Tourette's syndrome. Some new concepts

Tourette's syndrome is a chronic tic disorder in which motor and vocal tics begin in childhood, persist to adulthood, and occur predominantly in males, often in a familial setting. Following the delineation of the characteristic clinical features of TS, and as a result of increased educational efforts, there has been a heightened awareness of the frequency of this neurologic disorder in childhood and adolescence. Furthermore the demographic and other clinical neurophysiologic factors, coupled with the frequent and dramatic response of the tics to treatment with haloperidol, have strongly indicated an underlying disorder of neurotransmitter metabolism. One such hypothesis suggests that there is a relative overactivity of dopamine receptors, and findings from recent clinical and experimental studies are consistent with a defect in the ontogeny of the mesocortical group of dopamine neurons. New neuroimaging techniques applied to patients with TS may help to localize these overactive dopamine receptors and lead to different and more specific treatment strategies.