El Malhany N, Gulisano M, Rizzo R, Curatolo P
Section of Child Neuropsychiatry, Department of Neurosciences, Tor Vergata University, Viale Oxford 81, 00133, Rome, Italy,
Eur J Pediatr. 2015 Mar;174(3):279-88. doi: 10.1007/s00431-014-2417-0. Epub 2014 Sep 17.
Attention deficit hyperactivity disorder (ADHD) is the most common comorbid condition in patients with Tourette syndrome (TS). The co-occurrence of ADHD and TS is in most cases associated with a higher social and psychopathological impairment. Comorbidity between Tourette and ADHD appears to have a complex and partially known pathogenesis in which genetic, environmental, and neurobiological factors can be implicated. Genetic studies have revealed an involvement of dopaminergic, catecholaminergic, and GABAergic genes that modulated the activity of neurotransmitters. Furthermore, there are a lot of networks implicated in the development of ADHD and TS, involving cortical and striatal areas and basal ganglia. Although a large number of studies tried to find a common pathogenesis, the complex pathways responsible are not clear. The genes implicated in both disorders are currently unidentified, but it is probable that epigenetic factors associated with neural modifications can represent a substrate for the development of the diseases.
In this paper, recent advances in neurobiology of ADHD and TS are reviewed, providing a basis for understanding the complex common pathogenesis underlying the frequent co-occurrence of the two conditions and the therapeutic choices.
注意缺陷多动障碍（ADHD）是抽动秽语综合征（TS）患者中最常见的共病情况。ADHD与TS的共病在大多数情况下与更高的社会和精神病理损害相关。抽动秽语综合征与ADHD之间的共病似乎具有复杂且部分已知的发病机制，其中可能涉及遗传、环境和神经生物学因素。基因研究表明，多巴胺能、儿茶酚胺能和γ-氨基丁酸能基因参与其中，这些基因调节神经递质的活性。此外，有许多网络与ADHD和TS的发展有关，涉及皮质和纹状体区域以及基底神经节。尽管大量研究试图找到共同的发病机制，但相关的复杂途径尚不清楚。目前尚未确定与这两种疾病相关的基因，但与神经改变相关的表观遗传因素很可能是疾病发展的基础。
本文综述了ADHD和TS神经生物学的最新进展，为理解这两种疾病频繁共病的复杂共同发病机制及治疗选择提供了依据。
