Functional imaging in Tourette's syndrome

The cause or causes of Tourette's syndrome (TS) remain unknown. Functional imaging studies have evaluated several implicated neurotransmitter systems and focused predominantly on the frequency or severity of tics. The results have been inconclusive and frequently contradictory with little light shed on pathogenetic mechanisms. However, metabolic derangements have been demonstrated within regions of the basal ganglia, limbic system and sensori-motor cortex and are in keeping with the concept of TS as both a motor and behavioral disorder. TS has long been regarded an involuntary movement disorder. However, many patients have stated that without the premonitory sensation, there would be no tics. For this reason, it has been suggested that the premonitory urge may be considered the involuntary component of TS and the performance of the tic merely a voluntary response. Future studies are needed to differentiate functional changes relating to urge from those associated with the performance of tics and tic suppression.