和发声的严重程度间有一定相关性，秽语与模仿言语的发生间联系较密切；ＥＥＧ异常率为４２．７３％，其异常程度与抽动和发声的严重程度间无相关性，但秽语的出现与ＥＥＧ异常相关。     

Tourette综合征患者6～12年的随访研究

为探讨Ｔｏｕｒｅｔｅ综合征（ＴＳ,又称抽动秽语综合征）的预后及其影响因素,我们对１９８４～１９９０年在本院就诊的６５例ＴＳ患者进行了６～１２年随访。１．资料和方法：６５例中男５６例,女９例;初诊时平均年龄（９．０±２．５）岁,随访时平均年龄（１７．...     

Tourette syndrome and neuropsychological performance

This study examined performance on a battery of neuropsychological tests in a sample of 28 patients with Tourette's syndrome (TS). Test scores were converted to age-corrected T-scores to control for the effect of age on test performance. The frequency of abnormal test performances was variable, but more frequent on motor and sensory tasks. Symptom severity as measured by the Tourette Syndrome Global Scale was inversely related to neuropsychological performance. In general, neuropsychological performance was mildly below average. The pattern of performance was similar to previous studies of TS patients.     

难治性抽动秽语综合征的临床特点

目的探讨难治性Tourette综合征(Tourettesyndrom,TS)的临床特征。方法采用自制TS一般情况调查表、YGTSS(耶鲁综合抽动严重程度量表)、CBCL(Achenbach儿童行为量表)、WISC—CR(韦氏儿童智力量表中国修订版)对32例难治性TS(难治性组)患者和随机抽取的31例普通TS患者(普通组)分别进行测试和对照分析。结果(1)难治性TS患者在发病年龄、病前诱因、病程等方面与普通TS患者之间存在显著差异(P<0.05,P<0.01)。(2)难治性组CBCL总分显著高于普通组(P<0.01);难治性组19例6～11岁男性与普通组21例6～11岁男性CBCL测验比较,前者交往不良、强迫行为等6个行为问题因子得分显著高于后者(P<0.05,P<0.01),其CBCL总分也显著高于后者(P<0.01)。(3)在智力测验中,难治性组不仅其VIQ、PIQ、FIQ均显著低于普通组(P<0.05,P<0.01),而且在10项分测验中,算术分测验、理解分测验和译码分测验量表分均显著低于普通组。结论难治性TS具有自己的临床特征。     

Malignant Tourette syndrome.

The aim of this work was to draw attention to potentially life-threatening symptoms associated with Tourette syndrome (TS) and to explore their relationship to TS comorbidities. Medical records of all patients with TS evaluated at our Movement Disorders Clinic between July 2003 and July 2006 were reviewed. Data on patients with malignant TS, defined as >or=2 emergency room (ER) visits or >or=1 hospitalizations for TS symptoms or its associated behavioral comorbidities, were entered into a dataset and analyzed. Five illustrative cases are described. Of 333 TS patients evaluated during the 3-year period, 17 (5.1%) met the criteria for malignant TS. Hospital admission or ER visits were for tic-related injuries, self-injurious behavior (SIB), uncontrollable violence and temper, and suicidal ideation/attempts. Compared with patients with nonmalignant TS, those with malignant TS were significantly more likely to have a personal history of obsessive compulsive behavior/disorder (OCB/OCD), complex phonic tics, coprolalia, copropraxia, SIB, mood disorder, suicidal ideation, and poor response to medications. Although TS is rarely a disabling disorder, about 5% of patients referred to a specialty clinic have life-threatening symptoms. Malignant TS is associated with greater severity of motor symptoms and the presence of >or=2 behavioral comorbidities. OCD/OCB in particular may play a central role in malignant TS; obsessive compulsive qualities were associated with life-threatening tics, SIB, and suicidal ideation. Malignant TS is more refractory to medical treatment than nonmalignant TS.     

Clinical course of Tourette syndrome

Objective

Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder characterized by multiple motor and vocal tics lasting at least a year in duration. Children with TS often experience comorbid conditions such as obsessive-compulsive disorder (OCD) and attention-deficit disorder. The goal of this article was to review the long-term clinical course of tics and comorbid conditions in children with TS.

Method

We conducted a traditional literature search to locate relevant articles regarding long-term outcome and prognosis in TS and tic disorders.

Results

Tics typically have an onset between the ages of 4 and 6 years and reach their worst-ever severity between the ages of 10 and 12 years. On average, tic severity declines during adolescence. By early adulthood, roughly three-quarters of children with TS will have greatly diminished tic symptoms and over one-third will be tic free. Comorbid conditions, such as OCD and other anxiety and depressive disorders, are more common during the adolescence and early adulthood of individuals with TS than in the general population.

Conclusion

Although tics are the sine qua non of TS, they are often not the most enduring or impairing symptoms in children with TS. Measures used to enhance self-esteem, such as encouraging strong friendships and the exploration of interests, are crucial to ensuring positive adulthood outcome in TS.     

Tourette syndrome and comorbid early-onset schizophrenia

Objective

A study of the shared phenomenology between Tourette syndrome (TS) and schizophrenia.

Method

An illustrative case report is presented. We used a chart review of 399 clinically ascertained patients with TS to identify 10 cases meeting criteria for schizophrenia. From our 10 patients, salient clinical characteristics were then tabulated. We then extracted similar clinical characteristics from a previously published series of patients with comorbid TS and schizophrenia in order to combine cases and allow for a comparison between childhood-onset schizophrenia (COS), adolescent-onset schizophrenia (AdolOS), and adult-onset schizophrenia (AduOS) cases in these groups.

Results

We found 10 cases of schizophrenia (all were males) in the 399 TS patients for a prevalence rate of 2.5% (95% CI 0.96–4.04). Mean age of tic onset for TS diagnostic criteria ranged from 2-14 years with a mean of 8.2 years. The mean age of diagnosis for schizophrenia was 14.2 (range 9–23 years). We found six cases of schizophrenia with onset of positive psychotic symptoms by 13 years of age, two cases with onset after 13 years of age and before 18 years of age, and two cases with onset after 18 years of age. Attention deficit hyperactivity disorder was present at a higher rate (70%) than one would expect in a clinically ascertained group of patients with TS. Comparison between COS, AdolOS and AduOS in our pooled cases noted a sex bias skewed toward males. Catatonic symptoms may be more likely in child or adolescent onset cases and negative symptoms more likely in AduOS cases.

Conclusions

The 2.5% prevalence of schizophrenia in our TS sample exceeds the 1% expected rate of schizophrenia in the general population (chi-square=9.14; P=.0025). The six cases of COS (before 13 years of age) exceeds the expected rate of 1–2 per 100,000 (chi-square=4499; P=.0001). The 752-fold increase in observed rates of comorbid TS and COS over expected rates suggests a role for unknown common underlying etiologic factors. Based on clinical features, patients with TS and comorbid COS, AdolOS, or AduOS do not have different conditions. We conclude with suggestions for further research.     

Tourette syndrome in the elderly

An 82-year-old housewife presented with motor and phonic tics and coprolalia. These had developed in the months following an acute confusional state associated with posterior neck pain 10 years previously. Neurological examination, including MRI scan, was otherwise normal. The index illness was presumed to be encephalitis lethargica.     

Functional neuroimaging in Tourette syndrome

Functional neuroimaging of neuropsychiatric disorders is a complex discipline requiring skills in medical science, philosophy, and technical physics. This review first examines the broad categories of functional imaging studies that have been utilized in this area, comparing the strengths and weaknesses of each approach. This review then looks at much of the available literature on functional imaging in Tourette syndrome (TS) and provides a synthesis of data. The review will also examine the different methodologies employed and will suggest which methodologies are most likely to lead to elucidation of the pathophysiology of TS and related conditions.     

Tourette syndrome and obsessive-compulsive disorder

Tourette syndrome and obsessive-compulsive disorder are neuropsychiatric disorders that have sparked considerable interest over the decades. They are the focus of research for a remarkable diversity of disciplines, ranging from neuroimagers and prenatal epidemiologists to experts in the neural circuits that connect the cortex with the basal ganglia, as well as neuroimmunologists focusing on brain-based autoimmune phenomena. Several hypotheses have been put forward to explain the onset and exacerbation of these illnesses. Here, we discuss the clinical phenomenology and treatment options that are currently available. New psychopharmacological agents are being used that are based on a greater understanding of the neurobiology and are being used in combination with behavioral interventions. Longitudinal clinical investigations into clinical symptoms and the natural course are providing additional clues on the underlying pathophysiology. Recent advances in research models are also reviewed in an attempt to clarify some of the molecular etiologies that lead to these disorders.     

Clinical characteristics of Tourette syndrome

Abstract The aim of the present study was to examine the clinical characteristics of Tourette syndrome (TS) in terms of symptomatology, outcome and organic and genetic factors, and to compare these with results of previous studies on TS in Western countries and in Japan, on the basis of precise information taken from a large number of TS patients under psychiatric treatment in Japan. There was a total of 64 TS patients (55 males and nine females) selected from those who visited our outpatient clinic from 1974 to 1993 and were found to meet the criteria for Tourette's disorder of DSM-III-R. The mean patient age at entry to the present study was 17.4 years (SD:7.2). All data were collected through a systematic chart review of subjects, including data on tic symptoms and the course of their development; complications and developmental histories; family histories; medical and psychological examinations; treatment; severity and outcome. A check of the data showed that the mean age at onset was 6.9 years (SD:2.7). An analysis of the progression of the symptoms revealed that 'generalized tics' afflicting the entire body were found in 64.1% of subjects and coprolalia was found in 50%. The main complications were obsessive-compulsive symptoms (OCS) in 62.5% of patients and attention deficit hyperactivity disorder (ADHD) in 17.2%. Of their parents, 7.0% had tic disorders except TS and 1.6% had TS. Contrary to results from previous studies of TS, our study revealed that at least the incidence of coprolalia in TS patients in Japan is not lower than in Western countries. However, the frequency of familial cases seemed to be lower than previously reported for Western patients. Outcome was fairly related with 'generalized tics,' OCS, aggressiveness and ADHD.