Tourette's syndrome: a disorder of cingulate and orbitofrontal function?

We discuss the clinical characteristics of tics and Tourette's syndrome (TS) and also possible treatment options. Based upon an overview of published pathophysiological and PET data, and the results of a recent PET study of changes in opioid receptor binding in TS, we hypothesize that the disease arises due to dysfunction within the cingulate and orbitofrontal cortex. The beneficial effects of dopamine receptor antagonists and dopamine-depleting agents in TS are suggested to be mediated via basal ganglia-thalamofrontal circuits, while opioid agents may act directly on the cingulate.