Book Review

Treating Tourette Syndrome and Tic Disorders: A Guide for Practitioners

N Engl J Med 2007; 357:2640-2641December 20, 2007

Article

Treating Tourette Syndrome and Tic Disorders: A Guide for Practitioners
Edited by Douglas W. Woods, John C. Piacentini, and John T. Walkup. 287 pp. New York, Guilford Press, 2007. $38. ISBN: 978-1-59385-480-5

Among medical disorders, Gilles de la Tourette's syndrome, or Tourette's syndrome, crosses the spectrum of age groups and has both primary and secondary neurologic, psychiatric, and psychological manifestations. The disorder is clinically complex, has a natural waxing and waning of signs, and can be associated with simple repetitive movements and noises (i.e., simple tics) and on occasion with bizarre behaviors such as socially unaccepted flailing gyrations or involuntary swearing (i.e., coprolalia). Furthermore, Tourette's syndrome is often associated with distinct but sometimes overlapping problems such as hyperactivity, attention deficit disorders, and obsessive–compulsive behaviors. The array of problems that patients with Tourette's syndrome have leads them to consult neurologists, psychiatrists, psychologists, and counselors, as well as their primary care physicians. Because many pediatric patients continue to have clinically significant tics into adulthood, internists and family physicians as well as pediatricians fall into the category of primary care physicians. In this context, a comprehensive and multispecialty book on Tourette's syndrome is potentially an important medical contribution that could be useful to a wide variety of health professionals.

Treating Tourette Syndrome and Tic Disorders approaches the topic of Tourette's syndrome with up-to-date references and a comprehensive review of psychiatric and psychological issues related to children with Tourette's syndrome. The book is edited by two well-recognized clinical psychologists, Douglas W. Woods and John C. Piacentini, and an internationally renowned research psychiatrist, John T. Walkup, and has 23 additional authors, mostly from the fields of pediatrics, psychology, psychiatry, and education. The chapters cover the clinical spectrum of tic disorders, contain rich discussions of coexisting behavioral conditions, emphasize the psychological challenges for children with tics, and present the available psychosocial interventions. There is sensitivity and scholarship in these presentations, and health professionals treating children who have these problems will find these chapters succinct and well focused.

The main problem I found with the book is its narrow focus on the psychiatric and psychological aspects of the disease. The neurologic issues that are at the core of tic disorders as movement disorders are treated with a very different, and at times rather cursory, level of attention. A single chapter, though well written, condenses all genetic and neurobiologic problems that are related to the movement disorder, as well as all discussion of neuroimaging, into an overview. Likewise, a single chapter deals with the medical management and neuropharmacology of tics, whereas six chapters expound on the psychosocial management of tics, coexisting conditions, disruptive behavior, family issues, learning disabilities, problems at school, and social adjustment. This striking imbalance limits the book's audience despite the impression that is given by the book's subtitle, A Guide for Practitioners.

The chapter on neuropharmacologic treatment is outdated. Pergolide is discussed, but this drug is no longer on the market. This section should have been purged before publication. In addition, ropinirole is mentioned in a different section from pergolide, even though both drugs are dopaminergic agonists. Having a neurologist — more specifically a movement-disorder specialist — as a coeditor might have helped the book. Given that severe tics can cause secondary neurologic syndromes in the form of radiculopathies and compressive neuropathies, and that pharmacologic treatments can be associated with a variety of movement disorders that can be misinterpreted as tics, these important neurologic problems deserve attention in a book that is aimed at practitioners.

Whereas some rating scales are provided in their full format in this book, the most commonly used scales, such as the Yale Global Tic Severity Scale, are not included, leaving the practitioner to search the literature. More thorough discussions of the disorder in adults — beyond the psychological challenges — would have allowed practitioners to understand the particular neurologic and psychiatric manifestations of Tourette's syndrome in this group of patients and to incorporate these evolving issues into treatment plans that could be followed over the life spans of the patients.

Christopher G. Goetz, M.D.
Rush University Medical Center, Chicago, IL 60612