Assessment of Glymphatic System Function in Children With Tourette Syndrome Using Diffusion Tensor Image Analysis Along the Perivascular Space

Abstract

Background

In this study, we aimed to evaluate glymphatic system function in children with Tourette syndrome (TS) using diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) and explored its potential role in TS pathophysiology.

Methods

Seventy-six children with TS and 82 age- and sex-matched typically developing (TD) control participants underwent DTI scans. Glymphatic function was quantified using the ALPS index, derived from atlas-based regions of interest in the superior corona radiata and superior longitudinal fasciculus. We examined associations between the left ALPS (ALPS_L) index and clinical measures, including tic severity (Yale Global Tic Severity Scale [YGTSS]) and quality of life (Gilles de la Tourette Syndrome–Quality of Life Scale [GTS-QOL]). Mediation analysis assessed whether tic severity mediated the relationship between ALPS_L index and GTS-QOL subscales.

Results

The ALPS_L index was significantly reduced in the TS group compared with the TD group (p < .05). The ALPS_L index showed significant negative correlations with YGTSS motor tic (r = −0.850, p < .001), total tic (r = −0.702, p < .001), and global tic (r = −0.629, p < .001) severity. It was also negatively correlated with the physical/activities of daily living (ADL) (r = −0.265, p = .020) and obsessive-compulsive (r = −0.380, p < .001) subscales of the GTS-QOL. Motor tic severity partially mediated the relationship between the ALPS_L index and physical/ADL scores (β = −0.037; 95% CI, −0.060 to −0.015).

Conclusions

Children with TS exhibit altered glymphatic function, associated with tic severity and impaired QOL. These findings suggest that glymphatic dysfunction may underlie TS-related neurobiological abnormalities.