This study will use magnetic resonance imaging (MRI) and magnetic resonance spectroscopy
(MRS) of the brain to try to gain a better understanding of the disease process in Tourette s
syndrome, a neuropsychiatric disorder characterized by motor and vocal tics. Tourette s
syndrome is also associated with behavioral and emotional disturbances, including symptoms of
attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). MRI
and MRS show chemical substances in the brain. Findings in normal volunteers will be compared
with those of patients.
Healthy volunteers and patients with Tourette s syndrome 14 years of age and older may be
eligible for this study. Volunteers will be screened with a medical history and physical and
neurological examinations. Patients will be screened through NINDS protocol 93-N-0202.
Participants will undergo MRI and MRS. MRI uses a strong magnetic field and radio waves to
visualize brain anatomy and chemistry. For this study, the subject lies on a stretcher, which
is moved into a strong magnetic field (the MRI scanner). Earplugs are worn to muffle loud
thumping noises caused by the electrical switching of the radio frequency circuits. During
the study, the subject lies still during each scan, for 1 to 8 minutes at a time. Total
scanning time varies from 20 minutes to 2 hours, with most examinations lasting between 45
and 90 minutes. The subject can speak through an intercom with the staff member performing
the study at all times during the procedure. Up to 5 studies may be performed.
The purpose of this study is to obtain a better understanding of the pathophysiology of
Tourette's Syndrome (TS) with nuclear magnetic spectroscopic imaging. The basal ganglia have
been implicated in the origin of tics, and we plan to use spectroscopy to determine whether
there is any neuronal degeneration or a decrease in aminobutyric acid (GABA) within the basal
ganglia, thalamus, or frontal cortex of patients with TS when compared to normal individuals.
This research will be conducted using patients with TS and normal volunteers.
Patients and normal volunteers will be scanned with 3 Tesla General Electric (GE) magnetic
resonance imager using magnetic resonance spectroscopy (MRS) to measure N-acetylaspartate,
choline, creatine, lactate and GABA.
Concentrations of metabolites will be compared between two groups.
- INCLUSION CRITERIA:
Patients will have clinically documented TS as defined by Diagnostic and Statistical Manual
of Mental Disorders (DSM)-IV and an evaluation of tics severity using the Yale Tic Scale.
Fourty-four patients, ranging from 14-65 in age, will be recruited. Patients and normal
volunteers may be male or female; however, female subjects of child bearing potential will
have a pregnancy test and an interview prior to the study to ensure that pregnant subjects
will not participate in the study. Patients will be asked to stop any medication that can
influence their central nervous system for one week prior to exam. They will be asked to
abstain from alcohol for one week before the study.
Sixty-two normal controls will be included; controls will be screened in the NINDS Movement
Disorders Outpatient Clinic. After screening and consenting, controls will have
neurological and physical examinations. Controls with chronic illnesses, taking any
medication that affects the CNS will be excluded. Female subjects of child bearing
potential will have a pregnancy test and an interview prior to the study to ensure that
pregnant subjects will not participate in the study. They will be asked to abstain from
alcohol for one week before the study. More controls will be needed in order to ensure that
the sequence is working prior to the acquisition of data, since the sequence has only been
used in the 1.5T MRI scanner and we will be using the 3T.
Subjects younger than 14 years old.
Patients with MRI findings consistent with brain tumors, strokes, trauma or arteriovenous
Patients with progressive neurological disorders other than Tourette's syndrome.
Patients with a history of significant medical disorders, or who require chronic treatment
with other drugs which cannot be stopped.
Subjects with implanted devices such as pacemakers, medication pumps or defibrillators,
metal in the cranium except mouth, intracardiac lines, history of shrapnel injury or any
other condition/device that may be contraindicated or prevent the acquisition of the MRI.
Patients with cancer.
Patients not capable of giving an informed consent.