Longitudinal Structural MRI Study of Adulthood Outcome in Tourette Syndrome

描述(申请人提供)：多发性抽动症(TS)是一种儿童起病的神经精神障碍。在超过一半的病例中，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，跟踪患有TS的儿童直到成年。我们的目标是比较持续性TS病例与缓解期病例和未受影响的对照组的大脑发育。迈克尔·H·布洛赫是这一职业发展奖的候选人，他在过去的10年里一直在耶鲁大学研究和治疗TS及相关疾病，首先是作为医科学生，然后是精神病学住院医生。他将于2010年6月在耶鲁儿童研究中心完成阿尔伯特·J·索尔尼特综合培训计划的儿童和成人精神病学培训。阿尔伯特·J·索尔尼特培训计划是一个新颖的六年制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，他在住院三年后被任命为耶鲁大学强迫症诊所的助理主任。他还在实习期间完成了耶鲁大学公共卫生学院慢性病流行病学的研究生学位。在住院医师培训期间，他已经发表了20多篇关于TS和相关障碍的同行评议出版物，包括第一批发表在《美国精神病学、分子精神病学、JAACAP、神经病学和生物精神病学》杂志上的论文。这些文章中的大部分都是在詹姆斯·F·莱克曼医学博士和布拉德利·S·彼得森医学博士的指导下发表的，他们是这个K奖的推荐导师。候选人计划在他的获奖期结束时成为TS和相关障碍的发育神经成像的独立研究员。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。我们对46名被诊断为TS的儿童进行了跟踪调查，直至成年。这些儿童中的每一个在14岁之前都接受了详细的临床评估、结构神经成像和重点神经心理测试。我们已经发表了几篇关于这方面的手稿，在这个队列中证明了童年尾状核体积较小与年轻成年后抽动症状增加有关。我们的目标是(1)检查儿童基底节形态和儿童皮质厚度测量与成年抽动严重程度的关系，以及(2)对这些受试者重复结构神经成像扫描，以便我们能够比较持续TS患者、缓解性TS患者和未受影响的对照组之间的脑发育。 公共卫生相关性：超过一半的抽动秽语综合征(TS)儿童在青春期得到改善或缓解。然而，最严重的TS病例通常出现在成年人。我们将进行纵向结构神经成像，跟踪Tourette综合征儿童到年轻成人，目的是比较持续TS病例、TS缓解病例和未受影响的对照组的脑发育。

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.