Neurobiology of the Premonitory Urge in Tourette’s Syndrome: Pathophysiology and Treatment Implications
Open accessAbstract
Motor and vocal tics are relatively common motor manifestations identified as the core features of Tourette's syndrome (TS). Although traditional descriptions have focused on objective phenomenological observations, such as anatomical location, number and frequency of tics, patients' first-person accounts have consistently reported characteristic subjective correlates. These sensory phenomena are often described as a feeling of mounting inner tension or urge to move ("premonitory urge"), which is transiently relieved by tic expression. This article reviews the existing literature on the clinical and neurobiological aspects of the premonitory urge in patients with TS, with focus on its pathophysiology and possible treatment implications.
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Sensory phenomena are highly distressing, associated with increased obsessive-compulsive and tic severity and reduced quality of life, and are infrequently considered as outcomes in treatment trials.
“Sensory phenomena, although highly distressing [95], associated with increased obsessive-compulsive and tic severity [73, 75, 95] and reduced quality of life [95], are infrequently considered as outcomes in treatment trials [96].”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [96]
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Cavanna, A. E., Stecco, A., Rickards, H. E., Servo, S., Terazzi, E., Peterson, B. S., Robertson, M. M., Carriero, A., & Monaco, F. L. (2010) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2009.173666 · Cited by 48 · see citing works
Self-citationIncreased sensory feedback in Tourette syndrome
Biermann‐Ruben, K., Miller, A., Franzkowiak, S., Finis, J., Pollok, B., Wach, C., Südmeyer, M., Jonas, M., Thomalla, G., Müller‐Vahl, K., et al. (2012) · NeuroImage · doi:10.1016/j.neuroimage.2012.06.059 · Cited by 47 · see citing works
Behavioural treatments for Tourette syndrome: an evidence-based review.
Frank, M., & Cavanna, A. E. (2013) · PubMed · doi:10.3233/ben-120309 · Cited by 42 · see citing works
Self-citationChee, K. Y., & Sachdev, P. S. (1997) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.62.2.188 · Cited by 41 · see citing works
Botulinum toxin type A in simple motor tics: Short-term and long-term treatment-effects
Rath, J. J. G., Tavy, D. L. J., Wertenbroek, A. A. A. C. M., van Woerkom, T. C. A. M., & de Bruijn, S. F. T. M. (2010) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2009.11.011 · Cited by 41 · see citing works
Gilles de la Tourette: The man behind the syndrome
Rickards, H. E., & Cavanna, A. E. (2009) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2009.07.019 · Cited by 40 · see citing works
Self-citationSimpson, H. A., Jung, L., & Murphy, T. K. (2011) · Current Psychiatry Reports · doi:10.1007/s11920-011-0223-1 · Cited by 39 · see citing works
Depression in Tourette syndrome: A controlled and comparison study
Piedad, J. C. P., & Cavanna, A. E. (2016) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2016.03.030 · Cited by 39 · see citing works
Self-citationGulisano, M., Calì, P. V., Palermo, F., Robertson, M. M., & Rizzo, R. (2015) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2014.0154 · Cited by 38 · see citing works
Convergent Validity of the PUTS
Brandt, V. C., Beck, C., Sajin, V., Anders, S., & Münchau, A. M. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00051 · Cited by 37 · see citing works
Tourette Syndrome and Consciousness of Action
Cavanna, A. E., & Nani, A. (2013) · Europe PMC (PubMed Central) · doi:10.7916/d89z9g14 · Cited by 36 · see citing works
Self-citationMula, M., Cavanna, A. E., Critchley, H., Robertson, M. M., & Monaco, F. (2008) · Journal of Neuropsychiatry · doi:10.1176/jnp.2008.20.2.223 · Cited by 34 · see citing works
Self-citationTourette-Syndrom und andere Tic-Erkrankungen im Kindes- und Erwachsenenalter
Müller-Vahl, K. (2015) · Klinische Neurophysiologie · doi:10.1055/s-0034-1398541 · Cited by 34 · see citing works
Cassette EEG Sleep Recordings in Gilles de la Tourette Syndrome
Drake, M. E., Hietter, S. A., Bogner, J. E., et al. (1992) · Clinical Electroencephalography · doi:10.1177/155005949202300309 · Cited by 33 · see citing works
Insight and hindsight into Tourette syndrome.
Hollenbeck, P. J. (2001) · PubMed · Cited by 31 · see citing works
Validation of the University of São Paulo’s Sensory Phenomena Scale — English version
Sampaio, A. S., McCarthy, K., Mancuso, E., Stewart, S. E., & GELLER, D. A. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.02.008 · Cited by 29 · see citing works
The Most Cited Works in Tourette Syndrome
Mariam, N., & Cavanna, A. E. (2012) · Journal of Child Neurology · doi:10.1177/0883073811432887 · Cited by 25 · see citing works
Self-citationMadhusudan, N., & Cavanna, A. E. (2013) · Basal Ganglia · doi:10.1016/j.baga.2013.03.001 · Cited by 24 · see citing works
Self-citationTourette syndrome research highlights 2015
Richards, C. A., & BLACK, K. J. (2016) · F1000Research · doi:10.12688/f1000research.8769.1 · Cited by 24 · see citing works
Self-citationBereitschaftspotential in tic disorders: a preliminary observation.
Duggal, H. S., & Nizamie, S. H. (2002) · PubMed · Cited by 22 · see citing works
Research Trends in the Neuropsychiatry Literature Since the New Millennium.
Srirathan, H., & Cavanna, A. (2015) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/appi.neuropsych.15010024 · Cited by 19 · see citing works
Self-citationImproved criteria for the diagnosis of tic disorders in DSM-5
Cavanna, A. E. (2014) · Future Neurology · doi:10.2217/fnl.14.17 · Cited by 17 · see citing works
Self-citation
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Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder
Shephard, E., Stern, E. R., van den Heuvel, O. A., Costa, D. L. C., Batistuzzo, M. C., Godoy, P. B. G., Lopes, A. C., Brunoni, A. R., Hoexter, M. Q., Shavitt, R. G., et al. (2021) · Molecular Psychiatry · doi:10.1038/s41380-020-01007-8 · Cited by 250 · see citing works
Dimensions of interoception predict premonitory urges and tic severity in Tourette syndrome
Rae, C. L., Larsson, D. E. O., Garfinkel, S. N., & Critchley, H. D. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2018.12.036 · Cited by 57 · see citing works
Time Processing, Interoception, and Insula Activation: A Mini-Review on Clinical Disorders
Vicario, C. M., Nitsche, M. A., Salehinejad, M. A., Avanzino, L., & Martino, G. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01893 · Cited by 46 · see citing works
The buildup of an urge in obsessive–compulsive disorder: Behavioral and neuroimaging correlates
Stern, E. R., Brown, C., Ludlow, M., Shahab, R., Collins, K., Lieval, A., Tobe, R. H., Iosifescu, D. V., Burdick, K. E., & Fleysher, L. (2020) · Human Brain Mapping · doi:10.1002/hbm.24898 · Cited by 29 · see citing works
- Authors
- Cavanna, A. E., Black, K. J., Hallett, M., & Voon, V.
- Affiliations
- Aston University (GB)
- Venue
- The Journal of Neuropsychiatry and Clinical Neurosciences
- Published
- 2017-04
- Volume
- 29
- Issue
- 2
- Pages
- 95-104
- ISSN
- 0895-0172 (ISSN-L)
- 1545-7222
- PMC
- PMC5409107
- OpenAlex
- W2582737854
- Cited by
- 193
- References
- 119
- Citations by year
- 2026: 14 · 2025: 39 · 2024: 19 · 2023: 18 · 2022: 15 · 2021: 15 · 2020: 36 · 2019: 14 · 2018: 17 · 2017: 6
- FWCI
- 24.70
- Type
- journal article
- Language
- en
- Open access
- Locations
- Journal of Neuropsychiatry (publishedVersion)
- PubMed (publishedVersion)
- Aston Publications Explorer (Aston University) (acceptedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- Tourette Association of America
- Tourettes Action
- National Institutes of Health
- Medical Research Council (MR/P008747/1)
- National Institute of Neurological Disorders and Stroke (ZIANS003031)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Social Sciences › Psychology › Clinical Psychology › Stuttering Research and Treatment
- Keywords
- Tourette syndrome, premonitory urges, tics, motor tics, vocal tics, pathophysiology, therapeutic implications, inner tension
- MeSH terms
- Tourette Syndrome, Humans, Neurology, Tic Disorders, Databases, Bibliographic, Tics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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