Assessment of Children With Tic Onset in the Past 6 Months (NewTics)

The purpose of this research is to study why most children who have tics never develop Tourette syndrome but some do. In other words, we aim to find features that may predict whose tics will go away and whose tics will continue or worsen, in children ages 5 through 17 years whose first tic occurred within the past 6 months.

Up to 30% of all children will have a tic at some point. However, tics that last a whole year (or more) occur in only 3% of the population. Thus tic persistence may be more unusual than tic onset, yet almost no data exist on which people with recent-onset tics go on to be diagnosable with Tourette syndrome or chronic tic disorder, versus those whose tics are only transient.

The overall goal of this research is to identify, prospectively, what imaging, clinical or neuropsychological features of children who just recently started ticcing will go on to develop a chronic tic disorder (including Tourette syndrome). Hypotheses are derived primarily from studies of patients with established tic disorders.

Aim 1: Apply functional connectivity analysis, fMRI, structural MRI, clinical, and neuropsychological methods in the first-ever pathophysiological study of the "pre-Tourette" population. The goal is to address whether markers previously associated with chronic TS will predict in advance which children with recent-onset tics will progress to Tourette syndrome.

Aim 2: Generate preliminary data for an adequately powered future study.

Follow-up at 3 and 12 months will enable a preliminary comparison of children whose tics remit compared to those whose do not. Clinical and neuropsychological variables may predict poor long-term outcomes in children with tics. Additionally we will collect DNA samples from all subjects for future genetic analysis once we have a large enough sample; prior studies have examined subjects with an established tic disorder, i.e. both tic onset and tic persistence, whereas we will have an opportunity in this data set to examine genetic predictors specifically of tic persistence vs. disappearance.

A convenience sample of 36 children age 5-17 who have tics now but whose first-ever tic occurred within the past 6 months. Subjects will be a convenience sample from community and clinical sources.

• Tourette Syndrome
• Tourette's Disorder
• Chronic Motor or Vocal Tic Disorder
• Transient Tic Disorder
• Tic Disorder Not Otherwise Specified

• Recent-onset tics that will persist
  Children between 5 to 17 years of age with recent-onset tics (first tic occurred within the past 6 months) who, when reassessed at 1 year after the first tic began (i.e. 6-12 months after study enrollment) will turn out to meet criteria for a chronic tic disorder (including Tourette syndrome).
• Recent-onset tics that will remit
  Children between 5 to 17 years of age with recent-onset tics (first tic occurred within the past 6 months) who will no longer have tics when reassessed 1 year after the first tic began (6 to 12 months after study enrollment).

Inclusion Criteria:

• We will study a convenience sample of 36 children age 5-17 who have tics now, but developed them only in the past 6 months; and
• Informed consent from a parent and assent from the child.

Exclusion Criteria:

• Secondary tics,
• Known structural brain disease,
• Other movement disorders including essential tremor,
• Neurological disorders other than migraine, including cerebral palsy and epilepsy
• Moderate to severe mental retardation,
• Autism,
• Current major depression,
• Lifetime substance dependence or current substance abuse (DSM-IV),
• Lifetime manic episode or psychotic disorder (DSM-IV),
• Moderate to severe current systemic illness,
• Antipsychotics or tetrabenazine taken for >1 week ever or within the past month,
• Current use of certain medications,
• Lack of proficiency in the English language that will affect the informed consent process or the psychological testing.
• Additionally, children will be excluded from MRI if they have contraindications to MRI, a positive pregnancy test (females after menarche), or current use of certain medications.