Coprolalia na síndrome de Tourette

A coprolalia, ou seja, o tique vocal de falar palavrões, foi considerado por muito tempo o sinal patognomônico da síndrome de Tourette após a publicação dos 9 casos feita por Gilles de La Tourette a pedido de Charcot em 1889. Posteriormente, ao verificar-se que a coprolalia não era tão frequente assim, deixou de fazer parte necessária para o diagnóstico.
Acaba de sair um novo estudo que tenta elucidar quais as características que acompanham a presença de coprolalia na ST. Os autores encontraram que  um quarto apresentava algum coprofenômeno. A média de idade de início foi 12 anos, variando de 4 a 33 anos de idade. Os casos que apresentavam esses sintomas eram os que mais frequentemente tinham comorbidades e tinham os casos mais graves, indicando que talvez a presença de coprolalia possa refletir uma maior gravidade e maior acometimento de regiões cerebrais.  

Neurol Neurochir Pol. 2014;48(1):1-7. doi: 10.1016/j.pjnns.2013.03.001. Epub 2014 Jan 23.

Coprolalia and copropraxia in patients with Gilles de la Tourette syndrome.

Kobierska M1, Sitek M1, Gocyła K2, Janik P3.

Abstract

BACKGROUND AND PURPOSE:

Involuntary expression of socially unacceptable words (coprolalia) or gestures (copropraxia) is the best-known symptom of Gilles de Tourette syndrome (GTS) that contributes to the social impairment. The aim of the study was to assess the prevalence, age at onset and co-occurring symptoms of coprophenomena.

MATERIALS AND METHODS:

One hundred and sixty-eight consecutive subjects with GTS including 94 adults and 74 children and aged between 4 and 54 years (mean: 18.0±8.3) were studied. Demographic and clinical data were obtained from medical history and neurological examination.

RESULTS:

Coprolalia or copropraxia appeared in 44 patients. Both coprophenomena were present in 9 patients. Coprolalia occurred in 25.0% (n=42) and copropraxia in 6.5% (n=11) of patients. Mean age at onset was 12.2±5.7 years (range: 4-33) for coprolalia and 12.4±4.9 years (range: 7-24) for copropraxia. Coprolalia started 4.4±3.7 years (range: 0-16) after the onset of disease; copropraxia started 6.1±4.0 years (range: 1-12) after the onset of the disease. Coprolalia began in adulthood in six patients only, and copropraxia in one person. In six patients, coprolalia appeared in the first year of the disease. Copropraxia was never seen in the first year of the disease. Coprophenomena were more frequent in patients with comorbid mental disorders, behavioral problems and severe tics. Three quarters of patients reported significant influence of coprophenomena on daily living.

CONCLUSIONS:

Coprophenomena affect one quarter of GTS patients, appear in the time when tics are most severe, and are positively associated with comorbidity and more severe form of disease. Coprophenomena may reflect more widespread dysfunction of brain in GTS.

Copyright © 2014 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.