Volume 16, Issue 6 p. 1098-1104
Article

Neuropsychiatric assessment of Gilles de la Tourette patients: Comparative study with other hyperkinetic and hypokinetic movement disorders

Jaime Kulisevsky MD

Corresponding Author

Jaime Kulisevsky MD

Movement Disorders Unit, Department of Neurology, Sant Pau Hospital, Autonomous University of Barcelona, Spain

Movement Disorders Unit, Department of Neurology, Sant Pau Hospital, Sant Antoni M. Claret 167, 08025 Barcelona, SpainSearch for more papers by this author
Irene Litvan MD

Irene Litvan MD

Cognitive Neuropharmacology Unit, Defense & Veteran Head Injury Program, Henry M. Jackson Foundation, Bethesda, Maryland, USA

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Marcelo L. Berthier MD

Marcelo L. Berthier MD

Neurology and Dermatology Department, University of Málaga, Spain

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Berta Pascual-Sedano MD

Berta Pascual-Sedano MD

Movement Disorders Unit, Department of Neurology, Sant Pau Hospital, Autonomous University of Barcelona, Spain

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Jane S. Paulsen MD

Jane S. Paulsen MD

Departments of Psychiatry and Neurology, University of Iowa, Iowa City, Iowa, USA

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Jeffrey L. Cummings MD

Jeffrey L. Cummings MD

Departments of Neurology and Psychiatry and Biobehavioral Science, University of California at Los Angeles School of Medicine, Los Angeles, California, USA

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First published: 07 November 2001
Citations: 28

Abstract

The role of the basal ganglia in conditions with co-occurring movement disorders and neuropsychiatric symptoms is not well known. It has been hypothesized that hyperkinesia -disinhibited behaviors and hypokinesia-inhibited behaviors result from an imbalance between the direct and indirect striatal output pathways, and that differential involvement of these pathways could account for the concurrent abnormalities in movement and behavior observed in these disorders.

This study aimed to evaluate whether the pattern and the extent of the neuropsychiatric manifestations of patients with GTS, a hyperkinetic movement disorder of basal ganglia origin, differs from that of patients with other basal ganglia hyperkinetic (e.g., HD) or hypokinetic (e.g., PSP) movement disorders, and to determine whether patients with GTS show a greater frequency of hyperactive behaviors (e.g., agitation, irritability, euphoria, or anxiety) than PSP patients, and are comparable to patients with HD.

The Neuropsychiatric Inventory (NPI), a scale with established validity and reliability, was administered to 26 patients with GTS (mean age, 30.2 ± 2.2 years), and the results were compared with that of 29 patients with HD (mean age, 43.8 ± 2 years) and 34 with PSP (mean ± S.D. age, 66.6 ± 1.2 years).

There was no difference between the groups in the total NPI scores. However, there was a double dissociation in behaviors: patients with hyperkinetic disorders (HD and GTS) exhibited significantly more agitation, irritability, anxiety, euphoria, and hyperkinesia, whereas hypokinetic patients (PSP) exhibited more apathy. Patients with GTS showed greater scores than HD patients in all those scores differentiating HD and GTS from PSP patients (e.g., agitation, irritability, anxiety and euphoria), and were differentiated in a logistic regression analysis from both HD and PSP patients in having significantly more anxiety. We found that patients with GTS manifested predominantly hyperactive behaviors similar but more pronounced than those presented by patients with HD, while those with PSP manifested hypoactive behaviors.

Based on our findings and the proposed models of basal ganglia dysfunction in these disorders, we suggest that the hyperactive behaviors in GTS are comparable to those observed in HD, being both secondary to an excitatory subcortical output through the medial and orbitofrontal cortical circuits, while in PSP the hypoactive behaviors are secondary to hypostimulation of these circuits. Abnormalities of other brain structures (e.g., amygdala, brainstem nuclei) may account for the significantly higher anxiety scores differentiating GTS from HD patients. © 2001 Movement Disorder Society.