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TSA 4th International Scientific Symposium RECAP

Gerald Erenberg, M.D., Marilyn Benoit, M.D. and James Leckman, M.D.	John Walkup, M.D., Peter Como, M.D., Cathy Budman, M.D. and John Piacentini,Ph.D.	Mary Robertson,M.D. and Barbara Coffey, M.D.
Michael Himle, M.S. and Douglas Woods,Ph.D.. presented  the posterboards "An Evaluation of Tic Suppression and the Tic Rebound Effect in Children with TS."	Attendees at the 4th International Scientfic Symposium on Tourette Syndrome	Peter Hollenbeck Ph.D. presents Matthew State, M.D., Ph.D.  the Young Investigator Award
Lawrence Scahill, Ph.D., (center) with Masaya Segawa, M.D. and Yoshiko Nomura, M.D. of  Segawa Neurological Clinic for Children, Japan	John Walkup, M.D., Rosie Wartecker of TSA Canada and B. Duncan McKinlay, M.D.	Peter Hollenbeck, Ph.D., Sue Levi-Pearl, VP of Scientfic and Medical Affairs, TSA, Joseph Jankovic, M.D. and Lawrence Scahill, M.D.
Gerald Erenberg M.D. with his wife, Shu	Gerald Erenberg, M.D., Kellie Haines and Gerald Golden, M.D., along with puppets Magrau and Kamilla	Kellie Haines and Neal Swerdlow, M.D. Ph.D along with Kamilla

The extremely successful, 4th International Scientific Symposium on Tourette Syndrome was held in Cleveland, OH from June 25-27, 2004. Drs. Gerald Erenberg, John Walkup, and Neal Swerdlow served as co-chairmen of the event. While the three previous symposia were held at ten year intervals; the time frame for this symposium was reduced to five years because of the tremendous advances made in understanding the biological underpinnings of TS as well as in the application of new and refined approaches to clinical care in TS.

The objectives of the meeting were to identify research advances in TS, disseminated these within the scientific and medical communities, and to established new networks of basic and clinical scientists. The full proceedings of the symposium will be published in a special edition of the Advances in Neurology series, published by Lippincott, Williams and Wilkins.  

More than two hundred medical and scientific professionals from fifteen countries attended the event. Participating countries included Israel, Costa Rica, Argentina, Norway, Georgia, Japan, Taiwan and Hungary. The international faculty presented papers on a diverse range of topics including genetics, neurology (neuroimaging, neuropathology, neurophysiology, neuroimmunology) clinical trials (medication and non-medication), epidemiology and descriptive/diagnostic clinical science. 

The program commenced with a session on Clinical Phenomenology, in which Tourette Syndrome was defined and clinical assessment and rating scales of TS and associated co-morbid conditions was reviewed. This led to an in depth session on the current clinical and biological status of the most common co-morbid conditions, namely OCD, ADHD and other Behavioral Disorders. The biological etiology of the disorder was explored in the basic Neuroscience session, and a current hypothesis for the pathophysiology of tics involving basal ganglion function, in conjunction with known features of anatomical organization and dopamine neurotransmission was presented. The Neuroimaging session provided evidence of differences in specific regions of the brain of TS individuals and a possible relationship between brain morphometry and TS associated genes was suggested. In the Immunology session, the controversy concerning streptococcal involvement in TS symptoms continued and significant differences of opinion were expressed. The symposium concluded with sessions describing new treatment regimes for TS and their co-morbid conditions. An entire session was devoted to the application of Behavioral Therapy for controlling or reducing tic severity. A large clinical trial to assess efficacy of this treatment for TS will commence in September 2004.   

In addition to formal sessions, the symposium program included roundtable sessions in which participants could informally discuss TS related topics. Poster sessions, coinciding with refreshment breaks, provided all symposium delegates an opportunity to present their latest TS related research and to discuss their findings with other interested professionals.  These more informal interludes in the program were designed to encourage communication between researchers of different disciplines and to facilitate the establishment of networks between basic and clinical scientists. Information flow and communication across disciplines, is considered vital for the continued efficient and effective study of this complex disorder.   

Dr. Matthew State, Assistant Professor of Child Psychiatry and Genetics of the Yale University School of Medicine and Child Study Center, was awarded the TSA Early Career Research Award, for his work toward identifying the genes involved in TS. Dr State used cytogenetic techniques and concluded that rearrangements of small pieces of genetic material on chromosomes 13 and 18 were associated with TS. It is the first time that such an award has been made.

At the symposium, two awards were presented. Dr. Gerald Erenberg, Director of the Tourette Syndrome Clinic at the Cleveland Clinic Foundation, was honored for the outstanding medical contribution that he has made to all people with Tourette Syndrome. Dr. Erenberg served on the TSA’s Medical Advisory Board (MAB) for more than two decades and was chairman for many years.  Despite his entry into semi-retirement, Dr. Erenberg continues to provide valuable service to the TSA and the TS community.   

Prior to the Symposium, a task group of local and international neurology experts met to discuss the highly controversial use of Deep Brain Stimulation (DBS) for treating TS. The meeting was chaired by Dr. DeLong, from Emory University, who has used the procedure for treating patients with Parkinson’s disease. Input came from Medtronics, the company producing the electrodes; Dr Cath from the Netherlands where three TS patients have been treated; and Dr. Maciunas, who was the first to perform the procedure on a TS patient in this country. Significant time was spent on concerns about serious safety aspects such as infection and equipment failure and the fact that the loci for placing the electrodes, in TS patients, remain unknown. The TSA will continue to keep abreast of developments in this field and plans to partner with federal health institutions to explore the pressing issues that arose.