Clinical Trials Logo

Clinical Trial Summary

The Investigators propose a two-year, longitudinal pilot study of TS adults (>18) to determine impact of lifetime environmental stress exposure on tic severity, psychiatric comorbidity severity, and health-related quality of life (HRQOL).


Clinical Trial Description

Tourette syndrome (TS) is a widely prevalent neurodevelopmental disorder with limited treatment options,(1,2) substantial impact on quality of life in children(3-7) and adults,(4,8-10) and two-fold increased risk of premature death.(11,12) Tics are the defining feature of TS, and as a result, TS is often narrowly perceived in terms of tics alone. Tics themselves tend to wane in late adolescence, with distressing tics persisting in only one-third of TS patients.(13) Because tics generally diminish with age, the plight of adults with TS is often neglected. Over half of TS adults suffer from anxiety and depression,(10,14) and a similar percentage experience symptoms of attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD), findings recently corroborated in our own clinical population.(10) Many TS adults struggle to form meaningful relationships with peers, and one-third feel inadequately supported by their families.(13) The burden of TS in adulthood extends beyond mental and social health. In a national registry cohort study, individuals with TS had a mortality rate ratio of 1.8 relative to healthy controls, even after controlling for comorbid psychiatric diagnoses.(11) The causes of more frequent premature death in TS populations are unclear, with many mechanisms implicated, including suicide,(15) traumatic accidents,(12) substance abuse,(16) metabolic disorders,(12,17) and complications from pharmacotherapy.(18,19) Environmental stressors are also postulated to impact the course of TS.(20) An environmental stressor is any external condition or event that poses a threat to an individual's well-being.(21) Such stressors are known to alter brain development(22-24) and increase risk of adulthood psychopathology.(25,26) A single study has explored the role of environmental stressors in TS, finding that selected stressors predicted two-year tic and psychiatric symptom severity in a pediatric cohort (n=37 patients).(27) No similar investigations have been undertaken in TS adults. The Investigators hypothesize that environmental stressors are risk factors for more severe adult TS phenotype. The Investigators propose a two-year, longitudinal pilot study of TS adults (>18) to determine impact of lifetime environmental stress exposure on tic severity, psychiatric comorbidity severity, and health-related quality of life (HRQOL). Aim 1. Determine influence of lifetime environmental stressors on tic severity in TS adults. Hypothesis: Number of lifetime stressors at baseline assessment is associated with greater tic severity at two year follow-up. Seventy adults with TS will be recruited from the Vanderbilt TS Clinic to complete a baseline assessment, consisting of validated clinical rating scales for tic severity (Yale Global Tic Severity Scale), common psychiatric comorbidities, and lifetime environmental stressors (Stress and Adversity Inventory for Adults, STRAIN). Because acute and chronic stressors exert differential physiologic and clinical-level effects,(28-31) the STRAIN assesses these separately. The Investigators will use multivariable linear regression to examine the influence of acute and chronic lifetime stressor count at baseline on tic severity at two years, controlling for baseline tic severity and psychiatric comorbidities, as well as anti-tic medications at follow-up. Results will clarify the impact of environmental stressors on tic severity in TS adults. Aim 2. Determine influence of lifetime environmental stressors on depression in TS adults. Hypothesis: Number of lifetime stressors at baseline assessment is associated with more depressive symptoms at two-year follow-up. Depression is the psychiatric symptom that most impacts adult functioning and QOL.(10) As part of baseline and follow-up assessments, Aim 1 participants will complete standardized, semi-structured psychiatric interviews (Mini International Neuropsychiatric Interview, MINI) and validated self-report depression scales (NeuroQOL-Depression). The statistical approach from Aim 1 will be adopted to examine the influence of acute and chronic lifetime stressor count at baseline on depression symptom severity at two years, again controlling for select confounds. Findings will delineate the effects of acute and chronic environmental stressors on depression in adults with TS. Aim 3. Determine influence of positive childhood experiences on health-related quality of life (HRQOL) in TS adults. Hypothesis: Greater number of positive childhood experiences is associated with better HRQOL in TS adults at two-year follow-up. Positive childhood experiences partially mitigate the negative effects of adverse childhood experiences.(32) At baseline and follow-up visits, Aim 1 participants will report number and type of positive childhood experiences. They will also complete a validated HRQOL measure specific to TS: the Gilles de la Tourette-Quality of Life Scale (GTS-QOL). The Investigators will use multivariable regression modeling to examine the influence of positive childhood experiences on future HRQOL, controlling for environmental stressors and baseline HRQOL. Results will elucidate the potentially moderating role of positive childhood experiences on HRQOL in TS adults. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT04851678
Study type Observational
Source Vanderbilt University Medical Center
Contact Michelle Eckland, BS
Phone 615-875-7394
Email michelle.r.eckland.1@vumc.org
Status Recruiting
Phase
Start date September 30, 2021
Completion date June 30, 2026

See also
  Status Clinical Trial Phase
Completed NCT02605902 - Trial to Demonstrate the Efficacy and Safety of Internet-delivered Behavioral Treatment for Adults With Tic Disorders N/A
Completed NCT04007913 - Incorporating teleCBIT Into a Hospital-Based Tic Program N/A
Completed NCT02900144 - Modified Comprehensive Behavioral Intervention for Tics (M_CBIT) N/A
Completed NCT02216474 - Brain Stimulation in Movement Disorders N/A
Completed NCT02256475 - Safety, Pharmacokinetics, and Pharmacodynamics of NBI-98854 in Children and Adolescents With Tourette Syndrome Phase 1
Completed NCT01329198 - Brain Stimulation for the Treatment of Tourette Syndrome N/A
Terminated NCT00952601 - Pilot Study of the Modified Atkins Diet for Tourette Syndrome Phase 1
Enrolling by invitation NCT00355927 - Sedation During Microelectrode Recordings Before Deep Brain Stimulation for Movement Disorders. N/A
Completed NCT00206323 - A Randomized, Placebo-controlled, Tourette Syndrome Study. Phase 3
Completed NCT00004376 - Phase III Randomized, Double-Blind, Placebo-Controlled Study of Guanfacine for Tourette Syndrome and Attention Deficit Hyperactivity Disorder Phase 3
Completed NCT04498364 - Extinction Learning in Adults With Tourette Syndrome N/A
Completed NCT00755339 - Role of the Sensory Experience in Generating Motor Tics in Tourette Syndrome
Completed NCT03325010 - Safety, Tolerability, and Efficacy of NBI-98854 for the Treatment of Pediatric Subjects With Tourette Syndrome Phase 2
Not yet recruiting NCT06081348 - Sertraline vs. Placebo in the Treatment of Anxiety in Children and AdoLescents With NeurodevelopMental Disorders Phase 2
Completed NCT01702077 - Neurofeedback for Tourette Syndrome N/A
Completed NCT01719523 - Open-Trial of EPI-743 for Adults With Tourette Syndrome Phase 1
Completed NCT00231985 - Effectiveness of Behavior Therapy and Psychosocial Therapy for the Treatment of Tourette Syndrome and Chronic Tic Disorder Phase 2
Completed NCT00206336 - An Open-label Study to Determine the Efficacy and Safety of Topiramate in the Treatment of Tourette Syndrome. Phase 3
Terminated NCT03732534 - Rollover Study for Continuing NBI-98854 Administration in Pediatric Subjects With Tourette Syndrome Phase 2
Completed NCT03625453 - Study of ABX-1431 in Adult Patients With Tourette Syndrome or Chronic Motor Tic Disorder Phase 2