Volumetric MRI changes in the basal ganglia of 37 children with Tourette’s syndrome (TS), with and without ADHD, compared to 18 controls are reported from Johns Hopkins University School of Medicine, Baltimore, MD. Major findings were 1) right-handed control children had asymmetry of the putamen with left-sided predominence; 2) 13 TS patients had a reversal of putamen asymmetry compared to controls; and 3) ADHD in TS patients is associated with reduction in volume of the left globus pallidus and lenticular asymmetry. [1]

COMMENT. The basal ganglia appear to be involved in the pathogenesis of TS. ADHD in TS patients is associated with additional anatomic changes in the globus pallidus and lenticular region that differ from those primarily associated with tics.

Reduced basal ganglia volumes on MRI of TS patients are also reported from the Yale Child Study Center, New Haven, CT [2]. The left lenticular nuclei in TS patients were significantly reduced in volume, and the left globus pallidus and putamen mean volumes showed a 10% reduction. TS basal ganglia lacked the volumetric asymmetry (left greater than right) seen in normal controls.

Five of 7 patients with concurrent Tourette’s and Asperger’s syndromes showed developmental cortical anomalies on MRI, whereas normal MRI scans were found in 8 of 9 TS patients without AS, in a report from the Neurology Service, Hospital Clinic and Provincial, Barcelona, Spain [3]. The group with concurrent TS and AS had more clinical signs of CNS dysfunction and were more impaired on complex problem-solving and spatial tests than did TS patients without AS.