Нейроанатомические особенности при синдроме Жиля де ля Туретта

Тиковые расстройства, в том числе синдром Жиля де ля Туретта, представляют собой патологию психоневрологического развития и распространены в детской популяции. Клинические проявления этих расстройств варьируются в зависимости от индивидуальных особенностей, возраста, пола и наличия или отсутствия сопутствующих заболеваний. Патофизиология этих расстройств включает комбинацию генетических, экологических, психологических, иммунологических и нейробиологических факторов. С точки зрения фундаментальной нейрофизиологии синдром Жиля де ля Туретта связывают с нейрохимическим дисбалансом моноаминов и структурно-функциональными изменениями, затрагивающими нейронные сети, обеспечивающие двигательные акты: базальные ганглии, таламус и поясная кора. Существующие исследования демонстрируют вовлечение гораздо большего количества областей мозга, таких как префронтальная кора и мозжечок. В данной статье представлены последние исследования, описывающие нейроанатомические особенности у пациентов с синдромом Жиля де ля Туретта. Выявлена связь клинических проявлений заболевания с морфометрическими характеристиками базальных ганглиев, таламуса, мозжечка, поясной извилины и префронтальной коры пациентов с синдромом Жиля де ля Туретта.

1. Зыков В.П. Тики и синдром Туретта у детей. Журнал неврологии и психиатрии им. С.С. Корсакова. 2020;120(5):116–124. https://doi.org/10.17116/jnevro2020120051116

2. Чутко Л.С., Сурушкина С.Ю., Анисимова Т.И. Эмоциональные нарушения у подростков с синдромом Туретта и их матерей. Журнал неврологии и психиатрии им. С.С. Корсакова. 2018;118(11):56 59.

3. Yu L, Xu H, Jiang Z, Yang H, Cui Y, Li Y. Comorbidity of physical illnesses and mental disorders in outpatients with tic disorders: a retrospective study using the outpatient case system. Front Neurol. 2024:5;15:1397766. doi: 10.3389/fneur.2024.1397766

4. Kadesjö B, Gillberg C. Tourette’s disorder: epidemiology and comorbidity in primary school children. J Am Acad Child Adolesc Psychiatry. 2000;39(5): 548-555. https://doi.org/10.1097/00004583-200005000-00007

5. Li F, Cui Y, Li Y, Guo L, Ke X, Liu J, et al. Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17,524 individuals. J Child Psychol Psychiatry. (2022) 63:34–46. doi:10.1111/jcpp.13445

6. Alves HL, Quagliato EM. The prevalence of tic disorders in children and adolescents in Brazil. Arq Neuropsiquiatr. 2014;72(12):942-948. https://doi.org/10.1590/0004-282X20140174

7. Khalifa N, von Knorring A. Prevalence of tic disorders and Tourette syndrome in a Swedish school population. Developmental Medicine & Child Neurology. 2003;45:5. https://doi.org/10.1017/s0012162203000598

8. Surén P, Bakken IJ, Skurtveit S, Handal M, Reichborn-Kjennerud T, Stoltenberg C, Nøstvik LI, Weidle B. Tidsskr Nor Laegeforen. 2019;139(17). https://doi.org/10.4045/tidsskr.19.0411

9. Bloch MH, Peterson BS, Scahill L, Otka J, Katsovich L, Zhang H, Leckman JF. Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome. Arch Pediatr Adolesc Med. 2006;160(1):65-69. https://doi.org/10.1001/archpedi.160.1.65

10. Kurvits L, Martino D, Ganos C. Clinical features that evoke the concept of disinhibition in Tourette syndrome. Front Psychiatry. 2020;11(21):21. 10.3389/fpsyt.2020.00021

11. Yanjie Qi, Yi Zheng, Zhanjiang Li, Lan Xiong. Progress in Genetic Studies of Tourette’s Syndrome. Brain Sci. 2017;7:134. https://doi.org/10.3390/brainsci7100134

12. Cavallini MC, Di Bella D, Catalano M, Bellodi L. An association study between 5-HTTLPR polymorphism, COMT polymorphism, and Tourette’s syndrome. Psychiatry Res. 2000;97:93-100. https://doi.org/10.1016/s0165-1781(00)00220-1

13. Dehning S, Müller N, Matz J, Bender A, Kerle I, Benninghoff J, Musil R, Spellmann I, Bondy B, Möller H-J, et al. A genetic variant of HTR2C may play a role in the manifestation of Tourette syndrome. Psychiatr Genet. 2010;20:35-38. https://doi.org/10.1097/YPG.0b013e32833511ce

14. Moya PR, Wendland JR, Rubenstein LM, Timpano KR, Heiman GA, Tischfield JA, King RA, Andrews AM, Ramamoorthy S, McMahon FJ, et al. Common and rare alleles of the serotonin transporter gene, SLC6A4, associated with Tourette disorder. Mov Disord. 2013;28:1263-1270. https://doi.org/10.1002/mds.25460

15. Бондаренко Е.С., Зыков В.П., Острейко Т.Я. Особенности нейромедиаторного обмена при синдроме Туретта. Альманах «Исцеление». 1997;3:178-179

16. Tian Y, Gunther JR, Liao IH, Liu D, Ander BP, Stamova BS, Lit L, Jickling GC, Xu H, Zhan X, Sharp FR. GABA- and acetylcholine-related gene expression in blood correlate with tic severity and microarray evidence for alternative splicing in Tourette syndrome: a pilot study. Brain Res. 2011;1381:228-236. https://doi.org/10.1016/j.brainres.2011.01.026

17. Lamanna J, Ferro M, Spadini S, Racchetti G, Malgaroli A. The dysfunctional mechanisms throwing tics: structural and functional changes in Tourette syndrome. Behav Sci. 2023;13:668. https://doi.org/10.3390/bs13080668

18. Naro A, Billeri L, Colucci VP, et al. Brain functional connectivity in chronic tic disorders and Gilles de La Tourette syndrome. Prog Neurobiol. 2020;194:101884. https://doi.org/10.1016/j.pneurobio.2020.101884

19. Worbe Y, Marrakchi-Kacem L, Lecomte S, et al. Altered structural connectivity of cortico-striato-pallidothalamic networks in Gilles de la Tourette syndrome. Brain. 2015;138(Pt 2):472-482. https://doi.org/10.1093/brain/awu311

20. Bloch MH, Leckman JF, Zhu H, Peterson BS. Caudate volumes in childhood predict symptom severity in adults with tourette syndrome. Neurology. 2005;65:1253-1258. https://doi.org/10.1212/01.wnl.0000180957.98702.69

21. Peterson BS, Thomas P, Kane MJ, et al. Basal ganglia volumes in patients with gilles de la Tourette syndrome. Arch Gen Psychiatry. 2003;60(4):415-424. https://doi.org/10.1001/archpsyc.60.4.415

22. McCairn KW, Nagai Y, Hori Y, et al. A primary role for nucleus accumbens and related limbic network in vocal tics. Neuron. 2016;89(2):300-307. https://doi.org/10.1016/j.neuron.2015.12.025

23. McCairn KW, Nagai Y, Hori Y, et al. A primary role for nucleus accumbens and related limbic network in vocal tics. Neuron. 2016;89(2):300-307. https://doi.org/10.1016/j.neuron.2015.12.025

24. Peterson BS, Bronen RA, Duncan CC. Three cases of symptom change in Tourette’s syndrome and obsessive-compulsive disorder associated with paediatric cerebral malignancies. J Neurol Neurosurg Psychiatry. 1996;61(5):497-505. https://doi.org/10.1136/jnnp.61.5.497

25. Lee JS, Yoo SS, Cho SY, Ock SM, Lim MK, Panych LP. Abnormal thalamic volume in treatmentnaïve boys with Tourette syndrome. Acta Psychiatr Scand. 2006;113(1):64-67. https://doi.org/10.1111/j.1600-0447.2005.00666.x

26. Wang L, Lee DY, Bailey E, et al. Validity of large-deformation high dimensional brain mapping of the basal ganglia in adults with Tourette syndrome. Psychiatry Res Neuroimag. 2007;154(2):181-190. https://doi.org/10.1016/j.pscychresns.2006.08.006

27. Miller AM, Bansal R, Hao X, et al. Enlargement of thalamic nuclei in Tourette syndrome. Arch Gen Psychiatry. 2010;67(9):955-964. https://doi.org/10.1001/archgenpsychiatry.2010.102

28. Peterson BS, Staib L, Scahill L, et al. Regional brain and ventricular volumes in Tourette syndrome. Arch Gen Psychiatry. 2001;58(5):427-440. https://doi.org/10.1001/archpsyc.58.5.427

29. Peterson B, Leckman J, Scahill L, et al. Steroid hormones and CNS sexual dimorphisms modulate symptom expression in tourette’s syndrome. Psychoneuroendocrinology. 1992;17(6):553-563. https://doi.org/10.1016/0306-4530(92)90015-Y

30. Müller-Vahl KR, Grosskreutz J, Prell T, Kaufmann J, Bodammer N, Peschel T. Tics are caused by alterations in prefrontal areas, thalamus and putamen, while changes in the cingulate gyrus reflect secondary compensatory mechanisms. BMC Neurosci. 2014;15:6. https://doi.org/10.1186/1471-2202-15-6

31. Ramkiran S, Veselinović T, Dammers J, et al. How brain networks tic: predicting tic severity through rs-fMRI dynamics in Tourette syndrome. Hum Brain Mapp. 2023;44(11):4225-4238. https://doi.org/10.1002/hbm.26341

32. Ganos C, Kühn S, Kahl U, et al. Action inhibition in Tourette syndrome. Mov Disorders. 2014;29(12):1532- 1538. https://doi.org/10.1002/mds.25944

33. Vogt BA. Cingulate cortex in the three limbic subsystems. Handb Clin Neurol. 2019;166(3):39-51. https://doi.org/10.1016/B978-0-444-64196-0.00003-0

34. O’Neill J, Piacentini JC, Peterson BS. Cingulate role in Tourette syndrome. Handb Clin Neurol. 2019;166:165-221. https://doi.org/10.1016/B978-0-444-64196-0.00011-X

35. Dowdle LT, Brown TR, George MS, Hanlon CA. Single pulse TMS to the DLPFC, compared to a matched sham control, induces a direct, causal increase in caudate, cingulate, and thalamic BOLD signal. Brain Stimul. 2018;11(4):789-796. https://doi.org/10.1016/j.brs.2018.02.014

36. Braun A. The functional neuroanatomy of tourette’s syndrome: an FDG-PET study. II: relationships between regional cerebral metabolism and associated behavioral and cognitive features of the illness. Neuropsychopharmacology. 1995;13(2):151-168. https://doi.org/10.1016/0893-133X(95)00052-F

37. Wagner MJ, Luo L. Neocortex-cerebellum circuits for cognitive processing. Trends Neurosci. 2020;43(1):42-54. https://doi.org/10.1016/j.tins.2019.11.002

38. D’Urso G, Toscano E, Sanges V, et al. Cerebellar transcranial direct current stimulation in children with autism spectrum disorder: a pilot study on efficacy, feasibility, safety, and unexpected outcomes in tic disorder and epilepsy. J Clin Med. 2021;11(1):143. https://doi.org/10.3390/jcm11010143

39. Sigurdsson HP, Jackson SR, Jolley L, Mitchell E, Jackson GM. Alterations in cerebellar grey matter structure and covariance networks in young people with Tourette syndrome. Cortex. 2020;126:1-15. https://doi.org/10.1016/j.cortex.2019.12.022

40. Tobe RH, Bansal R, Xu D, et al. Cerebellar morphology in Tourette syndrome and obsessive-compulsive disorder. Ann Neurol. 2010;67(4):479-487. https://doi.org/10.1002/ana.21918

41. Perrotta G. Maladaptive stress: theoretical, neurobiological and clinical profiles. Arch Depress Anxiety. 2021;7(1):1-7. https://doi.org/10.17352/2455-5460.000057

42. Liberati AS, Perrotta G. Neuroanatomical and functional correlates in tic disorders and Tourette’s syndrome: A narrative review. Ibrain. 2024;10(4):439-449. https://doi.org/doi:10.1002/ibra.12177