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VUMC designated a Tourette syndrome center of excellence

Feb. 23, 2022, 2:00 PM

Vanderbilt Center for Tourette Syndrome and Other Tic Disorders team members include, from left, Angela White, RN, Mariana Ciobanu, MD, KellyAnn Primm, OTR/L, David Isaacs, MD, MPH, Heather Riordan, MD, Michelle Eckland, Jessica Stroh, RN, and Kayla Johnson, PharmD.
Vanderbilt Center for Tourette Syndrome and Other Tic Disorders team members include, from left, Angela White, RN, Mariana Ciobanu, MD, KellyAnn Primm, OTR/L, David Isaacs, MD, MPH, Heather Riordan, MD, Michelle Eckland, Jessica Stroh, RN, and Kayla Johnson, PharmD. (photo by Donn Jones)

by Paul Govern

The Vanderbilt Center for Tourette Syndrome and Other Tic Disorders has been designated a Tourette Association of America (TAA) Center of Excellence.

TAA currently recognizes 19 centers of excellence. The program at Vanderbilt University Medical Center is the first in Tennessee to receive the designation.

“This designation from TAA is in recognition of the coordinated multidisciplinary care we provide to children and adults with these disorders, complemented by our program of both basic science and clinical research and our center’s growing program of community and professional outreach,” said David Isaacs, MD, MPH, assistant professor of Neurology and Pediatrics, who works with both adult and pediatric patients with tic disorders.

Child neurology specialist Heather Riordan, MD, assistant professor of Pediatrics, adds, “We’re very pleased to receive this important recognition from TAA and look forward to continuing to grow our program to serve children, adults and referring clinicians from across the region.”

To provide a medical home for both children and adults with tic disorders, Riordan and Isaacs established VUMC’s Tourette Syndrome Clinic in 2019, with services for children provided both on the VUMC campus and in Franklin, Tennessee, and services for adults provided on campus at The Vanderbilt Clinic.

Tics tend to wax and wane and may persist for years or resolve within weeks or months. Arising in childhood or adolescence, Tourette syndrome is defined as motor and vocal tics persisting for a year or more.

“Tourette syndrome, chronic motor tic disorder and chronic vocal tic disorder are on the same clinical continuum,” Isaacs said. “We treat tics across these conditions the same, and we think that the underlying biology is the same.”

According to the TAA, 1% of children have Tourette syndrome or another chronic tic disorder.

Common co-occurring conditions with Tourette’s include obsessive-compulsive disorder and attention deficit hyperactivity disorder. Isaacs said bothersome tics persist into adulthood in approximately 30% of chronic tic disorder cases.

Riordan notes that education tends to play a large role when medical evaluation for a tic is first sought.

“Parents coming in for the first time are often unsure of what they are dealing with and what it might mean for their child,” she said. “Providing education and screening for co-occurring conditions offers reassurance and an opportunity to help the child, even if the tics themselves don’t require treatment.”

Filling out the clinic’s core multidisciplinary care team are occupational therapists KellyAnn Primm, OTR/L, and Lisa Gelfand, OTR/L; clinical neuropsychologist Andrew Molnar, PhD; neurosurgeon Sarah Bick, MD; specialty pharmacists Sabrina Livezey, PharmD, and Kayla Johnson, PharmD; and research analyst Michelle Eckland. Rounding out the center are psychiatrists, patient care coordinators and a research geneticist.

The clinic’s two occupational therapists have undertaken specialized certification to provide an established first-line, non-drug treatment called comprehensive behavioral intervention for tics, or CBIT. Tics are somewhat suppressible, and CBIT works in part by training patients to recognize premonitory urges and develop responses that compete with their tics.

“We’re delighted by this recognition for our center,” said therapist Primm. “As a therapist who works closely with our physicians to serve these patients, I appreciate the emphasis TAA places on a coordinated, multidisciplinary approach to care.”

Beyond CBIT, the occupational therapy team offers services for patients with tic disorders addressing impaired body awareness, poor focus, executive dysfunction, altered sensory processing and core or postural weakness.

Isaacs said, “If bothersome tics persist after CBIT, or if patients are poor candidates for CBIT due to young age or inability to effectively engage in the therapy, we’ll initiate medication.”

A few drugs come with on-label indications for tic disorders, but Isaacs said clinicians generally start with drugs that currently apply on an off-label basis, having become standard choices based on their efficacy and comparative lack of side effects.

For severe cases refractory to CBIT and medications, deep brain stimulation is a treatment option offered to adult patients at VUMC.

Riordan and Isaacs are involved in conducting clinical trials for new drugs to treat tic disorders, and Isaacs studies non-motor manifestations of movement disorders and biomarkers of Tourette’s. The disorder also features among the interests of research geneticist Lea Davis, PhD, associate professor of Medicine.

Reaching out to other specialists in the region, Isaacs and Riordan last year established a multidisciplinary Tourette syndrome working group, meeting online on a monthly basis to explore clinical and research topics.

Earlier this year, as part of the center’s coordination with a Middle Tennessee support group for tic disorders, clinicians at the center joined other specialists from across the state to provide a series of webinars for patients and their families.

For more information or to schedule an appointment, visit the clinic’s webpage.

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