There may be a linkage between Tourette syndrome and sex steroid
hormones, but the exact nature of the relationship between hormonal
fluctuations and TS is still under investigation. I've gathered some
information for you, but unfortunately there is no breakthrough
treatment available. The pattern of evidence from the medical studies
on women with TS is spotty, and sometimes contradictory. Some studies
seem to indicate that estrogenic hormones influence Tourette symptoms,
while in other studies androgenic hormones are implicated. In order to
use bioidentical hormones in treating a patient, a physician must
first have an understanding of the precise nature of the hormonal
abnormality, and in the case of Tourette syndrome, that understanding
is elusive.
======================================================================
"Q: I notice that during menstruation my TS symptoms get worse. Are
there medications that can help?
A: The interaction of hormones and the brain are certainly well known
and intriguing. The hormonal changes during the menstrual cycle can be
extremely troublesome for many women with and without TS. An
indication of this concern is the recent report of the use of
fluoxetine (Prozac) to minimize the effects of the premenstrual
syndrome (PMS). I am not aware that this has been tried in patients
with TS. However, for significantly affected individuals, it may be an
alternative to be considered. Women with extemely irregular cycles
might benefit from a consultation with a gynecologist to determine
whether cycling with hormones (progesterone, estrogen) might benefit
them both in terms of irregularity of cycle as well as mood."
Tourette Syndrome Association, Inc.
http://www.tsa-usa.org/research/fall96.html
======================================================================
An excerpt from a medical study called "Estrogen, progesterone, and
tic severity in women with Gilles de la Tourette syndrome.":
"Several case reports and one questionnaire-based study have noted a
premenstrual increase in tics thought to be secondary to low estrogen
levels. No study has actually measured estrogen and progesterone
levels through a menstrual cycle to correlate tic severity and
hormonal activity... This is the first study to examine prospectively
the fluctuation of objective tic counts and OCD symptoms in
association with menstrual-related shifts in hormonal levels...
Although marked changes occurred both in estrogen and progesterone
levels, confirming typical menstrual cycles, as well as in the
clinical measures of objective and subjective tic ratings and OCD
scores, there was no consistent correlation between hormonal levels
and fluctuations in tics or OCD symptoms."
Tourette Syndrome Support UK Forum
http://pub51.ezboard.com/ftourettesyndromesupportuk36971frm0.showMessage?topicID=123.topic
======================================================================
Abstracts from studies indexed by MedLine:
"In a survey of 47 women of all ages with Tourette syndrome, 26% had a
premenstrual increase in tics (P less than .001) when various hormonal
states were examined. An increase in tics at menarche predicted the
premenstrual tic exacerbation (P less than .001). In contrast, other
hormonally influenced conditions, such as premenstrual syndrome, oral
contraceptive use, pregnancy, and menopause were not associated with a
change in tic frequency. The finding of an increase in tic frequency
during the estrogenic phase of the menstrual cycle provides additional
insight into an important control mechanism for tic expression and
suggests possible therapeutic options."
PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1558574&dopt=Abstract
"Sex steroid hormones influence the dopaminergic systems of the
hypothalamus as well as the extrahypothalamic regions of the brain in
controlling movement and behavior in both humans and animals. This
review focuses on the effects of sex steroids on dopaminergic activity
in extrahypothalamic brain areas. Among sex steroids, estrogens have
been most extensively investigated, and many studies report that
estrogens affect behaviors mediated by the basal ganglia, such as in
humans suffering from extrapyramidal disorders. Epidemiological and
clinical evidence also suggests an influence of estrogens on the
vulnerability threshold for schizophrenia and sex differences in the
clinical expression of this disease. Clinical observations point to a
role of androgenic hormones in Gilles de la Tourette's syndrome."
PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8019704
"We present our hypothesis that various steroid hormones play an
important role in the symptom expression of Gilles de la Tourette's
syndrome (TS) and that androgenic hormones, in particular, are likely
to exacerbate symptoms of the disorder. We review the clinical
evidence supporting our hypothesis. Sex steroids establish brain
sexual dimorphisms early in CNS development, and we suggest mechanisms
whereby androgenic and other hormonal changes later in human
development might act at dimorphic brain regions to influence the
natural history of TS."
PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1287677
"Tourette's syndrome (TS) is associated with prominent gender
differences in clinical expression, tics with a sexual content, and a
stabilization or improvement of symptoms after puberty. It is herein
hypothesized that some tics can be viewed as inappropriately expressed
(normally inhibited) fragments of primitive motor and vocal programs
involved in reproductive activity. The brain regions involved in TS
(basal ganglia and limbic system) are proposed to be counterparts in
humans of those functioning in primitive reproductive behavior whose
development and organization are under sex hormone control. It is
further hypothesized that sex hormone action is mediated by excitatory
neurotransmitter mechanisms such that an excessive trophic effect
occurs early in development and a neurotoxic environment emerges later
on."
PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1355964
Other relevant articles, for which there is no abstract available:
"Estrogen as adjuvant treatment of Tourette syndrome."
PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2853944
"Menstrual-related fluctuations in Tourette's syndrome."
PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3477529
"Sexual hormones in the pathophysiology of Tourette's syndrome."
PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3162726
======================================================================
Here you'll find many useful links related to Tourette syndrome:
Tourette Syndrome Support: Links
http://www.cwgsy.net/community/tosy/links.htm
Links describing alternative therapies:
New York Online Access to Health
http://www.noah-health.org/english/illness/neuro/tourette.html#Alternative
The Tourette Syndrome Association website is a very helpful resource:
Tourette Syndrome Association, Inc.
http://www.tsa-usa.org/
The alt.support.tourette newsgroup provides an interchange of ideas
among patients, caregivers, physicians, and others interested in TS:
Newsgroup: alt.support.tourette
http://groups.google.com/groups?hl=en&lr=lang_en&ie=UTF-8&oe=UTF-8&newwindow=1&safe=off&group=alt.support.tourette
======================================================================
The Amen Clinic, founded by Dr. Daniel Amen, has an excellent
reputation for the management and treatment of OCD and Tourette
syndrome. The Amen Clinic has locations in southern California
(Newport Beach) and in northern California (Fairfield). Here's brief
info on Dr. Brian D.H. Goldman, of the clinic:
"Goldman, Brian D. H. MD
Psychiatrist specializing in child and adolescent psychopharmacology -
especially the management of Autism and Autism Spectrum Disorders,
conduct disorders, mood disorders in children and adolescents,
Tourette's Syndrome, Obsessive-Compulsive Disorder and ADHD."
Here's contact information for the Amen Clinic:
Amen Clinic
http://www.amenclinic.com/ac/contact_amenclinic.asp
This is much farther south, but you may want to contact the Swerdlow
Lab, at the University of California at San Diego, to see whether
there are any current studies that might be relevant to your daughter.
The Swerdlow Lab is on the cutting edge of research in the field.
UCSD: Swerdlow Lab
http://psychiatry.ucsd.edu/swerdlow/
"Dr. Swerdlow's research addresses clinical and preclinical issues
related to neuropsychiatric disorders of the limbic system and basal
ganglia. Generally, these are disorders characterized by an inability
to shut off or 'gate' intrusive thoughts, sensations or movements, and
include Obsessive Compulsive Disorder, Huntington's disease,
Tourette's Syndrome schizophrenia. His studies consist of behavioral,
neuropsychological and psychophysiological measures that assess
pathology in brain regions linking the limbic cortex and basal
ganglia, and he uses similar measurements in rats after lesions or
drug infusions into these brain regions. His preclinical studies are
aimed at understanding the neural and genetic bases for phenomena
identified via his clinical studies, and some preclinical work is also
aimed at drug development for the treatment of these disorders."
UCSD: Swerdlow Lab
http://psychiatry.ucsd.edu/swerdlow/about.html
You may be interested in the experience of my friend whose teenage son
has Tourette syndrome. My friend's son, under the guidance of a
psychopharmacologist, experienced significant improvement of his
symptoms after he was put on a program featuring the nutritional
supplements developed by medical technologist Bonnie Grimaldi.
Information about the supplements may be found here:
Bontech Supplements, Ltd.
http://www.bonniegr.com/
======================================================================
My search strategy in locating the material that I've posted above was
to perform searches on PubMed and Google, using various combinations
of the search terms "tourette," "tourette's," "hormone," "hormones,"
"steroid," "steroids," "menstrual," "menstruation," "menses,"
"estrogen," "progesterone," "androgen," and "testosterone."
I hope this helps. If anything is unclear, or if a link doesn't work
for you, please request clarification; I'll be glad to offer further
assistance before you rate my answer.
Best wishes,
pinkfreud |
