SHORT COMMUNICATION ADHD and Epilepsy in children with Tourette Syndrome: a triple comorbidity? R Rizzo (rerizzo@unict.it) 1 , M Gulisano 1 , PV Calì 1 , P Curatolo 2 1.Section of Child Neuropsychiatry, Department of Pediatrics, Catania University, Catania, Italy 2.Section of Child Neuropsychiatry, Department of Neurosciences, University Tor Vergata, Rome, Italy Correspondence R Rizzo, Department of Paediatrics, Catania Univer- sity, Via Santa Sofia 78, 95123, Catania. Tel: +393402647099 | Fax: +39095495673 | Email: rerizzo@unict.it Received 3 June 2010; revised 2 July 2010; accepted 9 July 2010. DOI:10.1111/j.1651-2227.2010.01951.x Tourette Syndrome (TS) is an inherited neurodevelopmen- tal disorder most commonly diagnosed in childhood or early adolescence, characterized by multiple motor tics and one or more phonic tics, which last for more than a year. Tics may be simple or complex in nature and vary in num- ber, frequency and severity over time. TS is not a unitary condition and can be disaggregated into more homo- geneous symptom components. With a prevalence of about 1%, TS is no longer considered a rare condition. TS has a multifactorial aetiology, in which genetic, immunological and hormonal factors interact to establish vulnerability. TS is associated with several comorbid disorders which are often the major source of impairment for affected children. Comorbidity between TS and ADHD is high even if the genetic relationship between ADHD and TS has not been fully established (1). The comorbidity of TS and epilepsy is rarely reported. In this paper, we report a series of eight young patients with TS who were followed up for at least 7 years, presenting comorbid mild ADHD symptoms and easily controlled seizures. Our series includes eight patients (seven males and one female) with a median age of 14.8 years (range 10–17) with definite diagnosis of TS according to Diagnostic and Statis- tical Manual of Mental Disorders-IV-Text Revised (DSM-IV-TR) criteria, assessed at the Neuropediatric Unit of Catania University, Italy, and followed up for a period of at least 7 years. Full personal and family histories were obtained with particular reference to epilepsy and TS-related disorders. For the definition of epilepsy, we considered the presence of at least two afebrile seizures; for the ADHD definition, we considered excessive inat- tention, hyperactivity and impulsivity either alone or in combination. All the patients underwent a complete physical and neu- rological examination, routine laboratory examinations, awake electroencephalogram (EEG) and cerebral magnetic resonance imaging (MRI). Patients’ assessment was carried out using the National Hospital Interview Schedule for Gilles de la Tourette Syn- drome, the Yale Global Tic Severity Rating Scale (YGTSS), the physician rated Diagnostic Confidence Index. The Con- ners’ Parents Scale, Child Behaviour Checklist and DSM- IV-TR criteria were used to evaluate the severity of ADHD and to define its subtype. Psychiatric comorbidities were also evaluated by the following scales: the Children’s Yale- Brown Obsessive Compulsive Scale, the Wechsler Intelli- gence Scale for Children, the self-report Child Depression Inventory and the Multidimensional Anxiety Scale for Children. Clinical findings of our eight patients are summarized in Table 1. Soft neurological signs such as incoordination and clumsiness were present in three patients. There was a positive family history for either tics or TS in four patients. All the patients had a typical onset of TS, presenting firstly motor tics at the age of 6.4 years (range 6–10 years), followed by vocal tics at the age of 9.8 years (range 8–13 years). One of them presented also obsessive compulsive disorder. Neuropsychological findings showed a normal IQ in six of eight patients. Three patients had mild tics and did not require any medi- cations. TS was pharmacologically treated in five patients who presented high YGTSS’ scores (>20) with severe impairment in their daily life; three patients received pim- ozide and two risperidone, obtaining an improvement of the symptoms and a reduction in YGTSS’ score (p value: 0.005). All of them are still under pharmacological treatment. Acta Pædiatrica ISSN 0803–5253 1894 ª2010 The Author(s)/Acta Pædiatrica ª2010 Foundation Acta Pædiatrica 2010 99, pp. 1894–1896