Neurobiology of the Premonitory Urge in Tourette's Syndrome: Pathophysiology and Treatment Implications

Overview

Journal J Neuropsychiatry Clin Neurosci

Specialties Neurology
Psychiatry

Date 2017 Jan 26

PMID 28121259

Citations 46

Authors

Andrea E Cavanna

Kevin J Black

Mark Hallett

Valerie Voon

Affiliations

Soon will be listed here.

Abstract

Motor and vocal tics are relatively common motor manifestations identified as the core features of Tourette's syndrome (TS). Although traditional descriptions have focused on objective phenomenological observations, such as anatomical location, number and frequency of tics, patients' first-person accounts have consistently reported characteristic subjective correlates. These sensory phenomena are often described as a feeling of mounting inner tension or urge to move ("premonitory urge"), which is transiently relieved by tic expression. This article reviews the existing literature on the clinical and neurobiological aspects of the premonitory urge in patients with TS, with focus on its pathophysiology and possible treatment implications.

Citing Articles

Functional connectivity of the precuneus and posterior cingulate cortex moderates the relationship between tic symptoms and premonitory urge in tourette syndrome.

Wang X, Zhang W, Men W, Hong X, Cui Y, Lei T Eur Child Adolesc Psychiatry. 2025; .

PMID: 40063278 DOI: 10.1007/s00787-025-02685-x.

Premonitory urge in tic disorders - a scoping review.

Wohlgemuth J, Watson K, Gill K, Isaacs D Front Psychiatry. 2025; 16:1504442.

PMID: 39950174 PMC: 11821575. DOI: 10.3389/fpsyt.2025.1504442.

A critical role of action-related functional networks in Gilles de la Tourette syndrome.

Baldermann J, Petry-Schmelzer J, Schuller T, Mahfoud L, Brandt G, Dembek T Nat Commun. 2024; 15(1):10687.

PMID: 39681552 PMC: 11649905. DOI: 10.1038/s41467-024-55242-6.

Identifying subgroups of urge suppression in Obsessive-Compulsive Disorder using machine learning.

Eng G, De Nadai A, Collins K, Recchia N, Tobe R, Bragdon L J Psychiatr Res. 2024; 177:129-139.

PMID: 39004004 PMC: 11409861. DOI: 10.1016/j.jpsychires.2024.06.052.

When the interoceptive and conceptual clash: The case of oppositional phenomenal self-modelling in Tourette syndrome.

Parvizi-Wayne D, Severs L Cogn Affect Behav Neurosci. 2024; 24(4):660-680.

PMID: 38777988 PMC: 11233343. DOI: 10.3758/s13415-024-01189-6.

References

Kane M . Premonitory urges as "attentional tics" in Tourette's syndrome. J Am Acad Child Adolesc Psychiatry. 1994; 33(6):805-8. DOI: 10.1097/00004583-199407000-00005. View

Bliss J . Sensory experiences of Gilles de la Tourette syndrome. Arch Gen Psychiatry. 1980; 37(12):1343-7. DOI: 10.1001/archpsyc.1980.01780250029002. View

Bohlhalter S, Goldfine A, MATTESON S, Garraux G, Hanakawa T, Kansaku K . Neural correlates of tic generation in Tourette syndrome: an event-related functional MRI study. Brain. 2006; 129(Pt 8):2029-37. DOI: 10.1093/brain/awl050. View

Cavanna A, Seri S . Tourette's syndrome. BMJ. 2013; 347:f4964. DOI: 10.1136/bmj.f4964. View

Cavanna A, Critchley H, Orth M, Stern J, Young M, Robertson M . Dissecting the Gilles de la Tourette spectrum: a factor analytic study on 639 patients. J Neurol Neurosurg Psychiatry. 2011; 82(12):1320-3. DOI: 10.1136/jnnp.2010.225029. View

Frank M, Cavanna A . Behavioural treatments for Tourette syndrome: an evidence-based review. Behav Neurol. 2012; 27(1):105-17. PMC: 5215725. DOI: 10.3233/BEN-120309. View

Verdellen C, Hoogduin C, Kato B, Keijsers G, Cath D, Hoijtink H . Habituation of premonitory sensations during exposure and response prevention treatment in Tourette's syndrome. Behav Modif. 2008; 32(2):215-27. DOI: 10.1177/0145445507309020. View

Jankovic J, Jimenez-Shahed J, Brown L . A randomised, double-blind, placebo-controlled study of topiramate in the treatment of Tourette syndrome. J Neurol Neurosurg Psychiatry. 2009; 81(1):70-3. DOI: 10.1136/jnnp.2009.185348. View

Gulisano M, Cali P, Palermo F, Robertson M, Rizzo R . Premonitory Urges in Patients with Gilles de la Tourette Syndrome: An Italian Translation and a 7-Year Follow-up. J Child Adolesc Psychopharmacol. 2015; 25(10):810-6. DOI: 10.1089/cap.2014.0154. View

10.

Banaschewski T, Woerner W, Rothenberger A . Premonitory sensory phenomena and suppressibility of tics in Tourette syndrome: developmental aspects in children and adolescents. Dev Med Child Neurol. 2003; 45(10):700-3. DOI: 10.1017/s0012162203001294. View

11.

Houghton D, Capriotti M, Conelea C, Woods D . Sensory Phenomena in Tourette Syndrome: Their Role in Symptom Formation and Treatment. Curr Dev Disord Rep. 2015; 1(4):245-251. PMC: 4381438. DOI: 10.1007/s40474-014-0026-2. View

12.

Specht M, Woods D, Nicotra C, Kelly L, Ricketts E, Conelea C . Effects of tic suppression: ability to suppress, rebound, negative reinforcement, and habituation to the premonitory urge. Behav Res Ther. 2012; 51(1):24-30. DOI: 10.1016/j.brat.2012.09.009. View

13.

Neuner I, Werner C, Arrubla J, Stocker T, Ehlen C, Wegener H . Imaging the where and when of tic generation and resting state networks in adult Tourette patients. Front Hum Neurosci. 2014; 8:362. PMC: 4035756. DOI: 10.3389/fnhum.2014.00362. View

14.

Robertson M . Mood disorders and Gilles de la Tourette's syndrome: An update on prevalence, etiology, comorbidity, clinical associations, and implications. J Psychosom Res. 2006; 61(3):349-58. DOI: 10.1016/j.jpsychores.2006.07.019. View

15.

Cohen A, Leckman J . Sensory phenomena associated with Gilles de la Tourette's syndrome. J Clin Psychiatry. 1992; 53(9):319-23. View

16.

Draper A, Jackson G, Morgan P, Jackson S . Premonitory urges are associated with decreased grey matter thickness within the insula and sensorimotor cortex in young people with Tourette syndrome. J Neuropsychol. 2015; 10(1):143-53. PMC: 4982075. DOI: 10.1111/jnp.12089. View

17.

Dutta N, Cavanna A . The effectiveness of habit reversal therapy in the treatment of Tourette syndrome and other chronic tic disorders: a systematic review. Funct Neurol. 2013; 28(1):7-12. PMC: 3812724. View

18.

Yael D, Vinner E, Bar-Gad I . Pathophysiology of tic disorders. Mov Disord. 2015; 30(9):1171-8. DOI: 10.1002/mds.26304. View

19.

Greene D, Koller J, Robichaux-Viehoever A, Bihun E, Schlaggar B, Black K . Reward enhances tic suppression in children within months of tic disorder onset. Dev Cogn Neurosci. 2014; 11:65-74. PMC: 4323948. DOI: 10.1016/j.dcn.2014.08.005. View

20.

Moretto G, Schwingenschuh P, Katschnig P, Bhatia K, Haggard P . Delayed experience of volition in Gilles de la Tourette syndrome. J Neurol Neurosurg Psychiatry. 2011; 82(12):1324-7. DOI: 10.1136/jnnp.2010.221143. View