Longitudinal Structural MRI Study of Adulthood Outcome in Tourette Syndrome

描述（由申请人提供）：图雷特综合征（TS）是一种儿童期发病的神经精神障碍。在半数以上的病例中，抽动在青春期会得到改善或缓解。然而，TS最严重的症状通常出现在成年期。在这个职业发展奖项中，我们将对患有TS的儿童进行纵向结构神经成像，直到成年。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。迈克尔·h·布洛赫，医学博士，理学硕士，本次职业发展奖的候选人，在过去的10年里，他一直在耶鲁大学研究和治疗TS及相关疾病，最初是作为一名医学生，然后是精神病学住院医师。他将于2010年6月在耶鲁儿童研究中心的Albert J. Solnit综合培训项目中完成他的儿童和成人精神病学培训。Albert J. Solnit培训计划是一个新颖的结合了临床和研究培训的六年儿童和成人精神病学住院医师计划。基于他的临床专业知识，他在实习第三年后被任命为耶鲁大学强迫症诊所的助理主任。在他的住院医师项目期间，他还完成了耶鲁大学公共卫生学院的慢性疾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审出版物，其中包括美国精神病学杂志，分子精神病学，JAACAP，神经病学和生物精神病学的第一作者出版物。这些文章的大部分是在James F. Leckman医学博士和Bradley S. Peterson医学博士的指导下发表的，他们是本次K奖的建议导师。该候选人计划在他的奖励期结束后成为TS和相关疾病的发育神经影像学的独立研究者。他计划在职业发展奖励期间接受结构神经影像学方面的培训和指导。我们跟踪了一组46名被诊断患有TS的儿童，直到成年。这些孩子在14岁之前都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论文，在这个队列中证明了儿童时期尾状核体积较小与成年后抽动症状增加有关。我们的目标是：(1)检查儿童基底神经节形态、儿童皮质厚度测量和成年抽动严重程度之间的关联；(2)对这些受试者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。

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.