Recent advances in Gilles de la Tourette syndrome: implications for clinical practice and future research

The clinical presentation and natural history of Gilles de la Tourette syndrome (TS) are reviewed. The waxing and waning of symptoms, the rostrocaudal progression of areas of motor involvement, complex stereotypies, and the familial aggregation of TS and chronic multiple tics are suggestions of underlying neurochemical disturbance; whereas attentional problems, impulsivity and obsessive-compulsive behaviors create interesting links with other disorders. The most robust metabolic findings are the lowered CSF HVA in many TS patients, and the positive response of symptoms to dopamine blockers and clonidine particularly, which would be consistent with dopamine receptor hypersensitivity and possible noradrenergic-dopaminergic interactions in TS. However, no definitive account of patho-physiology or genetic contributions to the disorder is yet available.