From The New England Journal of Medicine, September 30, 1999
In 1885, the French neurologist Georges Gilles de la Tourette, describing the first nine patients with Gilles de la Tourette syndrome, stated, "Everything is extraordinary in this disease: the name is ridiculous, its symptoms peculiar, its character equivocal, its cause unknown, its treatment problematical." More than a century later, this statement still holds, although the name of the disease has been changed to Tourette's syndrome (or Tourette's disorder). Considered rare and exotic at that time, Tourette's syndrome is a relatively common childhood-onset disorder characterized by multiple motor and vocal tics. Often lifelong in duration, the full syndrome affects up to 1 person in 2500 and the partial forms two or three times that many. In addition to tics, most patients have other symptoms such as obsessions, compulsions, motor hyperactivity, impulsivity, and distractibility, and many meet the criteria for the diagnosis of obsessive-compulsive disorder or attention-deficit-hyperactivity disorder. A variety of sensory and mental states, including urges and a buildup of tension, precede the tics and subside after the tics occur. Vulnerability to Tourette's syndrome is transmitted within families, although the gene or genes conferring vulnerability have yet to be fully identified. Although much has been learned about the symptoms, character, and course of this fascinating disorder since Gilles de la Tourette's original description, its cause is still unknown and its treatment remains challenging, even with modern pharmacotherapy. No one is more qualified to contribute a comprehensive textbook on the current understanding of the development of Tourette's syndrome than James Leckman and Donald Cohen of the Yale Child Study Center. With the help of their colleagues, Leckman and Cohen have broadened the scope of their last major book, Tourette's Syndrome and Tic Disorders: Clinical Understanding and Treatment (edited by D.J. Cohen, R.D. Bruun, and J.F. Leckman. New York: Wiley, 1988). That book was considered by clinicians and investigators to be a classic, but an update was needed, since the past 10 years have seen an exponential growth in research on neuroimaging techniques and the neuroscience and genetics of Tourette's syndrome. This book will appeal to clinicians, investigators, and students and to the families of persons afflicted with Tourette's syndrome. The book is comprehensive in scope; its goal was to review what the authors and their colleagues have learned from their studies and clinical care of patients with Tourette's syndrome and to frame the important questions that remain. A central tenet of the book, derived from the editors' and contributors' developmental and psychoanalytic orientation, is that persons with Tourette's syndrome are whole people whose inner worlds are marked by the struggle to maintain a sense of autonomy and integrity in the face of constant unwanted urges, images, and thoughts -- a siege against the self. This developmental understanding, informed by the authors' research in neurobiology, imaging, neuropsychology, and clinical care, is the foundation of the book's structure. The book contains three sections. The first, "Individuals, Symptoms, and Diagnoses," reviews the natural history of Tourette's syndrome, the phenomenology of tics and comorbid disorders, the neuropsychology of the disorder, and patients' adaptation to the disease and relationships with their peers. The second section, "Causes and Determinants," presents an evolving model of the pathogenesis of Tourette's syndrome. The authors hypothesize an interaction among neurobiologic substrates, genetic factors, and epigenetic or environmental factors that may confer susceptibility to or protection against Tourette's syndrome and related obsessive-compulsive disorders. They offer the concept that Tourette's syndrome and obsessive-compulsive disorder are the result of heightened but selective sensitivity to alterations in the internal milieu of the body and the external environment. This sensitivity, they argue, results from an escape from the inhibitory pathways in the brain, which link deep basal ganglionic structures with specific cortical areas. In Tourette's syndrome this enhanced sensitivity causes the exaggerated, uncoordinated expression of fragments of movement, cognition, and behavior that belong to the repertoire of ordinary, voluntary action in normal people. Also included in section 2 are reviews of the epidemiology, genetics, neuroanatomical circuitry, and neurochemistry of Tourette's syndrome. Section 3, "Partnerships for Making the Best of Tourette's," focuses on the Yale approach to evaluation and treatment and includes chapters on rating instruments, testing, and pharmacologic and psychosocial treatment. A final chapter reviews the role of voluntary organizations in clinical care, research, and public policy. This outstanding book is a model of comprehensive care for clinicians. Its strengths include the authors' successful integration of basic principles and approaches to clinical care from neurobiologic, developmental, and psychodynamic perspectives. The discussion of adaptive aspects of Tourette's syndrome and the emphasis on evaluation of the strengths and resilience of individual patients are also important features. Although treatment options are reviewed thoroughly, in part in separate chapters on pharmacotherapy and psychosocial therapy, the book would have been strengthened by a discussion of treatment recommendations based on the spectrum of Tourette's syndrome and obsessive-compulsive disorders. Reviewed by Barbara J. Coffey, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.


From Book News, Inc.
Contains 21 contributions comprising the work of researchers associated with the Yale Child Study Center, which has been at the forefront of research on Tourette's syndrome and associated disorders. Contributions are divided into three sections. The first addresses clinical symptoms, the major categories of disorders (Tourette's, obsessive-compulsive, attention deficit hyperactivity, and learning disability disorders), and strengths and adaptations of individuals with Tourette's. The second section discusses pathogenesis, including studies in epidemiology, genetics, epigenetic factors, neuroanatomy, and neurochemistry. The third section covers assessment and treatment. Book News, Inc.®, Portland, OR


Review
"...strongly recommended ...  The book is a must, for anyone , with a special interst in any aspect of TS...." (Infant & Child Development, June 2003)


Review
"...strongly recommended ...  The book is a must, for anyone , with a special interst in any aspect of TS...." (Infant & Child Development, June 2003)


Book Description
A revised and concise guide to the latest thoughts and findings on Tourette’s Syndrome Edited by two of the leading international authorities on Tourette’s Syndrome and tic-related, obsessive-compulsive disorders, Tourette’s Syndrome is the most up-to-date edited reference covering this neuropsychiatric disorder and related disorders from a variety of perspectives. Featuring contributors from the world-renowned Yale Child Study Center, this volume introduces a groundbreaking developmental framework for understanding Tourette’s–defined by persistent motor and vocal tics and frequently associated with obsessions, compulsions, and attentional difficulties–and maps out the diagnosis, genetics, manifestations, and treatment. Reflecting more than 25 years of research, this comprehensive resource describes the major categories of disorders (TS, obsessive-compulsive disorder, attention deficit hyperactivity disorder, learning disabilities) as well as the strengths and adaptation of individuals with Tourette’s. A broad, detailed discussion of pathogenesis is provided, including epidemiological studies and environmental risk and protective factors. The book also highlights the necessary partnerships between children, families, and clinicians in the struggle to achieve wished-for outcomes. Enriched by the knowledge of specialists at the forefront of genetics, psychology, neuropsychology, pharmacology, neurochemistry, and epidemiology, among other fields, Tourette’s Syndrome gives clinicians valuable insight into the minds of and proper care for individuals battling this and related disorders.


Book Info
Yale Child Study Center, New Haven, Connecticut. Reviews present knowledge of this syndrome and suggests important questions that remain unanswered. For clinicians and researchers. DNLM: Tourette Syndrome. Added to Brandon-Hill Medical List in April 2001.


The publisher, John Wiley & Sons
Once thought to be rare, Tourette's Syndrome is now seen as a relatively common childhood disorder either in its complete or partial incarnations. Drawing on the work of contributors hailing from the prestigeous Yale University Child Psychiatry Department, this edited volume explores the disorder from many persepctives, mapping out the diagnosis, genetics, phenomenology, natural history, and treatment of Tourette's Syndrome.


From the Back Cover
A revised and concise guide to the latest thoughts and findings on Tourette’s Syndrome Edited by two of the leading international authorities on Tourette’s Syndrome and tic-related, obsessive-compulsive disorders, Tourette’s Syndrome is the most up-to-date edited reference covering this neuropsychiatric disorder and related disorders from a variety of perspectives. Featuring contributors from the world-renowned Yale Child Study Center, this volume introduces a groundbreaking developmental framework for understanding Tourette’s–defined by persistent motor and vocal tics and frequently associated with obsessions, compulsions, and attentional difficulties–and maps out the diagnosis, genetics, manifestations, and treatment. Reflecting more than 25 years of research, this comprehensive resource describes the major categories of disorders (TS, obsessive-compulsive disorder, attention deficit hyperactivity disorder, learning disabilities) as well as the strengths and adaptation of individuals with Tourette’s. A broad, detailed discussion of pathogenesis is provided, including epidemiological studies and environmental risk and protective factors. The book also highlights the necessary partnerships between children, families, and clinicians in the struggle to achieve wished-for outcomes. Enriched by the knowledge of specialists at the forefront of genetics, psychology, neuropsychology, pharmacology, neurochemistry, and epidemiology, among other fields, Tourette’s Syndrome gives clinicians valuable insight into the minds of and proper care for individuals battling this and related disorders.


About the Author
JAMES F. LECKMAN, MD, is Neison Harris Professor of Child Psychiatry and Pediatrics at the Yale Child Study Center. DONALD J. COHEN, MD, is founder of the renowned clinical and scientific research programs for Tourette’s Syndrome at the Yale Child Study Center. He is well known for his clinical expertise and breadth of understanding. Dr. Cohen has served as the Director of the Child Study Center since 1983.

FROM THE PUBLISHER

Edited by two of the leading international authorities on Tourette's Syndrome and tic-related, obsessive-compulsive disorders, Tourette's Syndrome is the most up-to-date edited reference covering this neuropsychiatric disorder and related disorders from a variety of perspectives. Featuring contributors from the world-renowned Yale Child Study Center, this volume introduces a groundbreaking developmental framework for understanding Tourette's -- defined by persistent motor and vocal tics and frequently associated with obsessions, compulsions, and attentional difficulties -- and maps out the diagnosis, genetics, manifestations, and treatment.

Reflecting more than 25 years of research, this comprehensive resource describes the major categories of disorders (TS, obsessive-compulsive disorder, attention deficit hyperactivity disorder, learning disabilities) as well as the strengths and adaptation of individuals with Tourette's. A broad, detailed discussion of pathogenesis is provided, including epidemiological studies and environmental risk and protective factors. The book also highlights the necessary partnerships between children, families, and clinicians in the struggle to achieve wished-for outcomes.