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1. Yale Global Tic Severity Scale (YGTSS): Psychometric Quality of the Gold Standard for Tic Assessment Based on the Large-Scale EMTICS Study

Author

Martina Haas, Ewgeni Jakubovski, Carolin Fremer, Andrea Dietrich, Pieter J. Hoekstra, Burkard Jäger, Kirsten R. Müller-Vahl, The EMTICS Collaborative Group, Alan Apter, Valentina Baglioni, Juliane Ball, Noa Benaroya-Milshtein, Benjamin Bodmer, Emese Bognar, Bianka Burger, Judith Buse, Francesco Cardona, Marta Correa Vela, Nanette M. Debes, Maria Cristina Ferro, Blanca Garcia-Delgar, Mariangela Gulisano, Annelieke Hagen, Julie Hagstrøm, Tammy J. Hedderly, Isobel Heyman, Chaim Huyser, Marcos Madruga-Garrido, Anna Marotta, Davide Martino, Pablo Mir, Astrid Morer, Norbert Müller, Alexander Münchau, Peter Nagy, Valeria Neri, Thaïra J.C. Openneer, Alessandra Pellico, Ángela Periañez Vasco, Kerstin J. Plessen, Cesare Porcelli, Marina Redondo, Renata Rizzo, Veit Roessner, Daphna Ruhrman, Jaana M.L. Schnell, Anette Schrag, Paola Rosaria Silvestri, Liselotte Skov, Tamar Steinberg, Friederike Tagwerker Gloor, Zsanett Tarnok, Jennifer Tübing, Victoria L. Turner, Susanne Walitza, and Elif Weidinger

Subjects
Tourette's syndrome (TS), YGTSS = Yale Global Tic Severity Scale, psychometric properties, internal consistency, confirmatory factor analysis, Psychiatry, RC435-571
Abstract

The Yale Global Tic Severity Scale (YGTSS) is a clinician-rated instrument considered as the gold standard for assessing tics in patients with Tourette's Syndrome and other tic disorders. Previous psychometric investigations of the YGTSS exhibit different limitations such as small sample sizes and insufficient methods. To overcome these shortcomings, we used a subsample of the large-scale “European Multicentre Tics in Children Study” (EMTICS) including 706 children and adolescents with a chronic tic disorder and investigated convergent, discriminant and factorial validity, as well as internal consistency of the YGTSS. Our results confirm acceptable convergent and good to very good discriminant validity, respectively, indicated by a sufficiently high correlation of the YGTSS total tic score with the Clinical Global Impression Scale for tics (rs = 0.65) and only low to medium correlations with clinical severity ratings of attention deficit/hyperactivity symptoms (rs = 0.24), obsessive–compulsive symptoms (rs = 27) as well as internalizing symptoms (rs = 0.27). Internal consistency was found to be acceptable (Ω = 0.58 for YGTSS total tic score). A confirmatory factor analysis supports the concept of the two factors “motor tics” and “phonic tics,” but still demonstrated just a marginal model fit (root mean square error of approximation = 0.09 [0.08; 0.10], comparative fit index = 0.90, and Tucker Lewis index = 0.87). A subsequent analysis of local misspecifications revealed correlated measurement errors, suggesting opportunities for improvement regarding the item wording. In conclusion, our results indicate acceptable psychometric quality of the YGTSS. However, taking the wide use and importance of the YGTSS into account, our results suggest the need for further investigations and improvements of the YGTSS. In addition, our results show limitations of the global severity score as a sum score indicating that the separate use of the total tic score and the impairment rating is more beneficial.

Published
2021
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3. Vitamin D levels in children and adolescents with chronic tic disorders: a multicentre study

Author

Molly, Bond, Natalie, Moll, Alicia, Rosello, Rod, Bond, Jaana, Schnell, Bianka, Burger, Pieter, J Hoekstra, Andrea, Dietrich, Anette, Schrag, Eva, Kocovska, Martino, Davide, Norbert, Mueller, Markus, Schwarz, Ute-Christiane, Meier, EMTICS Collaborative Group: Alan Apter, Baglioni, Valentina, Juliane, Ball, Noa, Benaroya-Milshtein, Benjamin, Bodmer, Emese, Bognar, Judith, Buse, Cardona, Francesco Carmelo Giovanni, Marta Correa Vela, Nanette, M Debes, Maria Cristina Ferro, Carolin, Fremer, Blanca, Garcia-Delgar, Mariangela, Gulisano, Annelieke, Hagen, Julie, Hagstrøm, Tammy, J Hedderly, Isobel, Heyman, Chaim, Huyser, Marcos, Madruga-Garrido, Anna, Marotta, Pablo, Mir, Astrid, Morer, Norbert, Müller, Kirsten, R Müller-Vahl, Alexander, Münchau, Peter, Nagy, Neri, Valeria, Thaïra Jc Openneer, Pellico, Alessandra, Ángela Periañez Vasco, Kerstin, J Plessen, Cesare, Porcelli, Marina, Redondo, Rizzo, Renata, Veit, Roessner, Daphna, Ruhrman, Jaana Ml Schnell, Silvestri, PAOLA ROSARIA, Liselotte, Skov, Tamar, Steinberg, Friederike Tagwerker Gloor, Zsanett, Tarnok, Jennifer, Tübing, Victoria, L Turner, Susanne, Walitza, Elif, Weidinger, Clinical Cognitive Neuropsychiatry Research Program (CCNP), EMTICS Collaborative Group, Bruun, J.E., Grejsen, J., Ommundsen, C.L., Rubæk, M., Enghardt, S., Bokemeyer, S., Driedger-Garbe, C., Reichert, C., Schmalfeld, J., Duffield, T., Gergye, F., Kovacs, M., Vidomusz, R., Carmel, M., Fennig, S., Gev, E., Keller, N., Michaelovsky, E., Nahon, M., Regev, C., Simcha, T., Smollan, G., Weizman, A., Gagliardi, G., Tallon, M., Roazzi, P., van den Ban, E., de Bruijn, SFTM, Driessen, N., Lamerz, A., Messchendorp, M., Rath, JJG, Sival, NSD, Tromp, N., Visscher, F., de la Tourettes, S.G., Cáceres, M.T., Carrillo, F., Gómez-Garre, P., Vargas, L., Gariup, M., Stöber, S., Apter, A., Baglioni, V., Ball, J., Benaroya-Milshtein, N., Bodmer, B., Bond, M., Bognar, E., Burger, B., Buse, J., Cardona, F., Vela, M.C., Dietrich, A., Debes, N.M., Ferro, M.C., Fremer, C., Garcia-Delgar, B., Gulisano, M., Hagen, A., Hagstrøm, J., Hedderly, T.J., Heyman, I., Hoekstra, P.J., Huyser, C., Madruga-Garrido, M., Marotta, A., Martino, D., Meier, U.C., Mir, P., Moll, N., Morer, A., Mueller, N., Müller-Vahl, K., Münchau, A., Nagy, P., Neri, V., Openneer, TJC, Pellico, A., Vasco, Á.P., Plessen, K.J., Porcelli, C., Redondo, M., Rizzo, R., Roessner, V., Ruhrman, D., Schnell, JML, Schrag, A., Schwarz, M.J., Silvestri, P.R., Skov, L., Steinberg, T., Gloor, F.T., Tarnok, Z., Tübing, J., Turner, V.L., Walitza, S., Weidinger, E., and Woods, M.L.

Subjects
Obsessive-Compulsive Disorder, Tic disorder, medicine.medical_specialty, Adolescent, Tics, Comorbidity, Severity of Illness Index, Pediatrics, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, mental disorders, Developmental and Educational Psychology, medicine, Child and adolescent psychiatry, Vitamin D and neurology, Humans, ADHD, Vitamin D, Child, OCD, business.industry, Tourette, Symptom severity, General Medicine, Attention Deficit Disorder with Hyperactivity/psychology, Cross-Sectional Studies, Obsessive-Compulsive Disorder/epidemiology, Obsessive-Compulsive Disorder/psychology, Tic Disorders/metabolism, Tic Disorders/psychology, Tics/complications, Tics/metabolism, Tourette Syndrome/psychology, Vitamin D/metabolism, medicine.disease, 030227 psychiatry, Psychiatry and Mental health, Attention Deficit Disorder with Hyperactivity, Tic Disorders, Pediatrics, Perinatology and Child Health, Cohort, CTD, business, 030217 neurology & neurosurgery, Tourette Syndrome
Abstract

This study investigated whether vitamin D is associated with the presence or severity of chronic tic disorders and their psychiatric comorbidities. This cross-sectional study compared serum 25-hydroxyvitamin D [25(OH)D] (ng/ml) levels among three groups: children and adolescents (3–16 years) with CTD (n = 327); first-degree relatives (3–10 years) of individuals with CTD who were assessed for a period of up to 7 years for possible onset of tics and developed tics within this period (n = 31); and first-degree relatives who did not develop tics and were ≥ 10 years old at their last assessment (n = 93). The relationship between 25(OH)D and the presence and severity of tics, as well as comorbid obsessive–compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD), were analysed controlling for age, sex, season, centre, latitude, family relatedness, and comorbidities. When comparing the CTD cohort to the unaffected cohort, the observed result was contrary to the one expected: a 10 ng/ml increase in 25(OH)D was associated with higher odds of having CTD (OR 2.08, 95% CI 1.27–3.42, p p = 0.01) and was inversely associated with ADHD symptom severity (β = − 2.52, 95% CI − 4.16–0.88, p

Published
2022

4. Hair cortisol-a stress marker in children and adolescents with chronic tic disorders? A large European cross-sectional study

Author

Judith, Buse, Josefine, Rothe, Anne, Uhlmann, Benjamin, Bodmer, Clemens, Kirschbaum, Hoekstra, Pieter J., Andrea, Dietrich, Veit, Roessner, EMTICS collaborative group: Alan Apter, Baglioni, Valentina, Juliane, Ball, Noa, Benaroya-Milshtein, Emese, Bognar, Bianka, Burger, Cardona, Francesco Carmelo Giovanni, Marta Correa Vela, Maria Cristina Ferro, Blanca, Garcia-Delgar, Mariangela, Gulisano, Annelieke, Hagen, Julie, Hagstrøm, Hedderly, Tammy J., Isobel, Heyman, Chaim, Huyser, Marcos, Madruga-Garrido, Martino, Davide, Pablo, Mir, Astrid, Morer, Kirsten, Müller-Vahl, Alexander, Münchau, Peter, Nagy, Neri, Valeria, Openneer, Thaïra J. C., Pellico, Alessandra, Plessen, Kerstin J., Cesare, Porcelli, Rizzo, Renata, Daphna, Ruhrman, Schnell, Jaana M. L., Anette, Schrag, Silvestri, PAOLA ROSARIA, Liselotte, Skov, Tamar, Steinberg, Friederike Tagwerker Gloor, Zsanett Tarnok &amp, Elif, Weidinger, EMTICS collaborative group, Apter, A., Baglioni, V., Ball, J., Benaroya-Milshtein, N., Bodmer, B., Bognar, E., Burger, B., Buse, J., Cardona, F., Vela, M.C., Dietrich, A., Ferro, M.C., Garcia-Delgar, B., Gulisano, M., Hagen, A., Hagstrøm, J., Hedderly, T.J., Heyman, I., Hoekstra, P.J., Huyser, C., Madruga-Garrido, M., Martino, D., Mir, P., Morer, A., Müller-Vahl, K., Münchau, A., Nagy, P., Neri, V., Openneer, TJC, Pellico, A., Plessen, K.J., Porcelli, C., Rizzo, R., Roessner, V., Ruhrman, D., Schnell, JML, Schrag, A., Silvestri, P.R., Skov, L., Steinberg, T., Gloor, F.T., Tarnok, Z., Weidinger, E., and Clinical Cognitive Neuropsychiatry Research Program (CCNP)

Subjects
BIOMARKER, medicine.medical_specialty, Adolescent, Hydrocortisone, GENETICS, Tics, RESPONSIVITY, Cross-sectional study, Chronic tic disorders, Emotional and behavioral problems, Physiological stress marker, Psychosocial stress, Tourette, Tourette syndrome, 03 medical and health sciences, 0302 clinical medicine, Biomarkers, Child, Cross-Sectional Studies, Hair, Humans, Tic Disorders/diagnosis, Developmental and Educational Psychology, Child and adolescent psychiatry, Medicine, ASSOCIATIONS, business.industry, TOURETTE-SYNDROME, Stressor, OBSESSIVE-COMPULSIVE DISORDER, General Medicine, medicine.disease, PREVALENCE, 030227 psychiatry, INDIVIDUALS, Psychiatry and Mental health, PSYCHOMETRIC PROPERTIES, Tic Disorders, Pediatrics, Perinatology and Child Health, Cohort, Biomarker (medicine), STRENGTHS, business, 030217 neurology & neurosurgery, Clinical psychology
Abstract

Background There is clear evidence that tic disorders (TDs) are associated with psychosocial stress as well as emotional and behavioral problems. Studies have shown that individuals with TDs have higher acute physiological stress responses to external, single stressors (as reflected by saliva cortisol). The aim of the present study was to examine a physiological marker of longer-term stress (as reflected by hair cortisol concentration) in children and adolescents with TDs and unaffected siblings of individuals with TDs. Methods Two samples of a European cohort were included in this study. In the COURSE sample, 412 children and adolescents aged 3–16 years with a chronic TD including Tourette syndrome according to DSM IV-TR criteria were included. The ONSET sample included 131 3–10 years old siblings of individuals with TDs, who themselves had no tics. Differences in hair cortisol concentration (HCC) between the two samples were examined. Within the COURSE sample, relations of HCC with tic severity and perceived psychosocial stress as well as potential effects and interaction effects of comorbid emotional and behavioral problems and psychotropic medication on HCC were investigated. Results There were no differences in HCC between the two samples. In participants with TDs, there were no associations between HCC and tic severity or perceived psychosocial stress. No main effects of sex, psychotropic medication status and comorbid emotional and behavioral problems on HCC were found in participants with TDs. Conclusion A link between HCC and TDs is not supported by the present results.

Published
2021

5. Anti‐dopamine D2 receptor antibodies in chronic tic disorders

Author

Jennifer Tübing, Thaïra J.C. Openneer, Juliane Ball, Erika Bartolini, Anna Marotta, Giovanni Laviola, Peter Nagy, Marco Tallon, Zsanett Tarnok, Renata Rizzo, Alexander Münchau, Davide Martino, Nanette Mol Debes, Paolo Roazzi, Noa Benaroya-Milshtein, Isobel Heyman, Maria Cristina Ferro, Marianthi Georgitsi, Mariangela Gulisano, Julie Hagstrøm, Angela Periañez, Alan Apter, Liselotte Skov, Benjamin Bodmer, Zacharias Anastasiou, Daphna Ruhrman, Veit Roessner, Vasco Alessandra Pellico, Androulla Efstratiou, Annelieke Hagen, Francesco Addabbo, Kerstin J. Plessen, Immaculada Margarit, Carolin Fremer, Anette Schrag, Marta Correa Vela, Bianka Burger, Marcos Madruga-Garrido, Elif Weidinger, Onofrio Petruzzelli, Ute C. Meier, Friederike Tagwerker Gloor, Blanca Garcia-Delgar, Jaana M. L. Schnell, Marina Redondo, Sara Stöber, Francesco Cardona, Simone Macrì, Valeria Neri, Natalie Moll, Paola R. Silvestri, Pablo Mir, Graziella Orefici, Maura Buttiglione, Pieter J. Hoekstra, Cesare Porcelli, Emese Bognar, Astrid Morer, Susanne Walitza, Iordanis Karagiannidis, Monica Imperi, Markus J. Schwarz, Judith Buse, Valentina Baglioni, Chaim Huyser, Roberta Creti, Andrea Dietrich, Gregor A. Schütze, Tamar Steinberg, Peristera Paschou, Maria Gariup, Tammy Hedderly, Kirsten R. Müller-Vahl, Victoria Turner, Clinical Cognitive Neuropsychiatry Research Program (CCNP), Child Psychiatry, and ANS - Cellular & Molecular Mechanisms

Subjects
tourette syndrome, Male, 030506 rehabilitation, medicine.medical_specialty, Adolescent, Tics, Exacerbation, antiD2R antibodies, Logistic regression, Tourette syndrome, MOVEMENT, 03 medical and health sciences, GPCR, 0302 clinical medicine, McNemar's test, Developmental Neuroscience, tic exacerbations, Internal medicine, medicine, Humans, Child, Autoantibodies, Receptors, Dopamine D2, business.industry, Confounding, Autoantibody, Odds ratio, medicine.disease, tourette syndrome, antiD2R antibodies, tic exacerbations, Child, Preschool, Tic Disorders, Pediatrics, Perinatology and Child Health, Female, Neurology (clinical), 0305 other medical science, business, 030217 neurology & neurosurgery
Abstract

AIM To investigate the association between circulating anti-dopamine D2 receptor (D2R) autoantibodies and the exacerbation of tics in children with chronic tic disorders (CTDs). METHOD One hundred and thirty-seven children with CTDs (108 males, 29 females; mean age [SD] 10y 0mo [2y 7mo], range 4-16y) were recruited over 18 months. Patients were assessed at baseline, at tic exacerbation, and at 2 months after exacerbation. Serum anti-D2R antibodies were evaluated using a cell-based assay and blinded immunofluorescence microscopy scoring was performed by two raters. The association between visit type and presence of anti-D2R antibodies was measured with McNemar's test and repeated-measure logistic regression models, adjusting for potential demographic and clinical confounders. RESULTS At exacerbation, 11 (8%) participants became anti-D2R-positive ('early peri-exacerbation seroconverters'), and nine (6.6%) became anti-D2R-positive at post-exacerbation ('late peri-exacerbation seroconverters'). The anti-D2R antibodies were significantly associated with exacerbations when compared to baseline (McNemar's odds ratio=11, p=0.003) and conditional logistic regression confirmed this association (Z=3.49, p

Published
2020

6. Tic disorders in children and adolescents: does the clinical presentation differ in males and females? A report by the EMTICS group

Author

Blanca, Garcia‐delgar, Mateu, Servera, Coffey, Barbara J., Luisa, Lázaro, Thaïra, Openneer, Noa, Benaroya‐milshtein, Tami, Steinberg, Hoekstra, Pieter J., Andrea, Dietrich, Astrid Morer EMTICS collaborative group Alan Apter, Baglioni, Valentina, Juliane, Ball, Noa, Benaroya-Milshtein, Emese, Bognar, Bianka, Burger, Judith, Buse, Cardona, Francesco Carmelo Giovanni, Marta Correa Vela, Debes, Nanette M., Maria Cristina Ferro, Carolin, Fremer, Blanca, Garcia-Delgar, Mariangela, Gulisano, Annelieke, Hagen, Julie, Hagstrøm, Hedderly, Tammy J., Isobel, Heyman, Chaim, Huyser, Marcos, Madruga-Garrido, Anna, Marotta, Martino, Davide, Pablo, Mir, Astrid, Morer, Norbert, Müller, Kirsten, Müller-Vahl, Alexander, Münchau, Peter, Nagy, Neri, Valeria, Openneer, Thaïra J. C., Pellico, Alessandra, Plessen, Kerstin J., Cesare, Porcelli, Rizzo, Renata, Veit, Roessner, Daphna, Ruhrman, Schnell, Jaana M. L., Silvestri, PAOLA ROSARIA, Liselotte, Skov, Tamar, Steinberg, Friederike Tagwerker Gloor, Zsanett, Tarnok, Susanne Walitza &amp, Elif, Weidinger, Clinical Cognitive Neuropsychiatry Research Program (CCNP), Child Psychiatry, Child and Adolescent Psychiatry & Psychosocial Care, and ANS - Cellular & Molecular Mechanisms

Subjects
Male, Pediatrics, medicine.medical_specialty, congenital, hereditary, and neonatal diseases and abnormalities, Younger age, Tics, Adolescent, Autism Spectrum Disorder, Comorbidity, Adolescents, Tourette syndrome, Severity of Illness Index, Limited access, 03 medical and health sciences, 0302 clinical medicine, mental disorders, Sex differences, Developmental and Educational Psychology, Child and adolescent psychiatry, Medicine, Humans, 0501 psychology and cognitive sciences, 10. No inequality, Child, Children, business.industry, 05 social sciences, General Medicine, medicine.disease, 030227 psychiatry, body regions, Psychiatry and Mental health, Autism spectrum disorder, Attention Deficit Disorder with Hyperactivity, Tic Disorders, Pediatrics, Perinatology and Child Health, Female, Presentation (obstetrics), business, human activities, 050104 developmental & child psychology, Male predominance
Abstract

Tic disorders have a strong male predominance, with a male-to-female ratio of 4:1 in Tourette syndrome (TS) and 2:1 in persistent tic disorders. In other neurodevelopmental conditions, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), the disparity in sex distribution has been partially related to differences in symptom presentation between males and females. In tic disorders, however, little research has been conducted on this topic, probably due to the limited access to large samples with a significant proportion of females. The aim of this study was to describe sex differences in the clinical presentation of tic disorders in children and adolescents in one of the largest pediatric samples with TS/persistent tic disorders (n = 709, 23.3% females) recruited as part of the European Multicenter Tics in Children Study (EMTICS). Validated measures assessed the severity of tics and comorbid psychiatric symptoms. Using mixed-effect models, we found that sex had a significant influence on the severity of tics, ADHD symptoms, ASD symptoms, and emotional problems. Males had more severe symptoms than females, except for emotional problems. We also observed a statistically significant interaction between sex and age on the severity of tics and compulsions, with females showing higher symptom severity with increasing age than males. These findings indicate that the clinical presentation of TS/persistent tic disorders varies with sex. Males seem to exhibit a more noticeable pattern of clinical symptoms at a younger age that may contribute to their earlier detection in comparison to females.

Published
2022

7. Lack of Association of Group A Streptococcal Infections and Onset of Tics: European Multicenter Tics in Children Study

Author

Anette-Eleonore, Schrag, Martino, Davide, Hanyuying, Wang, Gareth, Ambler, Noa, Benaroya-Milstein, Maura, Buttiglione, Cardona, Francesco Carmelo Giovanni, Roberta, Creti, Androulla, Efstratiou, Tammy, Hedderly, Isobel, Heyman, Chaim, Huyser, Pablo, Mir, Astrid, Morer, Natalie, Moll, Norbert, E Müller, Kirsten, R Müller-Vahl, Kerstin, J Plessen, Cesare, Porcelli, Rizzo, Renata, Veit, Roessner, Markus, Schwarz, Zsanett, Tarnok, Susanne, Walitza, Andrea, Dietrich, Pieter, J Hoekstra Alan Apter, Baglioni, Valentina, Juliane, Ball, Noa, Benaroya-Milshtein, Benjamin, Bodmer, Emese, Bognar, Bianka, Burger, Judith, Buse, Marta Correa Vela, Nanette, M Debes, Maria Cristina Ferro, Carolin, Fremer, Blanca, Garcia-Delgar, Mariangela, Gulisano, Annelieke, Hagen, Julie, Hagstrøm, Tammy, J Hedderly, Pieter, J Hoekstra, Marcos, Madruga-Garrido, Anna, Marotta, Norbert, Müller, Alexander, Münchau, Peter, Nagy, Neri, Valeria, Thaïra Jc Openneer, Pellico, Alessandra, Ángela Periañez Vasco, Marina, Redondo, Daphna, Ruhrman, Jaana Ml Schnell, Anette, Schrag, Silvestri, PAOLA ROSARIA, Liselotte, Skov, Tamar, Steinberg, Friederike Tagwerker Gloor, Jennifer, Tübing, Victoria, L Turner, and Elif, Weidinger

Subjects
Neuroimmunity, Neuroinflammation, Tic Disorders, Streptococcal infections
Published
2022

8. European Multicentre Tics in Children Studies (EMTICS)

Author

Schrag, A, Martino, D, Apter, A, Ball, J, Bartolini, E, Benaroya-Milshtein, N, Buttiglione, M, Cardona, F, Creti, R, Efstratiou, A, Gariup, M, Georgitsi, M, Hedderly, T, Heyman, I, Margarit, I, Mir, P, Moll, N, Morer, A, Müller, N, Müller-Vahl, K, Münchau, A, Orefici, G, Plessen, Kj, Porcelli, C, Paschou, P, Rizzo, R, Roessner, V, Schwarz, Mj, Steinberg, T, Tagwerker Gloor, F, Tarnok, Z, Walitza, S, Dietrich, A, Hoekstra, Pj, Zacharias, Anastasiou, Isobel, Heyman, Chaim, Huyser, Marcos, Madruga, Pablo, Mir, Astrid, Morer, Nanette Mol Debes, Natalie, Moll, Norbert Mu ̈ller, Peter, Nagy, Kerstin Jessica Plessen, Cesare, Porcelli, Renata, Rizzo, Veit, Roessner, Jaana, Schnell, Liselotte, Skov, Zsanett, Tarnok, Susanne, Walitza, Andrea, Dietrich, Baglioni, Valentina, Juliane, Ball, Emese, Bognar, Bianka, Burger, Judith, Buse, Marta Correa Vela, Maria Cristina Ferro, Carolin, Fremer, Mariangela, Gulisano, Annelieke, Hagen, Julie, Hagstrøm, Anna, Marotta, Neri, Valeria, Thaïra J, C Openneer, Pellico, Alessandra, Kerstin, J Plessen, Daphna, Ruhrman, Jaana M, L Schnell, Silvestri, PAOLA ROSARIA, Tamar, Steinberg, Friederike Tagwerker Gloor, Elif, Weidinger, EMTICS Collaborative Group, Anastasiou, Z., Apter, A., Baglioni, V., Ball, J., Bartolini, E., Benaroya-Milshtein, N., Bodmer, B., Bognar, E., Burger, B., Buse, J., Buttiglione, M., Cardona, F., Correa Vela, M., Creti, R., Dietrich, A., Debes, N.M., Efstratiou, A., Ferro, M.C., Fremer, C., Garcia-Delgar, B., Gariup, M., Georgitsi, M., Gulisano, M., Hagen, A., Hagstrøm, J., Hedderly, T.J., Heyman, I., Hoekstra, P.J., Huyser, C., Imperi, M., Karagiannidis, I., Laviola, G., Macri, S., Madruga-Garrido, M., Margarit, I., Marotta, A., Martino, D., Meier, U.C., Mir, P., Moll, N., Morer, A., Müller, N., Müller-Vahl, K., Münchau, A., Nagy, P., Neri, V., Openneer, TJC, Orefici, G., Paschou, P., Pellico, A., Petruzzelli, O., Plessen, K.J., Porcelli, C., Redondo, M., Rizzo, R., Roazzi, P., Roessner, V., Ruhrman, D., Schnell, JML, Schrag, A., Schütze, G.A., Schwarz, M.J., Silvestri, P.R., Skov, L., Steinberg, T., Stöber, S., Gloor, F.T., Tallon, M., Tarnok, Z., Turner, V.L., Walitza, S., Weidinger, E., Woods, M.L., European Commission, National Institute for Health Research (UK), NIHR Biomedical Research Centre (UK), University College London, NHS Foundation Trust, GlaxoSmithKline, German Research Foundation, Instituto de Biomedicina de Sevilla (IBIS), and Clinical Cognitive Neuropsychiatry Research Program (CCNP)

Subjects
Male, Pediatrics, Tic disorder, BLOOD, Tourette syndrome, Obsessive–compulsive disorder, Cohort Studies, 0302 clinical medicine, Risk Factors, QUALITY-OF-LIFE, Obsessive-compulsive disorder, Developmental and Educational Psychology, Genetics, Longitudinal, Streptococcal infection, Stress, Prospective cohort study, Child, GENE-EXPRESSION, education.field_of_study, HAIR CORTISOL, 05 social sciences, A STREPTOCOCCAL INFECTIONS, Original Contribution, General Medicine, 3. Good health, Europe, Psychiatry and Mental health, LA-TOURETTE SYNDROME, Child, Preschool, NEUROPSYCHIATRIC DISORDERS, Cohort, Female, 050104 developmental & child psychology, Cohort study, medicine.medical_specialty, congenital, hereditary, and neonatal diseases and abnormalities, Tics, Adolescent, PSYCHOSOCIAL STRESS, Population, 03 medical and health sciences, mental disorders, medicine, Humans, 0501 psychology and cognitive sciences, Genetic Predisposition to Disease, education, Tic Disorders/complications, Tic Disorders/diagnosis, Tic Disorders/pathology, business.industry, OBSESSIVE-COMPULSIVE DISORDER, medicine.disease, 030227 psychiatry, nervous system diseases, body regions, PSYCHOMETRIC PROPERTIES, Tic Disorders, Pediatrics, Perinatology and Child Health, Chronic Tic Disorder, business, human activities
Abstract

EMTICS Collaborative Group., Genetic predisposition, autoimmunity and environmental factors [e.g. pre- and perinatal difficulties, Group A Streptococcal (GAS) and other infections, stress-inducing events] might interact to create a neurobiological vulnerability to the development of tics and associated behaviours. However, the existing evidence for this relies primarily on small prospective or larger retrospective population-based studies, and is therefore still inconclusive. This article describes the design and methodology of the EMTICS study, a longitudinal observational European multicentre study involving 16 clinical centres, with the following objectives: (1) to investigate the association of environmental factors (GAS exposure and psychosocial stress, primarily) with the onset and course of tics and/or obsessive–compulsive symptoms through the prospective observation of at-risk individuals (ONSET cohort: 260 children aged 3–10 years who are tic-free at study entry and have a first-degree relative with a chronic tic disorder) and affected individuals (COURSE cohort: 715 youth aged 3–16 years with a tic disorder); (2) to characterise the immune response to microbial antigens and the host’s immune response regulation in association with onset and exacerbations of tics; (3) to increase knowledge of the human gene pathways influencing the pathogenesis of tic disorders; and (4) to develop prediction models for the risk of onset and exacerbations of tic disorders. The EMTICS study is, to our knowledge, the largest prospective cohort assessment of the contribution of different genetic and environmental factors to the risk of developing tics in putatively predisposed individuals and to the risk of exacerbating tics in young individuals with chronic tic disorders., This project has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under Grant agreement no. 278367. Schrag was supported by the National Institute for Health Research UCLH Biomedical Research Centre, and Müller, Burger, Schnell and Weidinger by Stiftung Immunität und Seele. This research was supported by the National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London (Heyman); partially sponsored by GSK Vaccines (Margarit, Bartolini); and Deutsche Forschungsgemeinschaft (DFG): projects 1692/3-1, 4-1 (Münchau).

Published
2019

9. Association of Group A Streptococcus Exposure and Exacerbations of Chronic Tic Disorders

Author

Martino, Davide, Anette, Schrag, Zacharias, Anastasiou, Alan, Apter, Noa, Benaroya-Milstein, Maura, Buttiglione, Cardona, Francesco Carmelo Giovanni, Roberta, Creti, Androulla, Efstratiou, Tammy, Hedderly, Isobel, Heyman, Chaim, Huyser, Marcos, Madruga, Pablo, Mir, Astrid, Morer, Nanette Mol Debes, Natalie, Moll, Norbert Mu ̈ller, Kirsten Mu ̈ller-Vahl, Alexander, Munchau, Peter, Nagy, Kerstin Jessica Plessen, Cesare, Porcelli, Rizzo, Renata, Veit, Roessner, Jaana, Schnell, Markus, Schwarz, Liselotte, Skov, Tamar, Steinberg, Zsanett, Tarnok, Susanne, Walitza, Andrea, Dietrich, Hoekstra, Pieter J., Baglioni, Valentina, Juliane, Ball, Emese, Bognar, Bianka, Burger, Judith, Buse, Marta Correa Vela, Maria Cristina Ferro, Carolin, Fremer, Blanca, Garcia-Delgar, Mariangela, Gulisano, Annelieke, Hagen, Julie, Hagstrøm, Anna, Marotta, Neri, Valeria, Thaïra J, C Openneer, Pellico, Alessandra, Kerstin, J Plessen, Daphna, Ruhrman, Jaana M, L Schnell, Silvestri, PAOLA ROSARIA, Friederike Tagwerker Gloor, and Susanne Walitza, Elif Weidinger

Subjects
neuroimmunity, Tourette syndrome, tic disorders, neuroimmunity, tic disorders
Published
2021

10. Clinical precursors of tics: an EMTICS study

Author

Openneer, Tha€ıra J. C., Chaim, Huyser, Martino, Davide, Anette, Schrag, Alan, Apter, Baglioni, Valentina, Juliane, Ball, Noa, Benaroya-Milshtein, Emese, Bognar, Bianka, Burger, Judith, Buse, Cardona, Francesco Carmelo Giovanni, Marta Correa Vela, Nanette, M Debes, Andrea, Dietrich, Maria Cristina Ferro, Carolin, Fremer, Blanca, Garcia-Delgar, Mariangela, Gulisano, Annelieke, Hagen, Julie, Hagstrøm, Tammy, J Hedderly, Isobel, Heyman, Marcos, Madruga-Garrido, Pablo, Mir, Astrid, Morer, Norbert, Müller, Kirsten, Müller-Vahl, Alexander, Münchau, Peter, Nagy, Neri, Valeria, Thaïra J, C Openneer, Pellico, Alessandra, Kerstin, J Plessen, Cesare, Porcelli, Rizzo, Renata, Veit, Roessner, Daphna, Ruhrman, Jaana M, L Schnell, Silvestri, PAOLA ROSARIA, Liselotte, Skov, Tamar, Steinberg, Friederike Tagwerker Gloor, Zsanett, Tarnok, Susanne, Walitza, Elif, Weidinger, Hoekstra, Pieter J., Child Psychiatry, Child and Adolescent Psychiatry & Psychosocial Care, ANS - Cellular & Molecular Mechanisms, and Clinical Cognitive Neuropsychiatry Research Program (CCNP)

Subjects
Male, sex differences, Pediatrics, Longitudinal study, SYMPTOMS, Autism Spectrum Disorder, Comorbidity, Logistic regression, Tourette syndrome, 0302 clinical medicine, Developmental and Educational Psychology, Obsessive compulsive scale, Spectrum disorder, Longitudinal Studies, Child, 05 social sciences, PSYCHIATRIC-DISORDERS, clinical precursors, PREVALENCE, Psychiatry and Mental health, Autism spectrum disorder, Child, Preschool, Compulsions, Tics, Female, Psychology, 050104 developmental & child psychology, medicine.medical_specialty, congenital, hereditary, and neonatal diseases and abnormalities, conduct problems, 03 medical and health sciences, OBSESSIVE-COMPULSIVE SCALE, mental disorders, medicine, Humans, ADHD, 0501 psychology and cognitive sciences, tic onset, SPECTRUM DISORDER, TOURETTE-SYNDROME, medicine.disease, nervous system diseases, body regions, PSYCHOMETRIC PROPERTIES, SEVERITY, Attention Deficit Disorder with Hyperactivity, Tic Disorders, Pediatrics, Perinatology and Child Health, Selection operator, human activities, 030217 neurology & neurosurgery, DISRUPTIVE BEHAVIOR, Tourette Syndrome
Abstract

Background: Children with Tourette syndrome (TS) often have comorbid disorders, particularly attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). While subtle premorbid symptoms have been described in various psychiatric disorders, the presence of clinical precursors that may exist before the onset of tics is unknown. This longitudinal study aimed to find clinical precursors of tics by assessing a range of clinical characteristics prior to tic onset in comparison with children without onset of tics.Methods: A sample of 187 3- to 10-year-old first-degree unaffected relatives of children with TS were followed up to 7 years in the European Multicentre Tics in Children Study (EMTICS). We investigated whether clinical characteristics assessed at baseline predicted tic onset, comparing 126 children without tic onset to 61 children who developed tics. We used the least absolute shrinkage and selection operator (LASSO) method, a penalised logistic regression approach. We also explored sex differences and repeated our analyses in an age- and sex-matched subsample.Results: Children with tic onset were more frequently male (beta = -0.36), had higher baseline severity of conduct problems (beta = 0.23), autism spectrum disorder symptoms (ASD; beta = 0.08), compulsions (beta = 0.02) and emotional problems (beta = 0.03) compared to children without tic onset. Conduct and ASD problems were male-specific predictors, whereas severity of compulsions and oppositional (beta = 0.39) and emotional problems were female-specific predictors.Conclusion: This study supports the presence of clinical precursors prior to tic onset and highlights the need of sex-specific monitoring of children at risk of developing tics. This may aid in the earlier detection of tics, particularly in females. We moreover found that tics most often persisted one year after tic onset, in contrast to the common belief that tics are mostly transient.

Published
2021

11. Antibodies to neuronal surface proteins in Tourette Syndrome: Lack of evidence in a European paediatric cohort

Author

V. Baglioni, E. Coutinho, D.A. Menassa, M.P. Giannoccaro, L. Jacobson, M. Buttiglione, O. Petruzzelli, F. Cardona, A. Vincent, Zacharias Anastasiou, Alan Apter, Erika Bartolini, Noa Benaroya-Milshtein, Benjamin Bodmer, Emese Bognar, Bianka Burger, Marta Correa Vela, Roberta Creti, Andrea Dietrich, Nanette M. Debes, Androulla Efstratiou, Maria Cristina Ferro, Carolin Fremer, Blanca Garcia-Delgar, Maria Gariup, Marianthi Georgitsi, Mariangela Gulisano, Annelieke Hagen, Julie Hagstrøm, Tammy J. Hedderly, Isobel Heyman, Pieter J. Hoekstra, Chaim Huyser, Monica Imperi, Iordanis Karagiannidis, Giovanni Laviola, Simone Macri, Marcos Madruga-Garrido, Immaculada Margarit, Anna Marotta, Davide Martino, Ute C. Meier, Pablo Mir, Natalie Moll, Astrid Morer, Kirsten Müller-Vahl, Alexander Münchau, Peter Nagy, Valeria Neri, Thaïra J.C. Openneer, Graziella Orefici, Peristera Paschou, Alessandra Pellico, Cesare Porcelli, Marina Redondo, Renata Rizzo, Paolo Roazzi, Veit Roessner, Daphna Ruhrman, Jaana M.L. Schnell, Anette Schrag, Gregor A. Schütze, Markus J. Schwarz, Paola Rosaria Silvestri, Liselotte Skov, Tamar Steinberg, Sara Stöber, Marco Tallon, Zsanett Tarnok, Baglioni V., Coutinho E., Menassa D.A., Giannoccaro M.P., Jacobson L., Buttiglione M., Petruzzelli O., Cardona F., Vincent A., and Clinical Cognitive Neuropsychiatry Research Program (CCNP)

Subjects
0301 basic medicine, Male, Tics, Adolescent, DISORDERS, CNTNAP2, Immunology, Primary Cell Culture, CHILDREN, Hippocampal formation, Tourette syndrome, Hippocampus, Receptors, N-Methyl-D-Aspartate, Epitope, White People, Cohort Studies, 03 medical and health sciences, Behavioral Neuroscience, 0302 clinical medicine, Antigen, medicine, Animals, Humans, Child, Autoantibodies, Neurons, antibodies to neuronal antigens, movement disorders, biology, RECEPTOR, Endocrine and Autonomic Systems, business.industry, Dentate gyrus, Autoantibody, Brain, Membrane Proteins, medicine.disease, Rats, Tourette Syndrome, Tic Disorders, Neurodevelopmental Disorders, Neuronal- Surface Antibodies, Antineuronal Antibodies, Voltage-Gated Potassium Channels Antibodies, CASPR2, NMDAR, 030104 developmental biology, nervous system, Child, Preschool, Dentate Gyrus, biology.protein, Female, Antibody, business, 030217 neurology & neurosurgery
Abstract

The EMTICS collaborative group: Anastasiou, Zacharias; Apter, Alan; Baglioni, Valentina; Bartolini, Erika; Benaroya-Milshtein, Noa; Bodmer, Benjamin; Bognar, Emese; Burger', Bianka; Buttiglione, Maura; Cardona, Francesco; Vela, Marta Correa; Creti, Roberta; Dietrich, Andrea; Debes, Nanette M.; Efstratiou, Androulla; Ferro, Maria Cristina; Fremer, Carolin; Garcia-Delgar, Blanca; Gariup, Maria; Georgitsi, Marianthi; Gulisano, Mariangela; Hagen, Annelieke; Hagstrom, Julie; Hedderly, Tammy J.; Heyman, Isobel; Hoekstra, Pieter J.; Huyser, Chaim; Imperi, Monica; Karagiannidis, Iordanis; Laviola, Giovanni; Macri, Simone; Madruga-Garrido, Marcos; Margarit, Immaculada; Marotta, Anna; Martino, Davide; Meier, Ute C.; Mir, Pablo; Mo, Natalie; More, Astrid; Mueller-Vahl, Kirsten; Muenchau, Alexander; Nagy, Peter; Neri, Valeria; Openneer, Thafra J. C.; Orefici, Graziella; Paschou, Peristera; Pellico, Alessandra; Petruzzelli, Onofrio; Porcelli, Cesare; Redondo, Marina; Rizzo, Renata; Roazzi, Paolo; Roessner, Veit; Ruhrman, Daphna; Schnell, Jaana M. L.; Schrag, Anette; Schutze, Gregor A.; Schwarz, Markus J.; Silvestri, Paola Rosaria; Skov, Liselotte; Steinberg, Tamar; Stober, Sara; Tallon, Marco; Tarnok, Zsanett, In Tourette Syndrome (TS) a role for autoantibodies directed against neuronal proteins has long been suspected, but so far results are still inconsistent. The aim of this study was to look for antibodies to specific or undefined neuronal proteins that could be involved in the aetiology of the disease. Sera from children with Tourette Syndrome or another chronic tic disorder (TS/TD), collected as part of the longitudinal European Multicenter Tics in Children Study, were investigated. Participants included 30 siblings of patients with TS/TD prior to developing tics (preclinical stage) and the same children after the first tic onset (onset), and 158 patients in the chronic phase undergoing an acute relapse (exacerbation). Presence of antibodies binding to rodent brain tissue was assessed by immunohistology on rat brain sections and by immunofluorescent staining of live hippocampal neurons. Live cell-based assays were used to screen for antibodies to NMDAR, CASPR2, LGI1, AMPAR and GABAAR. Immunohistology indicated evidence of antibodies reactive with brain tissue, binding mainly to the hippocampus, the basal ganglia or the cerebellum in 26/218 (12%), with 8% of the preclinical or onset sera binding to the dentate gyrus/CA3 region or cerebellum. Only two individuals (one pre-clinical, one chronic) had antibodies binding the NMDAR and the binding was only weakly positive. No other specific antibodies were detected. Despite some immunoreactivity towards neuronal antigens on brain tissue, this was not mirrored by antibodies binding to live neurons, suggesting the presence of non-specific antibodies or those that bind non-pathogenic intracellular epitopes. NMDAR or the other neuronal surface antibodies tested were very infrequent in these patients. The evidence for pathogenic antibodies that could be causative of TS is weak.

Published
2019

12. The Relationship between Autism Spectrum Disorder and Tourette Syndrome in Childhood: An Overview of Shared Characteristics

Author

Maria Cristina Ferro, Carla Noemi Domini, Mariangela Gulisano, Renata Rizzo, and Paolo Curatolo

Subjects
medicine.medical_specialty, Population, behavioral disciplines and activities, Tourette syndrome, ASD, 03 medical and health sciences, 0302 clinical medicine, mental disorders, medicine, 0501 psychology and cognitive sciences, education, Psychiatry, education.field_of_study, business.industry, 05 social sciences, medicine.disease, Comorbidity, Autism spectrum disorder, Pediatrics, Perinatology and Child Health, Autism, Neurology (clinical), business, 030217 neurology & neurosurgery, 050104 developmental & child psychology, Clinical psychology
Abstract

Autism spectrum disorder (ASD) and Tourette syndrome (TS) are neurodevelopmental disorders. ASD and TS are traditionally considered to be separate conditions. Nevertheless, these disorders have a high degree of overlap, and “pure” cases are rare in both clinical and population-based studies. The aim of the present review was to analyze the similarities and differences between ASD and TS on the basis of genetic and neuroradiological findings.

Published
2017

14. Mosquitos (Diptera: Culicidae) en el caserío de Chingalé, Santander, donde se registró un caso humano de encefalitis equina venezolana

Author

María Cristina Ferro, Victor Alberto Olano, Martha Ahumada, and Scott Weaver

Subjects
Encephalitis virus, Venezuelan equine, encephalitis, arbovirus, Culex, Colombia, Medicine, Arctic medicine. Tropical medicine, RC955-962
Abstract

Introducción. El foco enzoótico del subtipo ID del virus de la encefalitis equina venezolana en la región del Magdalena Medio produce esporádicamente casos en humanos. El registro de un caso en una niña de tres años en el caserío de Chingalé, municipio de Puerto Wilches, Santander, motivó este estudio. Objetivo. Evaluar el caserío de Chingalé como probable sitio de infección. Materiales y métodos. En junio de 2005 se recolectaron mosquitos con trampas de luz CDC dentro y fuera de las casas; también se colocaron trampas Trinidad y hámster centinela alrededor de las viviendas. Resultados. En 107 muestreos se recolectaron 14.423 mosquitos distribuidos en 35 especies. La abundancia relativa de los posibles vectores del subtipo ID del virus de la encefalitis equina venezolana encontrados, Culex (Melanoconion) pedroi y Cx. (Mel) ocossa, en general, fue baja (

Published
2008
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