Longitudinal Structural MRI Study of Adulthood Outcome in Tourette Syndrome

描述（由申请人提供）：Tourette综合征（TS）是一种儿童期发作的神经精神疾病。在超过一半的情况下，抽搐在青春期改善或缓解。然而，TS最严重的症状通常出现在成年期。在这个职业发展奖中，我们将进行纵向结构神经成像，跟踪TS儿童到成年早期。我们的目标是比较持续性TS病例与缓解病例和未受影响的对照组的大脑发育。 Michael H. Bloch，医学博士，医学硕士，作为这个职业发展奖的候选人，在耶鲁大学作为一个医学生，然后在精神病学住院医生，花了10年的时间研究和治疗TS和相关疾病。他将在阿尔伯特J完成他的儿童和成人精神病学培训，2010年6月在耶鲁儿童研究中心参加Solnit综合培训项目。Albert J. Solnit培训计划是一个新颖的六年儿童和成人精神病学住院医师计划，结合了临床和研究培训。基于他的临床专业知识，他被任命为助理主任耶鲁大学强迫症诊所后，他的第三年的住院医生。他还在耶鲁大学公共卫生学院完成了慢性病流行病学研究生学位。在住院医师培训期间，他已经发表了20多篇关于TS和相关疾病的同行评议出版物，包括在美国精神病学杂志，分子精神病学，JAACAP，神经病学和生物精神病学上的第一作者出版物。这些文章的大部分是在詹姆斯·F。Leckman医学博士和布拉德利S.彼得森，医学博士，他们是K奖的导师候选人计划成为一个独立的研究员在发育神经成像的TS和相关疾病在他的奖励期完成。他计划在职业发展奖期间接受结构神经成像方面的培训和指导。 我们跟踪了一组46名被诊断患有TS的儿童，直到成年。这些儿童中的每一个都在14岁之前接受了详细的临床评估、结构神经成像和集中的神经心理学测试。我们已经发表了几篇关于这一点的手稿，证明在这个队列中，较小的儿童尾状核体积与成年早期抽动症状的增加有关。我们的目标是（1）检查儿童基底神经节形态和儿童皮质厚度测量值与成年抽动严重程度之间的关系，（2）对这些受试者进行重复结构神经成像扫描，以便我们可以比较持续性TS病例，缓解TS病例和未受影响的对照组之间的大脑发育。 公共卫生相关性：超过一半的抽动秽语综合征（TS）儿童在青春期改善或缓解。然而，最严重的TS病例通常出现在成年期。我们将进行纵向结构神经成像，跟踪Tourette综合征儿童到成年早期，目的是比较持续性TS病例与TS缓解病例和未受影响的对照组之间的大脑发育。

DESCRIPTION (provided by applicant): Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder. In over half of cases tics improve or remit during adolescence. However, the most severe symptoms of TS are usually seen in adulthood. In this career development award we will conduct a longitudinal structural neuroimaging that follows children with TS to young adulthood. Our goal is to compare the brain development in persistent TS cases to remitted cases and unaffected controls. Michael H. Bloch, M.D., M.S., the candidate for this career development award, has spent the last 10 years researching and treating TS and related disorders at Yale first as a medical student and then in psychiatry residency. He will complete his child and adult psychiatry training in the Albert J., Solnit Integrated Training Program at the Yale Child Study Center in June 2010. The Albert J. Solnit Training Program is a novel combined six-year child and adult psychiatry residency program that combines clinical and research training. Based on his clinical expertise, he was appointed as Assistant Director of the Yale OCD Clinic after his third year of residency. He has also completed a graduate degree in chronic disease epidemiology from the Yale School of Public Health during his residency program. He has already published over 20 peer-reviewed publications in TS and related disorder during his residency training including first-authored publications in the American Journal of Psychiatry, Molecular Psychiatry, JAACAP, Neurology and Biological Psychiatry. The majority of these articles were published under the mentorship of James F. Leckman M.D. and Bradley S. Peterson, M.D., who are the proposed mentors for this K award. The candidate plans to become an independent investigator in developmental neuroimaging of TS and related disorders at the completion of his awards period. He plans to get training and mentorship in structural neuroimaging during the career development award period. We have followed a cohort of 46 children diagnosed with TS to young adulthood. Each of these children received a detailed clinical assessment, structural neuroimaging and focused neuropsychological testing prior to age 14 years. We have published several manuscripts on this demonstrated in this cohort that smaller childhood caudate volumes were associated with increased tic symptoms in young adulthood. Our goals are to (1) examine the association of childhood basal ganglia morphology and childhood cortical thickness measures and adulthood tic severity and (2) repeat structural neuroimaging scans on these subjects so that we can compare brain development between persistent TS cases, remitted TS cases and unaffected controls. PUBLIC HEALTH RELEVANCE: Over half of children with Tourette syndrome (TS) improve or remit during adolescence. However, the most severe cases of TS are usually seen in adulthood. We will conduct a longitudinal structural neuroimaging that follows children with Tourette syndrome to young adulthood with the goal of comparing brain development between persistent TS cases to TS remitted cases and unaffected controls.