Kurvits Lille, Martino Davide, Ganos Christos
Department of Neurology, Charité University Hospital, Berlin, Germany.
Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
Front Psychiatry. 2020 Feb 25;11:21. doi: 10.3389/fpsyt.2020.00021. eCollection 2020.
The capacity to efficiently control motor output, by either refraining from prepotent actions or disengaging from ongoing motor behaviors, is necessary for our ability to thrive in a stimulus-rich and socially complex environment. Failure to engage in successful inhibitory motor control could lead to aberrant behaviors typified by an excess of motor performance. In tic disorders and Tourette syndrome (TS) - the most common tic disorder encountered in clinics - surplus motor output is rarely the only relevant clinical sign. A range of abnormal behaviors is often encountered which are historically viewed as "disinhibition phenomena". Here, we present the different clinical features of TS from distinct categorical domains (motor, sensory, complex behavioral) that evoke the concept of disinhibition and discuss their associations. We also present evidence for their consideration as phenomena of inhibitory dysfunction and provide an overview of studies on TS pathophysiology which support this view. We then critically dissect the concept of disinhibition in TS and illuminate other salient aspects, which should be considered in a unitary pathophysiological approach. We briefly touch upon the dangers of oversimplification and emphasize the necessity of conceptual diversity in the scientific exploration of TS, from disinhibition and beyond.
在丰富多变且社交复杂的环境中茁壮成长,我们需要具备有效控制运动输出的能力,即抑制优势动作或停止正在进行的运动行为。若无法成功进行抑制性运动控制,可能会导致以运动表现过度为特征的异常行为。在抽动障碍和图雷特综合征(TS)(临床最常见的抽动障碍)中,运动输出过剩很少是唯一相关的临床症状。通常还会出现一系列异常行为,这些行为在历史上被视为“去抑制现象”。在此,我们呈现TS在不同分类领域(运动、感觉、复杂行为)的不同临床特征,这些特征引发了去抑制的概念,并讨论它们之间的关联。我们还提供证据支持将它们视为抑制功能障碍现象,并概述支持这一观点的TS病理生理学研究。然后,我们批判性地剖析TS中的去抑制概念,并阐明其他突出方面,这些方面应在统一的病理生理学方法中加以考虑。我们简要提及过度简化的危害,并强调在TS的科学探索中,从去抑制及其他方面进行概念多样化的必要性。