Gilles is in the air

Premonitory urge in tic disorders–a scoping review

For our latest "Gilles is in the air" episode, we remain...across the pond and get the chance to hear more about premonitory urge, the sensory phenomenon described and characterised in numerous studies and publications for more than 30 years.
Our guests today have conducted a scoping review of premonitory urge in primary tic disorders to identify and address limitations and knowledge gaps. 
"Knowledge of the clinical characteristics, measurement, and neural mechanisms of premonitory urge has advanced considerably in recent years, but important knowledge gaps remain in each of these domains. Addressing these knowledge gaps will be key to developing effective interventions for premonitory urge." 
Jack Wohlgemuth works as a clinical research coordinator at Mount Sinai Hospital in New York City, where he is focused on research related to Tourette syndrome and other neurological movement disorders. He is interested in how the brains of individuals with tic disorders differ in their processing of signals from within the body, and how these differences are related to the uncomfortable sensory phenomena that are often experienced prior to tics (“premonitory urges”). Jack received his BA from Vanderbilt University. 
Bio page: https://labs.icahn.mssm.edu/waterslab/team/
Email: john.wohlgemuth@mountsinai.org 
David Isaacs, MD, MPH is a movement disorders neurologist and co-director of the Vanderbilt Center for Tourette Syndrome and Other Tic Disorders, a Tourette Association of America Center of Excellence.
He provides clinical care to children, adolescents, and adults with tic disorders. His research examines the clinical impact and neurophysiologic correlates of non-motor features of tic disorders. 
Bio page: https://www.vumc.org/neurology/person/david-isaacs-md
Email: david.a.isaacs@vumc.org
Some of the key points we discuss:
the goal and the methods of the study
as several premonitory urge-measuring scales have been identified, which one is the best to use?
prevalence estimates of premonitory urge in individuals with tics have been found between 37% and 93%; which factors influence the presence of the urge?
does the premonitory urge depend on the type, the location and the severity of the tics?
were the tics or the urges more bothersome?
based on several studies, it was mentioned that more severe urges are associated with greater disability; is this controlled with severity of tics and comorbidities?
how is such a variability explained in the results of studies that explore the association between urge severity and tic suppression ability?
how does the urge seem to impact cognition?
which brain areas are activated during the urge and how was this found?
which treatment(s) reduce the urge?
what knowledge gaps have you identified for future studies?
Thank you Jack and David for sharing your findings and expertise with us!
 

When you’re (not) the stereotype: coprolalia stigma in the lives of adults with Tourette syndrome

Our guest today is Rena Zito, associate professor of sociology in the Department of Sociology and Anthropology at Elon University in North Carolina, U.S.A and a person with Tourette Syndrome.
Her research focuses on social stigma, including how stigmatised populations form identities, preserve dignity, and combat social exclusion.
 
Drawing on interviews with 30 adults diagnosed with TS, she explores how this narrow stereotype circulates in media and everyday interactions, and how adults with TS push back against it, sometimes with unintended consequences for those whose tics confirm the stereotype.
 
Rena concludes that correcting myths about TS is vital, but it shouldn’t come at the expense of people with coprolalia. Advocacy groups, individuals with TS, and medical professionals can foster inclusion by acknowledging the full range of TS experiences and framing coprolalia as one of many possible tic expressions rather than treating it as an unfortunate exception.
 
Contact Rena Zito: rzito@elon.edu 
Bio: https://www.elon.edu/u/news/author/rzito/
View her article: https://www.tandfonline.com/doi/full/10.1080/01639625.2025.2531145 
 

The Art of Treating Tics and Tourette

Our guest today (the episode was recorded in late April 2025) is Dr Noa Benaroya Milstein, Head of the Child Psychiatry Division Schneider's Children Medical Centre of Israel, where she also serves as Head of the Tourette Clinic. She is a Senior Lecturer at the Tel Aviv University Faculty of Medicine and actively involved in local and multi-centre studies specialised in Tourette syndrome and associated disorders. 
We talk about first-line pharmacological treatments, co-occurring condition-treatment-prioritisation cases, assessing tic-related impairment, botulinum toxin injections, DBS, promising molecules, the effects of pregnancy and postpartum period on tics and the current landscape and available treatments in Israel.

Neuroleptic and other drug-induced tics

We are pleased to welcome today Tamara Pringsheim, who is a Professor with the Department of Clinical Neurosciences, Psychiatry, Paediatrics and Community Health Sciences at the University of Calgary. She also works as an evidence-based medicine methodologist for the American Academy of Neurology.  
Tamara is the president of the Tourette OCD Alberta Network, a nonprofit organisation that supports people living with Tourette syndrome and Obsessive-Compulsive Disorder in Alberta, and provides education and training on these disorders to healthcare providers. 
Suggested article: 
"The Impact of Montelukast Duration on the Risk of Neuropsychiatric Disorders in Children with Asthma: A Population-Based Cohort Study" Visit page

Median nerve stimulation in tic disorders

A long-awaited episode with Professor Stephen Jackson and Dr Barbara Morera from the University of Nottingham and Neurotherapeutics Ltd. 
They have been developing "a safe and effective non-drug treatment that reduces tics and the urge to tic, through gentle stimulation of the median nerve in the wrist". 
We are grateful to them for taking the time to answer very important questions that help us understand the effect of median nerve stimulation on tic suppression. 
Please find below the questions addressed and the key points of our conversation. 
Why is non-invasive stimulation of interest in the pathophysiological mechanism of tic generation?
How did the idea of using peripheral stimulation in modulating cortical motor excitability in tics occur?
When exploring the effect of median nerve stimulation on tic suppression in your study, what was your methodology (in terms of number of participants, inclusion criteria e.g. comorbidities, time and recurrence of stimulation, assessment of efficacy)?
What did it show? Did the MNS lead to a statistically significant reduction of tics?  
Is MNS supposed to work only during stimulation?
You showed that rhythmic but not arrhythmic trains of MNS lead to entrainment of 12 Hz oscillations and are of interest in tic reduction, is that right? How would you interpret this result?
In your work, tic intensity and tic frequency were studied.
What scale did you use?
Did you distinguish vocal tics and motor tics?
Did the participants have particularly severe forms of TS?
How did you demonstrate that these results are not only the effects of distraction?
What is the effect of MNS of volitional movements and cognitive function?
Who would benefit the most from MNS? / For what use in real life would MNS be useful? Both for children and adults? 
What do people feel when receiving this stimulation? Is it painful, irritating, annoying, strange?
Does MNS have a main effect or PU or tics? Are we able to know at this point
Is there a study planned with a larger sample or another objective? 
Is there another use of MNS in movement disorders?
When do you think it will be available on the market? At what price?
Stephen Jackson is Professor of Cognitive Neuroscience at the University of Nottingham and Director of the University’s Centre for Neuromodulation, Neurotechnology, and Neurotherapeutics. He is a co-founder of Neurotherapeutics Ltd, a university medical device spin-out established in 2021 to develop a wearable for of non-invasive brain stimulation (the Neupulse device) for the treatment of tic disorders. His current research focuses on developing non-invasive brain stimulation treatments for a range of brain disorders and mental health conditions.
Dr Barbara Morera is a neuroscientist who has been working with Prof. Stephen Jackson on the development of a non-invasive treatment for Tourette Syndrome and Chronic Tic Disorder for the last 8 years. Co-founder of the company Neurotherapeutics, a spin out company from the University of Nottingham, founded with the aim to make this treatment available for those who would like to control their tics.