Merging the Pathophysiology and Pharmacotherapy of Tics

Farhan Augustine, Harvey Singer

Research output: Contribution to journalReview article

Abstract

Background: Anatomically, cortical-basal ganglia-thalamo-cortical (CBGTC) circuits have an essential role in the expression of tics. At the biochemical level, the proper conveyance of messages through these circuits requires several functionally integrated neurotransmitter systems. In this manuscript, evidence supporting proposed pathophysiological abnormalities, both anatomical and chemical is reviewed. In addition, the results of standard and emerging tic-suppressing therapies affecting nine separate neurotransmitter systems are discussed. The goal of this review is to integrate our current understanding of the pathophysiology of Tourette syndrome (TS) with present and proposed pharmacotherapies for tic suppression. Methods: For this manuscript, literature searches were conducted for both current basic science and clinical information in PubMed, Google-Scholar, and other scholarly journals to September 2018. Results: The precise primary site of abnormality for tics remains undetermined. Although many pathophysiologic hypotheses favor a specific abnormality of the cortex, striatum, or globus pallidus, others recognize essential influences from regions such as the thalamus, cerebellum, brainstem, and ventral striatum. Some prefer an alteration within direct and indirect pathways, whereas others believe this fails to recognize the multiple interactions within and between CBGTC circuits. Although research and clinical evidence supports involvement of the dopaminergic system, additional data emphasizes the potential roles for several other neurotransmitter systems. Discussion: A greater understanding of the primary neurochemical defect in TS would be extremely valuable for the development of new tic-suppressing therapies. Nevertheless, recognizing the varied and complex interactions that exist in a multi-neurotransmitter system, successful therapy may not require direct targeting of the primary abnormality.

Original languageEnglish (US)
Number of pages1
JournalTremor and other hyperkinetic movements (New York, N.Y.)
Volume8
DOIs
StatePublished - Jan 1 2018

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Tics
Neurotransmitter Agents
Drug Therapy
Tourette Syndrome
Basal Ganglia
Information Science
Globus Pallidus
Thalamus
PubMed
Information Systems
Cerebellum
Brain Stem
Therapeutics
Research

Keywords

  • neurotransmitters
  • pathophysiology
  • tics
  • Tourette syndrome
  • treatment

Cite this

Merging the Pathophysiology and Pharmacotherapy of Tics. / Augustine, Farhan; Singer, Harvey.

In: Tremor and other hyperkinetic movements (New York, N.Y.), Vol. 8, 01.01.2018.

Research output: Contribution to journalReview article

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