Content area
Abstract
Perhaps Tourette's syndrome should be placed within the context of the hypothesis of Geschwind and Galaburde that susceptibility to neurodevelopmental disability is due to the complex interaction of androgenic and immunologic factors, which are themselves under genetic influence, acting on the developing brain to produce diverse patterns of organization.10 In this context, Balthasar's observation of an increased number of neurons in Tourette's syndrome, suggesting the persistence of an immature neuronal pattern, may be understandable.11 To the Editor: The analysis by Pauls and Leckman of families with Gilles de la Tourette's syndrome supports the hypothesis that obsessive-compulsive disorder and Tourette's syndrome may share a common cause. Whereas the former usually responds to serotonergic drugs (such as clomipramine, alprazolam, zimelidine, and fluoxetine),1 2 3 the agents of choice for Tourette's syndrome are dopamine antagonists (such as haloperidol and pimozide) or the alpha2 -adrenergic agent clonidine.4 The relative efficacy of different psychotropic agents in the two disorders is even more pronounced when one takes into account the fact that the agents affecting serotonergic functioning are not beneficial in the treatment of Tourette's syndrome and that, when used alone, antidepressant medications either worsen Tourette's syndrome or have not been useful in its treatment.4 The above letters were referred to the authors of the article in question, who offer the following reply: [...]the broad range of medications used and their nonspecific character suggest that they address aspects of the pathophysiology that are remote from the cause and proximal to the symptomatic expression of the various phenotypes. 1. Tourette's syndrome and attention deficit disorder with hyperactivity:are they genetically related? J Am Acad Child Psychiatry 1984;23:138 -46.