Rage attacks and Tourette Syndrome

Posted on 4 May 2020

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A short summary of a recent research paper

Structural and functional abnormalities within sensori-motor and limbic networks underpin intermittent explosive symptoms in Tourette disorder

Cyril Atkinson-Clement, Fuaad Sofia, Emilio Fernandez-Egea, Astrid de Liege, Benoit Beranger, Yanica Klein, Emmanuelle Deniau, Emmanuel Roze, Andreas Hartmann, Yulia Worbe

Sudden episodes of verbal or physical aggression, known under the names of intermittent explosive outbursts (IEO) or ‘rage attacks’ are frequently present in patients with Tourette disorder (TD) and are considered among the most disabling symptoms by patients and families.

In our study, recently published in the Journal of Psychiatric Research, we were interested to identify clinical factors that associated with these episodes as well as study the brain structure and function that related to presence of IEO in some of patients with TD.

We asked a large group of adult patients with TD to fill some questionnaires about their symptoms, presence and frequency of IEO and also to perform a brain scan. We found that these episodes were frequently present in our group of patients, as 47% of them reported IEO. Also, presence of IEO was associated in the majority of patients with Attentional Deficit Hyperactivity Disorder (ADHD) and with a higher impulsivity in general.

Brain scans on these patients suggested that IEO could be related to the abnormal structure and aberrant activity of the brain regions that play role in emotional regulation and impulse control, which could trigger aggressive behaviors in some patients.

These findings are important because:

-        They highlight the frequent association of the IEO with impulsivity and ADHD, suggesting that pharmacological and behavioral management of these frequent co-morbidities of TD could be very important to diminish these manifestations.

-        Identification of the brain areas that involved in the genesis of these symptoms opens new perspectives on treatment of these manifestations using non-invasive methods of modulation of brain activity, such as transcranial magnetic stimulation and neurofeedback.

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