title: José Aldo

text: Only a month later, in November 2005, Aldo went up a weight class to lightweight and fought respected Luta Livre black belt Luciano Azevedo at Jungle Fight 5. Aldo won the first round, winning most of the exchanges with solid combinations and leg kicks and stuffing Azevedo's numerous takedown attempts (he was nearly taken down early in the round, but appeared to purposefully fall out of the ropes to force a restart from the referee), as well as landing a solid knee as Azevedo went for a takedown. Aldo shrugged off Azevedo's first few takedown attempts in the second but was eventually taken down against the ropes by a double leg. Aldo raised his hips up looking for triangles and other submissions, but Azevedo easily defended.


title: José Aldo

text: Azevedo soon passed to half-guard and side control. He then transitioned to full mount. Aldo quickly gave up his back and rolled into the ropes. The referee restarted the fight in the center of the ring, where Azevedo locked his legs around Aldo in a body triangle. Aldo controlled Azevedo's hands for several seconds before falling back into the corner of the ring, where Azevedo was able to secure the fight-ending rear-naked choke 3:37 into round two. The loss was Aldo's first as a professional.


title: José Aldo

text: Aldo rebounded in his next fight, returning to featherweight against the then-undefeated Thiago "Minu" Meller at Gold Fighters Championship I on 20 May 2006, winning a unanimous decision in a very close fight. Round one could have gone either way, with Aldo getting two takedowns (both times getting into half-guard) and cutting Meller's right eyebrow with a left hand. Meller went for two armbars, nearly hyper-extending Aldo's right arm in the first attempt before Aldo was able to escape. Aldo won a lackluster round two, again taking Meller down and landing some hammer fists. A seemingly exhausted Aldo stalled against the ropes much of the third round, holding Meller in the clinch. Both landed some solid strikes in the few exchanges there were in the round.


title: José Aldo

text: In his last bout before joining the WEC, Aldo fought Pancrase veteran Shoji Maruyama in the Pancrase 2007 Neo-Blood Tournament Finals. Aldo won a unanimous decision, dominating Maruyama standing and on the ground. In the first exchange, Aldo landed a front kick to Maruyama's body, sending him to the canvas. He was able to land the cleaner shots in exchanges, where he connected with leg kicks and knees while in the clinch. He took Maruyama down almost at will with trips and body-locks; whereas Maruyama failed in all his attempts to get Aldo to the mat. On the ground, Aldo was able to get side control as well as top and back mount.


title: José Aldo

text: Aldo made his debut for mixed martial arts promoter World Extreme Cagefighting on 1 June 2008, at the Arco Arena in Sacramento, California. In his debut with the organization he defeated renowned fighter Alexandre Franca Nogueira at WEC 34. Aldo won his fight on 7 June 2009, at WEC 41 against Cub Swanson via double flying knee eight seconds into the first round.


title: José Aldo

text: Aldo won the WEC Featherweight Championship against Mike Brown on November 18, 2009 at WEC 44. He won by TKO in the second round. He was able to get Brown in the back mount, where he landed a barrage of punches, ending the fight at 1:20 of the round. José Aldo was the recipient of Fighter of the Year accolades for 2009 from both MMA Live and Sherdog.com.


title: José Aldo

text: Aldo faced former titleholder Urijah Faber on 24 April 2010, at WEC 48. Aldo defeated Faber via unanimous decision (49–45, 49–45, and 50–45). Aldo was able to use effective leg and body kicks (a total of thirty-two) to stifle Faber, sending him to the canvas several times with solid kicks. For the remaining 1:40 of the fourth round, Aldo trapped Faber in the crucifix, peppering him with punches and elbows. Aldo did not engage most of the fifth (although he did land a body shot that nearly crumpled Faber). This was Aldo's first decision win in his WEC career.


title: José Aldo

text: Aldo defended his title against Manny Gamburyan by KO at 1:32 of the second round on 30 September 2010 at WEC 51.


title: José Aldo

text: Aldo and his camp have often mentioned his desire to eventually make the move up in weight to the lightweight division (155-pound limit). Having rolled through all of his opposition in the WEC featherweight class, the UFC offered Aldo a fight against Kenny Florian, who has challenged for the UFC lightweight title. Aldo and his camp declined the fight, instead deciding to remain at featherweight for the time being to defend his WEC belt.


title: José Aldo

text: On 28 October 2010, World Extreme Cagefighting merged with the Ultimate Fighting Championship. As part of the merger, all WEC fighters were transferred to the UFC. Aldo became the inaugural UFC Featherweight Champion, receiving the first ever UFC featherweight title belt on Saturday, 20 November 2010 at UFC 123. His first defense was set to take place at UFC 125 against Josh Grispi. Aldo was forced to withdraw from UFC 125 after suffering a neck injury.


title: José Aldo

text: Aldo made his first title defense against Mark Hominick on 30 April 2011, at UFC 129 by defeating the Canadian by a unanimous decision in a bout that earned "Fight of the Night" honors.


title: José Aldo

text: Aldo had his second title defense against Kenny Florian on 8 October 2011, at UFC 136, where he won by unanimous decision.


title: José Aldo

text: Aldo next faced Chad Mendes on 14 January 2012, at UFC 142, Aldo won via KO in the final second of the first round. His post-fight celebration, where he sprinted out of the cage and into the crowd at the HSBC Arena in Rio, is regarded as one of his most iconic moments as champion.


title: José Aldo

text: After a series of injuries and opponent change-ups, Aldo faced former UFC Lightweight Champion Frankie Edgar at UFC 156. Aldo retained his belt via unanimous decision (49–46, 49–46, and 48–47). The performance earned both participants "Fight of the Night" honors. This performance resulted in Aldo setting the record for most championship bouts, including his original title plus three defences.


title: José Aldo

text: Aldo was expected to face Anthony Pettis on 3 August 2013, at UFC 163. However, in mid-June Pettis pulled out of the bout citing a knee injury and was replaced by Chan Sung Jung. Aldo defeated Jung via fourth-round TKO, finishing Jung with a flurry of strikes after Jung suffered a dislocated shoulder while throwing an overhand right.


title: José Aldo

text: On 1 February 2014, at UFC 169 Aldo defended his title by defeating Ricardo Lamas by unanimous decision (49–46, 49–46, and 49–46).


title: José Aldo

text: Aldo again was in talks to fight Pettis after defending his title against Lamas. At the post-fight press conference, Aldo expressed interest to move up and fight Pettis at 155 lbs. However, those plans were quickly refuted as Pettis was selected to serve as a coach on .


title: José Aldo

text: A rematch with Chad Mendes was expected to take place on 2 August 2014, in the event headliner at UFC 176. However, in early July, Aldo pulled out of the bout with an injury. The rematch with Mendes was subsequently rescheduled and took place for 25 October 2014 at UFC 179. Despite getting dropped in the first round and being rocked in the third, Aldo scored two knockdowns of his own, one in the first and the other in the third and also rocked Mendes throughout the fight, winning four of the five rounds in the eyes of the judges thus taking the fight by unanimous decision (49–46, 49–46, and 49–46). The win also earned him his third "Fight of the Night" bonus award, and was selected Fight of the Year by multiple MMA outlets.


title: José Aldo

text: Aldo was scheduled to face Conor McGregor on 11 July 2015, at UFC 189. On 30 June, Aldo pulled out of the fight, citing a rib injury which makes him unable to fight. Chad Mendes took his place and was defeated by McGregor for an interim title. Aldo faced McGregor in a title unification match on 12 December 2015, at UFC 194. He lost the fight via knockout 13 seconds into the first round, resulting in his first defeat in over ten years and his first ever loss at featherweight, ending a 15 fight win streak in the division.


title: José Aldo

text: Aldo faced Frankie Edgar in a rematch on 9 July 2016, at UFC 200 for the interim UFC Featherweight Championship. Aldo won the fight by unanimous decision (49–46, 49–46, and 48–47). On 26 November 2016, reigning UFC Featherweight Champion Conor McGregor was stripped of the title after winning the UFC Lightweight Championship, having never defended the Featherweight belt since he won it in December 2015. As a result, Aldo was promoted to Featherweight Champion.


title: José Aldo

text: Aldo faced interim featherweight champion Max Holloway in a title unification bout on 3 June 2017, in the main event at UFC 212. After winning the first two rounds on all three judges scorecards, he lost the fight by TKO in the third round. Despite the loss, the fight earned Aldo his fourth "Fight of the Night" bonus award. This was Aldo's 3rd loss in his 29 fight career.


title: José Aldo

text: Aldo was scheduled to face Ricardo Lamas on 16 December 2017, at . However, Aldo was pulled from the bout in favour of a rematch with Holloway two weeks earlier at UFC 218, replacing an injured Frankie Edgar. Similarly to the first fight, Aldo found success in the opening rounds before slowing down and losing the fight via TKO in the third round.


title: José Aldo

text: Aldo faced Jeremy Stephens at UFC on Fox 30 on 28 July 2018. The fight was Aldo's first non-title (three round) fight in over nine years. Aldo won the fight by TKO after a left hook to the body dropped Stephens, and the fight was stopped due to subsequent strikes from Aldo. This win earned him the Performance of the Night award.


title: José Aldo

text: Aldo faced Renato Moicano on 2 February 2019 in the co-main event at UFC Fight Night 144. He won the fight via TKO in the second round. This win earned him the "Performance of the Night" award.


title: José Aldo

text: Aldo faced Alexander Volkanovski at UFC 237 on 11 May 2019, in Rio de Janeiro, Brazil. Aldo lost the fight via unanimous decision.


title: José Aldo

text: On 24 June 2019, it was announced that Aldo had signed a new exclusive eight-fight contract with the UFC prior to his bout with Volkanovski. This marked a major deviation from Aldo's previous firm stance on retiring by the end of 2019, in which he stated "I had already planned to stop when I was 30 years old and begin something else. I'm at a point where I have to make a decision, and nothing is going to change my mind. Martial arts is always going to be a part of my life, but everything has a beginning, a middle, and an end. And I see this coming to an end."


title: José Aldo

text: On 23 October 2019, it was announced that Aldo would be moving down to the Bantamweight division. He faced Marlon Moraes at UFC 245 on 14 December 2019. He lost the largely contested bout via split decision.


title: José Aldo

text: Aldo was expected to face UFC Bantamweight Champion Henry Cejudo on 9 May 2020 at then UFC 250. However, Aldo pulled out on 8 April due to visa issues as the event was expected to be moved to the United States due to the COVID-19 pandemic. Following Cejudo's title defense against Dominick Cruz at UFC 249, Cejudo announced he would be retiring from active mixed martial arts competition and he vacated the UFC bantamweight championship. The UFC then announced that Aldo would be facing Petr Yan at UFC 251 on 12 July 2020, for the vacant bantamweight title. Aldo lost the bout via technical knockout in round five.


title: José Aldo

text: Aldo faced Marlon Vera on 19 December 2020 at UFC Fight Night 183. He won the fight via unanimous decision.


title: José Aldo

text: Aldo faced Rob Font in the main event of UFC on ESPN 31 on 4 December 2021. After nearly finishing Font with punches multiple times, Aldo won the fight via unanimous decision.


title: José Aldo

text: On September 18, 2022, the same day as the birth of his son, it was announced that Aldo had retired from MMA with one fight remaining on his UFC contract. Despite the initial reports, Aldo remains under contract with the UFC but was granted a permission to pursue opportunities in other sports.


title: José Aldo

text: Aldo is known primarily for his Muay Thai style striking and leg kicks, coupled with defensive wrestling. Aldo also holds a black belt in Brazilian native Catch wrestling style Luta livre and Brazilian Jiu-jitsu. He has also trained Muay Thai with Dutch shootboxer Andy Souwer since his fight with Mark Hominick.


title: José Aldo

text: On 28 September 2014, at Nova União, under the tutelage of Mestre Roberto Leitão (10th Dan), Daniel F. A. Malvino "Pirata" (1st Dan), Marco Ruas (7th Dan) and Daniel D'dane (4th Dan), Aldo was awarded his black belt in Luta Livre. His Luta Livre instructor lineage is as follows: Roberto Leitão Sr. → João Ricardo N. de Almeida → Marco Ruas → José Aldo.


title: José Aldo

text: Aldo has the most wins and knockouts in UFC and WEC featherweight history; he has landed a total of 691 significant strikes in the UFC and the WEC.


title: José Aldo

text: Aldo was poor growing up and often went on days with little to no food. WEC general manager Reed Harris states, "They were telling me that Wagnney Fabiano would be at the gym, and José would show up, and Wagnney would say, 'Have you eaten today or yesterday?' If not, they would go get him some food. That's how poor he was." When asked in an interview with WEC what his motivation is, Aldo replied, "My personal desires. My dream, my goal is to own my own house. This dream motivates me more and more as I get closer to fulfilling it." The Brazilian film "Mais Forte que o Mundo" was based on his early life.


title: José Aldo

text: Aldo is married to Vivianne Perreira, who has a purple belt in jiu-jitsu and has fought twice professionally in Muay Thai. Their daughter was born in 2012. On September 18, 2022, Vivianne gave birth to the couple's first son.


title: José Aldo

text: Aldo is an avid football fan and supports Clube de Regatas do Flamengo and English Premier League club Chelsea FC.


title: Tourette syndrome

text: Tourette syndrome or Tourette's syndrome (abbreviated as TS or Tourette's) is a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) tic. Common tics are blinking, coughing, throat clearing, sniffing, and facial movements. These are typically preceded by an unwanted urge or sensation in the affected muscles known as a premonitory urge, can sometimes be suppressed temporarily, and characteristically change in location, strength, and frequency. Tourette's is at the more severe end of a spectrum of tic disorders. The tics often go unnoticed by casual observers.


title: Tourette syndrome

text: Tourette's was once regarded as a rare and bizarre syndrome and has popularly been associated with coprolalia (the utterance of obscene words or socially inappropriate and derogatory remarks). It is no longer considered rare; about 1% of school-age children and adolescents are estimated to have Tourette's, and coprolalia occurs only in a minority. There are no specific tests for diagnosing Tourette's; it is not always correctly identified, because most cases are mild, and the severity of tics decreases for most children as they pass through adolescence. Therefore, many go undiagnosed or may never seek medical attention. Extreme Tourette's in adulthood, though sensationalized in the media, is rare, but for a small minority, severely debilitating tics can persist into adulthood. Tourette's does not affect intelligence or life expectancy.


title: Tourette syndrome

text: There is no cure for Tourette's and no single most effective medication. In most cases, medication for tics is not necessary, and behavioral therapies are the first-line treatment. Education is an important part of any treatment plan, and explanation alone often provides sufficient reassurance that no other treatment is necessary. Other conditions, such as attention deficit hyperactivity disorder (ADHD) and obsessive–compulsive disorder (OCD), are more likely to be present among those who are referred to specialty clinics than they are among the broader population of persons with Tourette's. These co-occurring conditions often cause more impairment to the individual than the tics; hence it is important to correctly distinguish co-occurring conditions and treat them.


title: Tourette syndrome

text: Tourette syndrome was named by French neurologist Jean-Martin Charcot for his intern, Georges Gilles de la Tourette, who published in 1885 an account of nine patients with a "convulsive tic disorder". While the exact cause is unknown, it is believed to involve a combination of genetic and environmental factors. The mechanism appears to involve dysfunction in neural circuits between the basal ganglia and related structures in the brain.


title: Tourette syndrome

text: Most published research on Tourette syndrome originates in the United States; in international TS research and clinical practice, the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) is preferred over the World Health Organization (WHO) classification, which is criticized in the 2021 "European Clinical Guidelines.


title: Tourette syndrome

text: In the fifth version of the DSM (DSM-5), published in 2013, Tourette syndrome is classified as a motor disorder (a disorder of the nervous system that causes abnormal and involuntary movements). It is listed in the neurodevelopmental disorder category. Tourette's is at the more severe end of the spectrum of tic disorders; its diagnosis requires multiple motor tics and at least one vocal tic to be present for more than a year. Tics are sudden, repetitive, nonrhythmic movements that involve discrete muscle groups, while vocal (phonic) tics involve laryngeal, pharyngeal, oral, nasal or respiratory muscles to produce sounds. The tics must not be explained by other medical conditions or substance use.


title: Tourette syndrome

text: Other conditions on the spectrum include persistent (chronic) motor or vocal tics, in which one type of tic (motor or vocal, but not both) has been present for more than a year; and provisional tic disorder, in which motor or vocal tics have been present for less than one year. The fifth edition of the DSM replaced what had been called "transient tic disorder" with "provisional tic disorder", recognizing that "transient" can only be defined in retrospect. Some experts believe that TS and persistent (chronic) motor or vocal tic disorder should be considered the same condition, because vocal tics are also motor tics in the sense that they are muscular contractions of nasal or respiratory muscles.


title: Tourette syndrome

text: Tourette syndrome is defined only slightly differently by the WHO; in its ICD-11, the International Statistical Classification of Diseases and Related Health Problems, Tourette syndrome is classified as a disease of the nervous system and a neurodevelopmental disorder, and only one motor tic is required for diagnosis. Older versions of the ICD called it "combined vocal and multiple motor tic disorder [de la Tourette]".


title: Tourette syndrome

text: Genetic studies indicate that tic disorders cover a spectrum that is not recognized by the clear-cut distinctions in the current diagnostic framework. Since 2008, studies have suggested that Tourette's is not a unitary condition with a distinct mechanism, as described in the existing classification systems. Instead, the studies suggest that subtypes should be recognized to distinguish "pure TS" from TS that is accompanied by attention deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder (OCD) or other disorders, similar to the way that subtypes have been established for other conditions, such as type 1 and type 2 diabetes. Elucidation of these subtypes awaits fuller understanding of the genetic and other causes of tic disorders.


title: Tourette syndrome

text: Tics are movements or sounds that take place "intermittently and unpredictably out of a background of normal motor activity", having the appearance of "normal behaviors gone wrong". The tics associated with Tourette's wax and wane; they change in number, frequency, severity, anatomical location, and complexity; each person experiences a unique pattern of fluctuation in their severity and frequency. Tics may also occur in "bouts of bouts", which also vary among people. The variation in tic severity may occur over hours, days, or weeks. Tics may increase when someone is experiencing stress, fatigue, anxiety, or illness, or when engaged in relaxing activities like watching TV. They sometimes decrease when an individual is engrossed in or focused on an activity like playing a musical instrument.


title: Tourette syndrome

text: In contrast to the abnormal movements associated with other movement disorders, the tics of Tourette's are nonrhythmic, often preceded by an unwanted urge, and temporarily suppressible. Over time, about 90% of individuals with Tourette's feel an urge preceding the tic, similar to the urge to sneeze or scratch an itch. The urges and sensations that precede the expression of a tic are referred to as premonitory sensory phenomena or premonitory urges. People describe the urge to express the tic as a buildup of tension, pressure, or energy which they ultimately choose consciously to release, as if they "had to do it" to relieve the sensation or until it feels "just right". The urge may cause a distressing sensation in the part of the body associated with the resulting tic; the tic is a response that relieves the urge in the anatomical location of the tic. Examples of this urge are the feeling of having something in one's throat, leading to a tic to clear one's throat, or a localized discomfort in the shoulders leading to shrugging the shoulders. The actual tic may be felt as relieving this tension or sensation, similar to scratching an itch or blinking to relieve an uncomfortable feeling in the eye. Some people with Tourette's may not be aware of the premonitory urge associated with tics. Children may be less aware of it than are adults, but their awareness tends to increase with maturity; by the age of ten, most children recognize the premonitory urge.


title: Tourette syndrome

text: Premonitory urges which precede the tic make suppression of the impending tic possible. Because of the urges that precede them, tics are described as semi-voluntary or ""unvoluntary"", rather than specifically "involuntary"; they may be experienced as a "voluntary", suppressible response to the unwanted premonitory urge. The ability to suppress tics varies among individuals, and may be more developed in adults than children. People with tics are sometimes able to suppress them for limited periods of time, but doing so often results in tension or mental exhaustion. People with Tourette's may seek a secluded spot to release the suppressed urge, or there may be a marked increase in tics after a period of suppression at school or work. Children may suppress tics while in the doctor's office, so they may need to be observed when not aware of being watched.


title: Tourette syndrome

text: Complex tics related to speech include coprolalia, echolalia and palilalia. Coprolalia is the spontaneous utterance of socially objectionable or taboo words or phrases. Although it is the most publicized symptom of Tourette's, only about 10% of people with Tourette's exhibit it, and it is not required for a diagnosis. Echolalia (repeating the words of others) and palilalia (repeating one's own words) occur in a minority of cases. Complex motor tics include copropraxia (obscene or forbidden gestures, or inappropriate touching), echopraxia (repetition or imitation of another person's actions) and palipraxia (repeating one's own movements).


title: Tourette syndrome

text: There is no typical case of Tourette syndrome, but the age of onset and the severity of symptoms follow a fairly reliable course. Although onset may occur anytime before eighteen years, the typical age of onset of tics is from five to seven, and is usually before adolescence. A 1998 study from the Yale Child Study Center showed that tic severity increased with age until it reached its highest point between ages eight and twelve. Severity declines steadily for most children as they pass through adolescence, when half to two-thirds of children see a dramatic decrease in tics.


title: Tourette syndrome

text: In people with TS, the first tics to appear usually affect the head, face, and shoulders, and include blinking, facial movements, sniffing and throat clearing. Vocal tics often appear months or years after motor tics but can appear first. Among people who experience more severe tics, complex tics may develop, including "arm straightening, touching, tapping, jumping, hopping and twirling". There are different movements in contrasting disorders (for example, the autism spectrum disorders), such as self-stimulation and stereotypies.


title: Tourette syndrome

text: The severity of symptoms varies widely among people with Tourette's, and many cases may be undetected. Most cases are mild and almost unnoticeable; many people with TS may not realize they have tics. Because tics are more commonly expressed in private, Tourette syndrome may go unrecognized, and casual observers might not notice tics. Most studies of TS involve males, who have a higher prevalence of TS than females, and gender-based differences are not well studied; a 2021 review suggested that the characteristics and progression for females, particularly in adulthood, may differ and better studies are needed.


title: Tourette syndrome

text: Most adults with TS have mild symptoms and do not seek medical attention. While tics subside for the majority after adolescence, some of the "most severe and debilitating forms of tic disorder are encountered" in adults. In some cases, what appear to be adult-onset tics can be childhood tics re-surfacing.


title: Tourette syndrome

text: Because people with milder symptoms are unlikely to be referred to specialty clinics, studies of Tourette's have an inherent bias towards more severe cases. When symptoms are severe enough to warrant referral to clinics, ADHD and OCD are often also found. In specialty clinics, 30% of those with TS also have mood or anxiety disorders or disruptive behaviors. In the absence of ADHD, tic disorders do not appear to be associated with disruptive behavior or functional impairment, while impairment in school, family, or peer relations is greater in those who have more comorbid conditions. When ADHD is present along with tics, the occurrence of conduct disorder and oppositional defiant disorder increases. Aggressive behaviors and angry outbursts in people with TS are not well understood; they are not associated with severe tics, but are connected with the presence of ADHD. ADHD may also contribute to higher rates of anxiety, and aggression and anger control problems are more likely when both OCD and ADHD co-occur with Tourette's.


title: Tourette syndrome

text: Compulsions that resemble tics are present in some individuals with OCD; "tic-related OCD" is hypothesized to be a subgroup of OCD, distinguished from non-tic related OCD by the type and nature of obsessions and compulsions. Compared to the more typical compulsions of OCD without tics that relate to contamination, tic-related OCD presents with more "counting, aggressive thoughts, symmetry and touching" compulsions. Compulsions associated with OCD without tics are usually related to obsessions and anxiety, while those in tic-related OCD are more likely to be a response to a premonitory urge. There are increased rates of anxiety and depression in those adults with TS who also have OCD.


title: Tourette syndrome

text: Among individuals with TS studied in clinics, between 2.9% and 20% had autism spectrum disorders, but one study indicates that a high association of autism and TS may be partly due to difficulties distinguishing between tics and tic-like behaviors or OCD symptoms seen in people with autism.


title: Tourette syndrome

text: Not all people with Tourette's have ADHD or OCD or other comorbid conditions, and estimates of the rate of pure TS or TS-only vary from 15% to 57%; in clinical populations, a high percentage of those under care do have ADHD. Children and adolescents with pure TS are not significantly different from their peers without TS on ratings of aggressive behaviors or conduct disorders, or on measures of social adaptation. Similarly, adults with pure TS do not appear to have the social difficulties present in those with TS plus ADHD.


title: Tourette syndrome

text: Among those with an older age of onset, more substance abuse and mood disorders are found, and there may be self-injurious tics. Adults who have severe, often treatment-resistant tics are more likely to also have mood disorders and OCD. Coprolalia is more likely in people with severe tics plus multiple comorbid conditions.


title: Tourette syndrome

text: There are no major impairments in neuropsychological function among people with Tourette's, but conditions that occur along with tics can cause variation in neurocognitive function. A better understanding of comorbid conditions is needed to untangle any neuropsychological differences between TS-only individuals and those with comorbid conditions.


title: Tourette syndrome

text: Only slight impairments are found in intellectual ability, attentional ability, and nonverbal memory—but ADHD, other comorbid disorders, or tic severity could account for these differences. In contrast with earlier findings, visual motor integration and visuoconstructive skills are not found to be impaired, while comorbid conditions may have a small effect on motor skills. Comorbid conditions and severity of tics may account for variable results in verbal fluency, which can be slightly impaired. There might be slight impairment in social cognition, but not in the ability to plan or make decisions. Children with TS-only do not show cognitive deficits. They are faster than average for their age on timed tests of motor coordination, and constant tic suppression may lead to an advantage in switching between tasks because of increased inhibitory control.


title: Tourette syndrome

text: Learning disabilities may be present, but whether they are due to tics or comorbid conditions is controversial; older studies that reported higher rates of learning disability did not control well for the presence of comorbid conditions. There are often difficulties with handwriting, and disabilities in written expression and math are reported in those with TS plus other conditions.


title: Tourette syndrome

text: The exact cause of Tourette's is unknown, but it is well established that both genetic and environmental factors are involved. Genetic epidemiology studies have shown that Tourette's is highly heritable, and 10 to 100 times more likely to be found among close family members than in the general population. The exact mode of inheritance is not known; no single gene has been identified, and hundreds of genes are likely involved. Genome-wide association studies were published in 2013 and 2015 in which no finding reached a threshold for significance; a 2019 meta-analysis found only a single genome-wide significant locus on chromosome 13, but that result was not found in broader samples. Twin studies show that 50 to 77% of identical twins share a TS diagnosis, while only 10 to 23% of fraternal twins do. But not everyone who inherits the genetic vulnerability will show symptoms. A few rare highly penetrant genetic mutations have been found that explain only a small number of cases in single families (the "SLITRK1, HDC", and "CNTNAP2" genes).


title: Tourette syndrome

text: Psychosocial or other non-genetic factors—while not causing Tourette's—can affect the severity of TS in vulnerable individuals and influence the expression of the inherited genes. Pre-natal and peri-natal events increase the risk that a tic disorder or comorbid OCD will be expressed in those with the genetic vulnerability. These include paternal age; forceps delivery; stress or severe nausea during pregnancy; and use of tobacco, caffeine, alcohol, and cannabis during pregnancy. Babies who are born premature with low birthweight, or who have low Apgar scores, are also at increased risk; in premature twins, the lower birthweight twin is more likely to develop TS.


title: Tourette syndrome

text: Autoimmune processes may affect the onset of tics or exacerbate them. Both OCD and tic disorders are hypothesized to arise in a subset of children as a result of a post-streptococcal autoimmune process. Its potential effect is described by the controversial hypothesis called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections), which proposes five criteria for diagnosis in children. PANDAS and the newer pediatric acute-onset neuropsychiatric syndrome (PANS) hypotheses are the focus of clinical and laboratory research, but remain unproven. There is also a broader hypothesis that links immune-system abnormalities and immune dysregulation with TS.


title: Tourette syndrome

text: Some forms of OCD may be genetically linked to Tourette's, although the genetic factors in OCD with and without tics may differ. The genetic relationship of ADHD to Tourette syndrome, however, has not been fully established. A genetic link between autism and Tourette's has not been established as of 2017.


title: Tourette syndrome

text: The exact mechanism affecting the inherited vulnerability to Tourette's is not well established. Tics are believed to result from dysfunction in cortical and subcortical brain regions: the thalamus, basal ganglia and frontal cortex. Neuroanatomic models suggest failures in circuits connecting the brain's cortex and subcortex; imaging techniques implicate the frontal cortex and basal ganglia. In the 2010s, neuroimaging and postmortem brain studies, as well as animal and genetic studies, made progress towards better understanding the neurobiological mechanisms leading to Tourette's. These studies support the basal ganglia model, in which neurons in the striatum are activated and inhibit outputs from the basal ganglia.


title: Tourette syndrome

text: Cortico-striato-thalamo-cortical (CSTC) circuits, or neural pathways, provide inputs to the basal ganglia from the cortex. These circuits connect the basal ganglia with other areas of the brain to transfer information that regulates planning and control of movements, behavior, decision-making, and learning. Behavior is regulated by cross-connections that "allow the integration of information" from these circuits. Involuntary movements may result from impairments in these CSTC circuits, including the sensorimotor, limbic, language and decision making pathways. Abnormalities in these circuits may be responsible for tics and premonitory urges.


title: Tourette syndrome

text: The caudate nuclei may be smaller in subjects with tics compared to those without tics, supporting the hypothesis of pathology in CSTC circuits in Tourette's. The ability to suppress tics depends on brain circuits that "regulate response inhibition and cognitive control of motor behavior". Children with TS are found to have a larger prefrontal cortex, which may be the result of an adaptation to help regulate tics. It is likely that tics decrease with age as the capacity of the frontal cortex increases. Cortico-basal ganglia (CBG) circuits may also be impaired, contributing to "sensory, limbic and executive" features. The release of dopamine in the basal ganglia is higher in people with Tourette's, implicating biochemical changes from "overactive and dysregulated dopaminergic transmissions".


title: Tourette syndrome

text: Histamine and the H3 receptor may play a role in the alterations of neural circuitry. A reduced level of histamine in the H3 receptor may result in an increase in other neurotransmitters, causing tics. Postmortem studies have also implicated "dysregulation of neuroinflammatory processes".


title: Tourette syndrome

text: According to the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), Tourette's may be diagnosed when a person exhibits both multiple motor tics and one or more vocal tics over a period of one year. The motor and vocal tics need not be concurrent. The onset must have occurred before the age of 18 and cannot be attributed to the effects of another condition or substance (such as cocaine). Hence, other medical conditions that include tics or tic-like movements—for example, autism or other causes of tics—must be ruled out.


title: Tourette syndrome

text: Patients referred for a tic disorder are assessed based on their family history of tics, vulnerability to ADHD, obsessive–compulsive symptoms, and a number of other chronic medical, psychiatric and neurological conditions. In individuals with a typical onset and a family history of tics or OCD, a basic physical and neurological examination may be sufficient. There are no specific medical or screening tests that can be used to diagnose Tourette's; the diagnosis is usually made based on observation of the individual's symptoms and family history, and after ruling out secondary causes of tic disorders (tourettism).


title: Tourette syndrome

text: Delayed diagnosis often occurs because professionals mistakenly believe that TS is rare, always involves coprolalia, or must be severely impairing. The DSM has recognized since 2000 that many individuals with Tourette's do not have significant impairment; diagnosis does not require the presence of coprolalia or a comorbid condition, such as ADHD or OCD. Tourette's may be misdiagnosed because of the wide expression of severity, ranging from mild (in the majority of cases) or moderate, to severe (the rare but more widely recognized and publicized cases). About 20% of people with Tourette syndrome do not realize that they have tics.


title: Tourette syndrome

text: Tics that appear early in the course of TS are often confused with allergies, asthma, vision problems, and other conditions. Pediatricians, allergists and ophthalmologists are among the first to see or identify a child as having tics, although the majority of tics are first identified by the child's parents. Coughing, blinking, and tics that mimic unrelated conditions such as asthma are commonly misdiagnosed. In the UK, there is an average delay of three years between symptom onset and diagnosis.


title: Tourette syndrome

text: Tics that may appear to mimic those of Tourette's—but are associated with disorders other than Tourette's—are known as tourettism and are ruled out in the differential diagnosis for Tourette syndrome. The abnormal movements associated with choreas, dystonias, myoclonus, and dyskinesias are distinct from the tics of Tourette's in that they are more rhythmic, not suppressible, and not preceded by an unwanted urge. Developmental and autism spectrum disorders may manifest tics, other stereotyped movements, and stereotypic movement disorder. The stereotyped movements associated with autism typically have an earlier age of onset; are more symmetrical, rhythmical and bilateral; and involve the extremities (for example, flapping the hands).


title: Tourette syndrome

text: If another condition might better explain the tics, tests may be done; for example, if there is diagnostic confusion between tics and seizure activity, an EEG may be ordered. An MRI can rule out brain abnormalities, but such brain imaging studies are not usually warranted. Measuring thyroid-stimulating hormone blood levels can rule out hypothyroidism, which can be a cause of tics. If there is a family history of liver disease, serum copper and ceruloplasmin levels can rule out Wilson's disease. The typical age of onset of TS is before adolescence. In teenagers and adults with an abrupt onset of tics and other behavioral symptoms, a urine drug screen for stimulants might be requested.


title: Tourette syndrome

text: Increasing episodes of tic-like behavior among teenagers (predominantly adolescent girls) were reported in several countries during the COVID-19 pandemic. Researchers linked their occurrence to followers of certain TikTok or YouTube artists. Described in 2006 as "psychogenic", abrupt-onset movements resembling tics are referred to as a "functional movement disorder" or "functional tic-like movements". Functional tic-like movements can be difficult to distinguish from tics that have an organic (rather than psychological) cause. They may occur alone or co-exist in individuals with tic disorders. These tics are inconsistent with the classic tics of TS in several ways: the premonitory urge (present in 90% of those with tics disorders) is absent in functional tic-like movements; the suppressibility seen in tic disorders is lacking; there is no family or childhood history of tics and there is a female predominance in functional tics, with a later-than-typical age of first presentation; onset is more abrupt than typical with movements that are more suggestible; and there is less co-occurring OCD or ADHD and more co-occurring disorders. Functional tics are "not fully stereotypical", do not respond to medications, do not demonstrate the classic waxing and waning pattern of Tourettic tics, and do not progress in the typical fashion, in which tics often first appear in the face and gradually move to limbs.


title: Tourette syndrome

text: Other conditions that may manifest tics include Sydenham's chorea; idiopathic dystonia; and genetic conditions such as Huntington's disease, neuroacanthocytosis, pantothenate kinase-associated neurodegeneration, Duchenne muscular dystrophy, Wilson's disease, and tuberous sclerosis. Other possibilities include chromosomal disorders such as Down syndrome, Klinefelter syndrome, XYY syndrome and fragile X syndrome. Acquired causes of tics include drug-induced tics, head trauma, encephalitis, stroke, and carbon monoxide poisoning. The extreme self-injurious behaviors of Lesch-Nyhan syndrome may be confused with Tourette syndrome or stereotypies, but self-injury is rare in TS even in cases of violent tics. Most of these conditions are rarer than tic disorders and a thorough history and examination may be enough to rule them out without medical or screening tests.


title: Tourette syndrome

text: Although not all those with Tourette's have comorbid conditions, most presenting for clinical care exhibit symptoms of other conditions along with their tics. ADHD and OCD are the most common, but autism spectrum disorders or anxiety, mood, personality, oppositional defiant, and conduct disorders may also be present. Learning disabilities and sleep disorders may be present; higher rates of sleep disturbance and migraine than in the general population are reported. A thorough evaluation for comorbidity is called for when symptoms and impairment warrant, and careful assessment of people with TS includes comprehensive screening for these conditions.


title: Tourette syndrome

text: Comorbid conditions such as OCD and ADHD can be more impairing than tics, and cause greater impact on overall functioning. Disruptive behaviors, impaired functioning, or cognitive impairment in individuals with comorbid Tourette's and ADHD may be accounted for by the ADHD, highlighting the importance of identifying comorbid conditions. Children and adolescents with TS who have learning difficulties are candidates for psychoeducational testing, particularly if the child also has ADHD.


title: Tourette syndrome

text: There is no cure for Tourette's. There is no single most effective medication, and no one medication effectively treats all symptoms. Most medications prescribed for tics have not been approved for that use, and no medication is without the risk of significant adverse effects. Treatment is focused on identifying the most troubling or impairing symptoms and helping the individual manage them. Because comorbid conditions are often a larger source of impairment than tics, they are a priority in treatment. The management of Tourette's is individualized and involves shared decision-making between the clinician, patient, family and caregivers. Practice guidelines for the treatment of tics were published by the American Academy of Neurology in 2019.


title: Tourette syndrome

text: Education, reassurance and psychobehavioral therapy are often sufficient for the majority of cases. In particular, psychoeducation targeting the patient and their family and surrounding community is a key management strategy. Watchful waiting "is an acceptable approach" for those who are not functionally impaired. Symptom management may include behavioral, psychological and pharmacological therapies. Pharmacological intervention is reserved for more severe symptoms, while psychotherapy or cognitive behavioral therapy (CBT) may ameliorate depression and social isolation, and improve family support. The decision to use behavioral or pharmacological treatment is "usually made after the educational and supportive interventions have been in place for a period of months, and it is clear that the tic symptoms are persistently severe and are themselves a source of impairment in terms of self-esteem, relationships with the family or peers, or school performance".


title: Tourette syndrome

text: Knowledge, education and understanding are uppermost in management plans for tic disorders, and psychoeducation is the first step. A child's parents are typically the first to notice their tics; they may feel worried, imagine that they are somehow responsible, or feel burdened by misinformation about Tourette's. Effectively educating parents about the diagnosis and providing social support can ease their anxiety. This support can also lower the chance that their child will be unnecessarily medicated or experience an exacerbation of tics due to their parents' emotional state.


title: Tourette syndrome

text: People with Tourette's may suffer socially if their tics are viewed as "bizarre". If a child has disabling tics, or tics that interfere with social or academic functioning, supportive psychotherapy or school accommodations can be helpful. Even children with milder tics may be angry, depressed or have low self-esteem as a result of increased teasing, bullying, rejection by peers or social stigmatization, and this can lead to social withdrawal. Some children feel empowered by presenting a peer awareness program to their classmates. It can be helpful to educate teachers and school staff about typical tics, how they fluctuate during the day, how they impact the child, and how to distinguish tics from naughty behavior. By learning to identify tics, adults can refrain from asking or expecting a child to stop ticcing, because "tic suppression can be exhausting, unpleasant, and attention-demanding and can result in a subsequent rebound bout of tics".


title: Tourette syndrome

text: Adults with TS may withdraw socially to avoid stigmatization and discrimination because of their tics. Depending on their country's healthcare system, they may receive social services or help from support groups.


title: Tourette syndrome

text: Behavioral therapies using habit reversal training (HRT) and exposure and response prevention (ERP) are first-line interventions in the management of Tourette syndrome, and have been shown to be effective. Because tics are somewhat suppressible, when people with TS are aware of the premonitory urge that precedes a tic, they can be trained to develop a response to the urge that competes with the tic. Comprehensive behavioral intervention for tics (CBIT) is based on HRT, the best researched behavioral therapy for tics. TS experts debate whether increasing a child's awareness of tics with HRT/CBIT (as opposed to ignoring tics) can lead to more tics later in life.


title: Tourette syndrome

text: When disruptive behaviors related to comorbid conditions exist, anger control training and parent management training can be effective. CBT is a useful treatment when OCD is present. Relaxation techniques, such as exercise, yoga and meditation may be useful in relieving the stress that can aggravate tics. Beyond HRT, the majority of behavioral interventions for Tourette's (for example, relaxation training and biofeedback) have not been systematically evaluated and are not empirically supported.


title: Tourette syndrome

text: Children with tics typically present when their tics are most severe, but because the condition waxes and wanes, medication is not started immediately or changed often. Tics may subside with education, reassurance and a supportive environment. When medication is used, the goal is not to eliminate symptoms. Instead, the lowest dose that manages symptoms without adverse effects is used, because adverse effects may be more disturbing than the symptoms being treated with medication.


title: Tourette syndrome

text: The classes of medication with proven efficacy in treating tics—typical and atypical neuroleptics—can have long-term and short-term adverse effects. Some antihypertensive agents are also used to treat tics; studies show variable efficacy but a lower side effect profile than the neuroleptics. The antihypertensives clonidine and guanfacine are typically tried first in children; they can also help with ADHD symptoms, but there is less evidence that they are effective for adults. The neuroleptics risperidone and aripiprazole are tried when antihypertensives are not effective, and are generally tried first for adults. Because of lower side effects, aripiprazole is preferred over other antipsychotics. The most effective medication for tics is haloperidol, but it has a higher risk of side effects. Methylphenidate can be used to treat ADHD that co-occurs with tics, and can be used in combination with clonidine. Selective serotonin reuptake inhibitors are used to manage anxiety and OCD.


title: Tourette syndrome

text: Complementary and alternative medicine approaches, such as dietary modification, neurofeedback and allergy testing and control have popular appeal, but they have no proven benefit in the management of Tourette syndrome. Despite this lack of evidence, up to two-thirds of parents, caregivers and individuals with TS use dietary approaches and alternative treatments and do not always inform their physicians.


title: Tourette syndrome

text: There is low confidence that tics are reduced with tetrahydrocannabinol, and insufficient evidence for other cannabis-based medications in the treatment of Tourette's. There is no good evidence supporting the use of acupuncture or transcranial magnetic stimulation; neither is there evidence supporting intravenous immunoglobulin, plasma exchange, or antibiotics for the treatment of PANDAS.


title: Tourette syndrome

text: Deep brain stimulation (DBS) has become a valid option for individuals with severe symptoms that do not respond to conventional therapy and management, although it is an experimental treatment. Selecting candidates who may benefit from DBS is challenging, and the appropriate lower age range for surgery is unclear; it is potentially useful in less than 3% of individuals. The ideal brain location to target has not been identified as of 2019.


title: Tourette syndrome

text: A quarter of women report that their tics increase before menstruation; however, studies have not shown consistent evidence of a change in frequency or severity of tics related to pregnancy or hormonal levels. Overall, symptoms in women respond better to haloperidol than they do for men.


title: Tourette syndrome

text: Most women find they can withdraw from medication during pregnancy without much trouble. When needed, medications are used at the lowest doses possible. During pregnancy, neuroleptic medications are avoided when possible because of the risk of pregnancy complications. When needed, olanzapine, risperidone and quetiapine are most often used as they have not been shown to cause fetal abnormalities. One report found that haloperidol could be used during pregnancy, to minimize the side effects in the mother, including low blood pressure, and anticholinergic effects, although it may cross the placenta.


title: Tourette syndrome

text: If severe tics might interfere with administration of local anesthesia, other anesthesia options are considered. Neuroleptics in low doses may not affect the breastfed infant, but most medications are avoided. Clonidine and amphetamines may be present in breast milk.


title: Tourette syndrome

text: Tourette syndrome is a spectrum disorder—its severity ranges from mild to severe. Symptoms typically subside as children pass through adolescence. In a group of ten children at the average age of highest tic severity (around ten or eleven), almost four will see complete remission by adulthood. Another four will have minimal or mild tics in adulthood, but not complete remission. The remaining two will have moderate or severe tics as adults, but only rarely will their symptoms in adulthood be more severe than in childhood.


title: Tourette syndrome

text: Regardless of symptom severity, individuals with Tourette's have a normal life span. Symptoms may be lifelong and chronic for some, but the condition is not degenerative or life-threatening. Intelligence among those with pure TS follows a normal curve, although there may be small differences in intelligence in those with comorbid conditions. The severity of tics early in life does not predict their severity in later life. There is no reliable means of predicting the course of symptoms for a particular individual, but the prognosis is generally favorable. By the age of fourteen to sixteen, when the highest tic severity has typically passed, a more reliable prognosis might be made.


title: Tourette syndrome

text: Tics may be at their highest severity when they are diagnosed, and often improve as an individual's family and friends come to better understand the condition. Studies report that almost eight out of ten children with Tourette's experience a reduction in the severity of their tics by adulthood, and some adults who still have tics may not be aware that they have them. A study that used video to record tics in adults found that nine out of ten adults still had tics, and half of the adults who considered themselves tic-free displayed evidence of mild tics.


title: Tourette syndrome

text: People with Tourette's are affected by the consequences of tics and by the efforts to suppress them. Head and eye tics can interfere with reading or lead to headaches, and forceful tics can lead to repetitive strain injury. Severe tics can lead to pain or injuries; as an example, a rare cervical disc herniation was reported from a neck tic. Some people may learn to camouflage socially inappropriate tics or channel the energy of their tics into a functional endeavor.


title: Tourette syndrome

text: A supportive family and environment generally give those with Tourette's the skills to manage the disorder. Outcomes in adulthood are associated more with the perceived significance of having tics as a child than with the actual severity of the tics. A person who was misunderstood, punished or teased at home or at school is likely to fare worse than a child who enjoyed an understanding environment. The long-lasting effects of bullying and teasing can influence self-esteem, self-confidence, and even employment choices and opportunities. Comorbid ADHD can severely affect the child's well-being in all realms, and extend into adulthood.


title: Tourette syndrome

text: Factors impacting quality of life change over time, given the natural fluctuating course of tic disorders, the development of coping strategies, and a person's age. As ADHD symptoms improve with maturity, adults report less negative impact in their occupational lives than do children in their educational lives. Tics have a greater impact on adults' psychosocial function, including financial burdens, than they do on children. Adults are more likely to report a reduced quality of life due to depression or anxiety; depression contributes a greater burden than tics to adults' quality of life compared to children. As coping strategies become more effective with age, the impact of OCD symptoms seems to diminish.


title: Tourette syndrome

text: Tourette syndrome is a common but underdiagnosed condition that reaches across all social, racial and ethnic groups. It is three to four times more frequent in males than in females. Observed prevalence rates are higher among children than adults because tics tend to remit or subside with maturity and a diagnosis may no longer be warranted for many adults. Up to 1% of the overall population experiences tic disorders, including chronic tics and transient (provisional or unspecified) tics in childhood. Chronic tics affect 5% of children and transient tics affect up to 20%.


title: Tourette syndrome

text: Many individuals with tics do not know they have tics, or do not seek a diagnosis, so epidemiological studies of TS "reflect a strong ascertainment bias" towards those with co-occurring conditions. The reported prevalence of TS varies "according to the source, age, and sex of the sample; the ascertainment procedures; and diagnostic system", with a range reported between 0.15% and 3.0% for children and adolescents. Sukhodolsky, et al. wrote in 2017 that the best estimate of TS prevalence in children was 1.4%. Both Robertson and Stern states that the prevalence in children is 1%. The prevalence of TS in the general population is estimated as 0.3% to 1.0%. According to turn of the century census data, these prevalence estimates translated to half a million children in the US with TS and half a million people in the UK with TS, although symptoms in many older individuals would be almost unrecognizable.


title: Tourette syndrome

text: Tourette syndrome was once thought to be rare: in 1972, the US National Institutes of Health (NIH) believed there were fewer than 100 cases in the United States, and a 1973 registry reported only 485 cases worldwide. However, numerous studies published since 2000 have consistently demonstrated that the prevalence is much higher. Recognizing that tics may often be undiagnosed and hard to detect, newer studies use direct classroom observation and multiple informants (parents, teachers and trained observers), and therefore record more cases than older studies. As the diagnostic threshold and assessment methodology have moved towards recognition of milder cases, the estimated prevalence has increased.


title: Tourette syndrome

text: Because of the high male prevalence of TS, there is limited data on females from which conclusion about gender-based differences can be drawn; caution may be warranted in extending conclusions to females regarding the characteristics and treatment of tics based on studies of mostly males. A 2021 review stated that females may see a later peak than males in symptoms, with less remission over time, along with a higher prevalence of anxiety and mood disorders.


title: Tourette syndrome

text: A French doctor, Jean Marc Gaspard Itard, reported the first case of Tourette syndrome in 1825, describing the Marquise de Dampierre, an important woman of nobility in her time. In 1884, Jean-Martin Charcot, an influential French physician, assigned his student and intern Georges Gilles de la Tourette, to study patients with movement disorders at the Salpêtrière Hospital, with the goal of defining a condition distinct from hysteria and chorea. In 1885, Gilles de la Tourette published an account in "Study of a Nervous Affliction" of nine people with "convulsive tic disorder", concluding that a new clinical category should be defined. The eponym was bestowed by Charcot after and on behalf of Gilles de la Tourette, who later became Charcot's senior resident.


title: Tourette syndrome

text: Following the 19th-century descriptions, a psychogenic view prevailed and little progress was made in explaining or treating tics until well into the 20th century. The possibility that movement disorders, including Tourette syndrome, might have an organic origin was raised when an encephalitis lethargica epidemic from 1918 to 1926 was linked to an increase in tic disorders.


title: Tourette syndrome

text: During the 1960s and 1970s, as the beneficial effects of haloperidol on tics became known, the psychoanalytic approach to Tourette syndrome was questioned. The turning point came in 1965, when Arthur K. Shapiro—described as "the father of modern tic disorder research"—used haloperidol to treat a person with Tourette's, and published a paper criticizing the psychoanalytic approach. In 1975, "The New York Times" headlined an article with "Bizarre outbursts of Tourette's disease victims linked to chemical disorder in brain", and Shapiro said: "The bizarre symptoms of this illness are rivaled only by the bizarre treatments used to treat it."


title: Tourette syndrome

text: During the 1990s, a more neutral view of Tourette's emerged, in which a genetic predisposition is seen to interact with non-genetic and environmental factors. The fourth revision of the DSM (DSM-IV) in 1994 added a diagnostic requirement for "marked distress or significant impairment in social, occupational, or other important areas of functioning", which led to an outcry from TS experts and researchers, who noted that many people were not even aware they had TS, nor were they distressed by their tics; clinicians and researchers resorted to using the older criteria in research and practice. In 2000, the American Psychiatric Association revised its diagnostic criteria in the fourth text revision of the DSM (DSM-IV-TR) to remove the impairment requirement, recognizing that clinicians often see people who have Tourette's without distress or impairment.


title: Tourette syndrome

text: Not everyone with Tourette's wants treatment or a cure, especially if that means they may lose something else in the process. The researchers Leckman and Cohen believe that there may be latent advantages associated with an individual's genetic vulnerability to developing Tourette syndrome that may have adaptive value, such as heightened awareness and increased attention to detail and surroundings.


title: Tourette syndrome

text: Accomplished musicians, athletes, public speakers and professionals from all walks of life are found among people with Tourette's. The athlete Tim Howard, described by the "Chicago Tribune" as the "rarest of creatures—an American soccer hero", and by the Tourette Syndrome Association as the "most notable individual with Tourette Syndrome around the world", says that his neurological makeup gave him an enhanced perception and an acute focus that contributed to his success on the field.


title: Tourette syndrome

text: Samuel Johnson is a historical figure who likely had Tourette syndrome, as evidenced by the writings of his friend James Boswell. Johnson wrote "A Dictionary of the English Language" in 1747, and was a prolific writer, poet, and critic. There is little support for speculation that Mozart had Tourette's: the potentially coprolalic aspect of vocal tics is not transferred to writing, so Mozart's scatological writings are not relevant; the composer's available medical history is not thorough; the side effects of other conditions may be misinterpreted; and "the evidence of motor tics in Mozart's life is doubtful".


title: Tourette syndrome

text: Likely portrayals of TS or tic disorders in fiction predating Gilles de la Tourette's work are "Mr. Pancks" in Charles Dickens's "Little Dorrit" and "Nikolai Levin" in Leo Tolstoy's "Anna Karenina". The entertainment industry has been criticized for depicting those with Tourette syndrome as social misfits whose only tic is coprolalia, which has furthered the public's misunderstanding and stigmatization of those with Tourette's. The coprolalic symptoms of Tourette's are also fodder for radio and television talk shows in the US and for the British media. High-profile media coverage focuses on treatments that do not have established safety or efficacy, such as deep brain stimulation, and alternative therapies involving unstudied efficacy and side effects are pursued by many parents.


title: Tourette syndrome

text: Research since 1999 has advanced knowledge of Tourette's in the areas of genetics, neuroimaging, neurophysiology, and neuropathology, but questions remain about how best to classify it and how closely it is related to other movement or psychiatric disorders. Modeled after genetic breakthroughs seen with large-scale efforts in other neurodevelopmental disorders, three groups are collaborating in research of the genetics of Tourette's:


title: Tourette syndrome

text: Compared to the progress made in gene discovery in certain neurodevelopmental or mental health disorders—autism, schizophrenia and bipolar disorder—the scale of related TS research is lagging in the United States due to funding.


title: GameCube

text: The is a home video game console developed and released by Nintendo in Japan on September 14, 2001, in North America on November 18, 2001, and in PAL territories in 2002. It is the successor to the Nintendo 64 (1996), and predecessor of the Wii (2006). In the sixth generation of video game consoles, the GameCube competed with Sony's PlayStation 2 and Microsoft's Xbox. Flagship games include "Super Smash Bros. Melee", "Luigi's Mansion", "Super Mario Sunshine", "Metroid Prime", "", "Pikmin", "Pikmin 2", "", "Chibi-Robo!", and "Animal Crossing".


title: GameCube

text: Development was enabled by the 1997 formation of computer graphics company ArtX, of former SGI employees who had created the Nintendo 64, and which was later acquired by ATI to produce the GameCube's GPU. In May 1999, Nintendo announced codename Dolphin, released in 2001 as the GameCube. It is Nintendo's first console to use optical discs instead of ROM cartridges, supplemented by writable memory cards for saved games. Unlike its competitors, it is solely focused on gaming and does not play mass media like DVD or CD. The console supports limited online gaming for a few games via a GameCube broadband or modem adapter and can connect to a Game Boy Advance with a link cable for exclusive in-game features using the handheld as a second screen and controller. The GameCube supports e-Reader cards to unlock special features in a few games. The Game Boy Player add-on runs Game Boy, Game Boy Color, and Game Boy Advance cartridge games.


title: GameCube

text: Reception of the GameCube was mixed. It was praised for its controller and extensive library of high-quality games, but was criticized for its exterior design and lack of multimedia features. Nintendo sold GameCube units worldwide, much fewer than anticipated, and discontinued it in 2007. It was succeeded by the Wii; the first model launched in November 2006 with full backward compatibility with GameCube games and accessories.


title: GameCube

text: In 1997, a graphics hardware design company called ArtX was launched with twenty engineers who had previously worked at SGI. ArtX was led by Wei Yen, who had been SGI's head of Nintendo Operations and of Project Reality, which from 1993 to 1996 had scaled SGI's supercomputer design down to become the Nintendo 64.


title: GameCube

text: Partnering with Nintendo in May 1998, ArtX began the complete design of the system logic and graphics processor (codenamed Flipper) of Nintendo's sixth-generation video game console. The console's succession of codenames was N2000, Star Cube, and Nintendo Advance. On May 12, 1999, the console was first publicly announced at Nintendo's press conference with the codename Dolphin, as the successor to the Nintendo 64. This included strategic alliances with IBM to create Dolphin's PowerPC-based CPU, codenamed Gekko, and with Panasonic (Matsushita) to create its DVD drive and its own Dolphin-based devices. Nintendo then began providing development kits to game developers such as Rare and Retro Studios.


title: GameCube

text: In April 2000, ArtX was acquired by ATI, whereupon the Flipper graphics processor design had already been mostly completed by ArtX and was not overtly influenced by ATI. In total, ArtX cofounder Greg Buchner recalled that their portion of the console's hardware design timeline had arced from inception in 1998 to completion in 2000. Of the ArtX acquisition, an ATI spokesperson said, "ATI now becomes a major supplier to the game console market via Nintendo. The Dolphin platform is reputed to be king of the hill in terms of graphics and video performance with 128-bit architecture."


title: GameCube

text: The console was announced as the GameCube at a press conference in Japan on August 25, 2000, abbreviated as both "NGC" and "GC" in Japan and "GCN" in Europe and North America. Nintendo unveiled its software lineup for the sixth-generation console at E3 2001, focusing on fifteen launch games, including "Luigi's Mansion" and "". Several games originally scheduled to launch with the console were delayed. It is also the first Nintendo home console since the Famicom not to have a "Mario" launch game.


title: GameCube

text: Long before the console's launch, Nintendo had developed and patented an early prototype of motion controls for the GameCube, with which developer Factor 5 had experimented for its launch games. Greg Thomas, Sega of America's VP of Development said, "What does worry me is Dolphin's sensory controllers [which are rumored to include microphones and headphone jacks] because there's an example of someone thinking about something different." These motion control concepts would not be deployed to consumers for several years, until the Wii Remote.


title: GameCube

text: Prior to the GameCube's release, Nintendo focused resources on the launch of the Game Boy Advance, a handheld game console and successor to the original Game Boy and Game Boy Color. As a result, several games originally destined for the Nintendo 64 console were postponed to become early releases on the GameCube. The last first-party game in 2001 for the Nintendo 64 was released in May, one month before the Game Boy Advance's launch and six months before the GameCube's, due to the company's shift in resources. Concurrently, Nintendo was developing GameCube software provisioning future connectivity with the Game Boy Advance. Certain games, such as "" and "Final Fantasy Crystal Chronicles", can use the handheld as a secondary screen and controller when connected to the console via a link cable.


title: GameCube

text: Nintendo began its marketing campaign with the catchphrase "The Nintendo Difference" at its E3 2001 reveal. The goal was to distinguish itself from the competition as an entertainment company. Later advertisements have the slogan, "Born to Play", and game ads feature a rotating cube animation that morphs into a GameCube logo and end with a voice whispering, "GameCube". On May 21, 2001, the console's launch price of was announced, lower than that of the PlayStation 2 and Xbox. Nintendo spent $76 million marketing the GameCube.


title: GameCube

text: In September 2020, leaked documents included Nintendo's plans for a GameCube model that would be both portable with a built-in display and dockable to a TV, similar to its later console the Nintendo Switch. Other leaks suggest plans for a GameCube successor, codenamed Tako, with HD graphics and slots for SD and memory cards, apparently resulting from a partnership with ATI (now AMD) and scheduled for release in 2005.


title: GameCube

text: The GameCube was launched in Japan on September 14, 2001. Approximately 500,000 units were shipped in time to retailers. The console was scheduled to launch two months later in North America on November 5, 2001, but the date was pushed back in an effort to increase the number of available units. The console eventually launched in North America on November 18, 2001, with over 700,000 units shipped to the region. Other regions followed suit the following year beginning with Europe in the second quarter of 2002.


title: GameCube

text: On April 22, 2002, veteran third-party Nintendo console developer Factor 5 announced its 3D audio software development kit titled MusyX. In collaboration with Dolby Laboratories, MusyX provides motion-based surround sound encoded as Dolby Pro Logic II.


title: GameCube

text: The Triforce arcade board is a joint development between Nintendo, Namco, and Sega, based on the GameCube's design. Its games include "Mario Kart Arcade GP" and "F-Zero AX".


title: GameCube

text: Nintendo launched the Wii, the home console successor to the GameCube, on November 19, 2006, in North America and in December 2006 in other regions. In February 2007, Nintendo announced that it had ceased first-party support for the GameCube and that the console had been discontinued, as it was shifting its manufacturing and development efforts towards the Wii and Nintendo DS. GameCube controllers, game discs, and certain accessories continued to be supported via the Wii's backward compatibility, although this feature was removed in later iterations of the Wii console. Several games originally developed for the GameCube were either reworked for a Wii release, such as "Super Paper Mario", or released on both consoles, such as the Wii launch game "".


title: GameCube

text: GameCube controllers continued to be supported via backward compatibility on Nintendo's next consoles, the Wii U, and Nintendo Switch, with the GameCube controller adapter in 2014's "Super Smash Bros. for Wii U" and 2018's "Super Smash Bros. Ultimate".


title: GameCube

text: Howard Cheng, technical director of Nintendo technology development, said the company's goal was to select a "simple RISC architecture" to help speed the development of games by making it easier on software developers. IGN reported that the system was "designed from the get-go to attract third-party developers by offering more power at a cheaper price. Nintendo's design document for the console specifies that cost is of utmost importance, followed by space." Hardware partner ArtX's Vice President Greg Buchner stated that their guiding thought on the console's hardware design was to target the developers rather than the players, and to "look into a crystal ball" and discern "what's going to allow the Miyamoto-sans of the world to develop the best games".


title: GameCube

text: Initiating the GameCube's design in 1998, Nintendo partnered with ArtX (then acquired by ATI Technologies during development) for the system logic and the GPU, and with IBM for the CPU. IBM designed a PowerPC-based processor with custom architectural extensions for the next-generation console, known as Gekko, which runs at 486 MHz and features a floating point unit (FPU) capable of a total throughput of 1.9 GFLOPS and a peak of 10.5 GFLOPS. Described as "an extension of the IBM PowerPC architecture", the Gekko CPU is based on the PowerPC 750CXe with IBM's 0.18μm CMOS technology, which features copper interconnects. Codenamed Flipper, the GPU runs at 162 MHz, and in addition to graphics manages other tasks through its audio and input/output (I/O) processors.


title: GameCube

text: The GameCube is Nintendo's first console to not use primarily cartridge media, following the Famicom Data Recorder, Famicom Disk System, SNES-CD, and 64DD which represent past explorations of complementary storage technologies. The GameCube introduced a proprietary miniDVD optical disc format for up to 1.5 GB of data. It was designed by Matsushita Electric Industrial (now Panasonic Corporation) with a proprietary copy-protection scheme unlike the Content Scramble System (CSS) in standard DVDs. The size is sufficient for most games, although a few multi-platform games require an extra disc, higher video compression, or removal of content. By comparison, the PlayStation 2 and Xbox use CDs and DVDs up to 8.5 GB.


title: GameCube

text: Like its predecessor, the Nintendo 64, GameCube models were produced in several different color motifs. The system launched in "Indigo", the primary color shown in advertising and on the logo, and in "Jet Black". One year later, Nintendo released a "Platinum" limited-edition GameCube, which uses a silver color scheme for both the console and controller. A "Spice" orange-colored console was eventually released only in Japan, though that scheme is only on controllers released in other countries.


title: GameCube

text: Nintendo developed stereoscopic 3D technology for the GameCube, supported by one launch game, "Luigi's Mansion". However, the feature never reached production. 3D televisions were not widespread, and it was deemed that compatible displays and crystals for the add-on accessories would be too cost-prohibitive for the consumer. Two audio Easter eggs can be invoked when the power is activated with the "Z" button on the Player 1 controller held down, or with four controllers connected and holding down the "Z" buttons.


title: GameCube

text: The GameCube features two memory card ports for saving game data. Nintendo released three memory card options: Memory Card 59 in gray (512 KB), Memory Card 251 in black (2 MB), and Memory Card 1019 in white (8 MB). These are often advertised in megabits instead: 4 Mb, 16 Mb, and 64 Mb, respectively. Memory cards with larger capacities were released by third-party manufacturers.


title: GameCube

text: Nintendo learned from its experiences—both positive and negative—with the Nintendo 64's three-handled controller design and chose a two-handled, "handlebar" design for the GameCube. The shape was popularized by Sony's PlayStation controller released in 1994 and its follow-up DualShock series in 1997 with vibration feedback and two analog sticks to improve the 3D experience. Nintendo and Microsoft designed similar features in the controllers for their sixth-generation consoles, but instead of having the analog sticks in parallel, they are staggered by swapping the positions of the directional pad (d-pad) and left analog stick. The GameCube controller features a total of eight buttons, two analog sticks, a d-pad, and a rumble motor. The primary analog stick is on the left with the d-pad located below and closer to the center. On the right are four buttons: a large, green "A" button in the center, a smaller red "B" button to the left, an "X" button to the right, and a "Y" button at the top. Below and to the inside is a yellow "C" analog stick, which often serves a variety of in-game functions, such as controlling the camera angle. The Start/Pause button is located in the middle, and the rumble motor is encased within the center of the controller.


title: GameCube

text: On the top are two "pressure-sensitive" trigger buttons marked "L" and "R". Each essentially provides two functions: one analog and one digital. As the trigger is depressed, it emits an increasing analog signal. Once fully depressed, the trigger "clicks" with a digital signal that a game can use for a separate function. There is also a purple, digital button on the right side marked "Z".


title: GameCube

text: The A button has a uniquely prominent size and placement, having been the primary action button in past Nintendo controller designs. The rubberized analog stick, within the overall button orientation, addresses "Nintendo thumb" pain.


title: GameCube

text: In 2002, Nintendo introduced the WaveBird Wireless Controller, the first wireless gamepad developed by a first-party console manufacturer. The RF-based wireless controller is similar in design to the standard controller. It communicates with the GameCube with a wireless receiver dongle. Powered by two AA batteries, it lacks vibration.


title: GameCube

text: The GameCube uses GameCube Game Discs, and the Game Boy Player accessory runs Game Pak cartridges for the Game Boy, Game Boy Color, and Game Boy Advance. The GameCube's successor, the Wii, supports backward compatibility with GameCube controllers, memory cards, and games but not the Game Boy Player or other hardware attachments. However, later revisions of the Wii—including the "Family Edition" released in 2011 and the Wii Mini released in 2012—do not support any GameCube hardware or software.


title: GameCube

text: The is a hybrid version of the GameCube with a standard DVD player, developed by Panasonic in a strategic alliance with Nintendo to develop the optical drive for the original GameCube hardware. Its stainless steel case is completely revised with a DVD-sized front-loading tray, a backlit LCD screen with playback controls, and a carrying handle like the GameCube. Announced by Panasonic on October 19, 2001, it was released exclusively in Japan on December 14 at a suggested retail price of ¥39,800; however, low sales resulted in Panasonic announcing the discontinuation of the Q on December 18, 2003. The Q supports CDs, DVDs, and GameCube discs but there is virtually no integration between the GameCube and DVD player modes.


title: GameCube

text: The GameCube is Nintendo's first home console with a system menu, activated by powering on without a valid game disc or by holding down the A button while one is loaded.


title: GameCube

text: In its lifespan from 2001 to 2007, Nintendo licensed over 600 GameCube games. Nintendo bolstered the console's popularity by creating new franchises, such as "Pikmin" and "Animal Crossing", and renewing some that had skipped the Nintendo 64, such as with "Metroid Prime". Longer standing franchises include the critically acclaimed "" and "Super Mario Sunshine", and the GameCube's best-selling game, "Super Smash Bros. Melee", at 7 million copies worldwide. Other Nintendo games are successors to Nintendo 64 games, such as "F-Zero GX"; ""; ""; "Mario Party 4", "5", "6", and "7"; "Mario Power Tennis"; and "". Though committed to its software library, Nintendo was still criticized for not releasing enough launch window games and by the release of "Luigi's Mansion" instead of a 3D "Mario" game.


title: GameCube

text: Nintendo had struggled with its family-friendly image during the late 1990s and most of the 2000s. However, during this period, it released more video games for a mature audience with mostly successful results. While the video game industry was focusing on more mature audiences and online connections, Nintendo regained older players who had gravitated to the PlayStation 2 and Xbox during the early 2000s. Some games aimed at older audiences were critically and financially successfulmore than on Dreamcast, and less than on PlayStation 2 and Xbox. Such examples include "", "Super Smash Bros. Melee", "Resident Evil 4", "", "Killer7", "Star Wars Rogue Squadron II: Rogue Leader", "Final Fantasy Crystal Chronicles", "Resident Evil" (2002), "Metroid Prime", "", "Soul Calibur II", "Resident Evil Zero", "F-Zero GX", "Star Fox Adventures", and "". One of the most well-known GameCube games for mature audiences is "Eternal Darkness: Sanity’s Requiem", which underperformed financially, but garnered critical acclaim and is now regarded as a cult classic.


title: GameCube

text: Early in Nintendo's history, the company had achieved considerable success with third-party developer support on the Nintendo Entertainment System and Super NES. Competition from the Sega Genesis and Sony PlayStation in the 1990s changed the market's landscape and reduced Nintendo's ability to obtain exclusive, third-party support on the Nintendo 64. The Nintendo 64 Game Pak cartridge format increased the cost to manufacture software, as opposed to the cheaper, higher-capacity optical discs on PlayStation.


title: GameCube

text: With the GameCube, Nintendo intended to reverse the trend as evidenced by the number of third-party games available at launch. The new optical disc format increased game storage capacity significantly and reduced production costs. Successful exclusives include "" from Factor 5, "Resident Evil 4" from Capcom, and "" from Konami. Sega discontinued its Dreamcast console to become a third-party developer, porting Dreamcast games such as "Crazy Taxi" and "Sonic Adventure 2", and developing new franchises, such as "Super Monkey Ball". Longtime Nintendo partner Rare, which had developed "GoldenEye 007", "Perfect Dark", "Banjo-Kazooie", "Conker's Bad Fur Day", and the "Donkey Kong Country" series, released "Star Fox Adventures" for GameCube, its final Nintendo game before acquisition by Microsoft in 2002. Several third-party developers were contracted to work on new games for Nintendo franchises, including "" (which became a Player's Choice re-release), "Donkey Konga" by Namco, and "Wario World" from Treasure.


title: GameCube

text: Third-party GameCube support was some of the most extensive of any Nintendo console predating the Wii. Some third-party developers, such as Midway, Namco, Activision, Konami, Ubisoft, THQ, Disney Interactive Studios, Humongous Entertainment, EA and EA Sports, continued to release GameCube games into 2007. One of the biggest third-party GameCube developers was Sega, which had quit the console hardware market to become a third-party game developer after the failure of the Dreamcast. It partnered with long-time rival Nintendo, and with Microsoft and Sony, to recuperate profits lost from the Dreamcast. Sega was a successful third-party developer since the early 2000s, mostly those for the family market, such as "Super Monkey Ball", "Phantasy Star Online", "Sonic Adventure", "Sonic Adventure 2: Battle", and "Sonic Heroes".


title: GameCube

text: Nintendo's GameCube did not put heavy focus on online games earlier in the console's life. Only eight GameCube games support network connectivity, five with Internet support and three with local area network (LAN) support. The only Internet capable games released in western territories are three role-playing games (RPGs) in Sega's "Phantasy Star" series: "Phantasy Star Online Episode I & II", "Phantasy Star Online Episode I & II Plus", and "". The official servers were decommissioned in 2007, but players can still connect to fan maintained private servers. Japan received two additional games with Internet capabilities, a cooperative RPG, "Homeland" and a baseball game with downloadable content, "Jikkyō Powerful Pro Yakyū 10". Lastly, three racing games have LAN multiplayer modes: "1080° Avalanche", "Kirby Air Ride", and "". Those can be forced over the Internet with third-party PC software capable of tunneling the GameCube's network traffic.


title: GameCube

text: Online play requires an official broadband or modem adapter because the GameCube lacks out of the box network capabilities. Nintendo never commissioned any Internet services for GameCube, but allowed other publishers to manage custom online experiences.


title: GameCube

text: The GameCube received mixed reviews following its launch. "PC Magazine" praised the overall hardware design and quality of games available at launch. CNET gave an average review rating, noting that though the console lacks a few features offered by its competition, it is relatively inexpensive, has a great controller design, and launched a decent lineup of games. In later reviews, criticism mounted against the console often centering on its overall look and feel, describing it as "toy-ish". With poor sales figures and the associated financial harm to Nintendo, a "Time International" article called the GameCube an "unmitigated disaster".


title: GameCube

text: Retrospectively, Joystiq compared the GameCube's launch window to its successor, the Wii, noting that the GameCube's "lack of games" resulted in a subpar launch, and the console's limited selection of online games damaged its market share in the long run. "Time International" concluded that the system had low sales figures, because it lacked "technical innovations".


title: GameCube

text: In Japan, between 280,000 and 300,000 GameCube consoles were sold during the first three days of its sale, out of an initial shipment of 450,000 units. During its launch weekend, $100 million worth of GameCube products were sold in North America. The console was sold out in several stores, faster than initial sales of both of its competitors, the Xbox and the PlayStation 2. Nintendo reported that the most popular launch game is "Luigi's Mansion", with more sales at its launch than "Super Mario 64" had. Other popular games include "" and "". By early December 2001, 600,000 units had been sold in the US.


title: GameCube

text: Nintendo predicted 50 million GameCube units by 2005, but only sold 22 million GameCube units worldwide during its lifespan, placing it slightly behind the Xbox's 24 million, though it did manage to outsell the Xbox in Japan, and well behind the PlayStation 2's 155 million. Its sales exceeded that of the Xbox 360 in Japan. The GameCube's predecessor, the Nintendo 64, also outperformed it at nearly 33 million units. It also exceeded the short-lived Dreamcast, which yielded 9.13 million units. In September 2009, IGN ranked the GameCube 16th in its list of best gaming consoles of all time, placing it behind all three of its sixth-generation competitors: the PlayStation 2 (3rd), the Dreamcast (8th), and the Xbox (11th). As of March 31, 2003, 9.55 million GameCube units had been sold worldwide, behind Nintendo's initial goal of 10 million consoles. Two Ars Technica articles from 2006 showed that Nintendo had officially sold 24 million GameCube consoles worldwide.


title: GameCube

text: Many of Nintendo's own first-party games, such as "Super Smash Bros. Melee", "Pokémon Colosseum", and "", had strong sales, though this did not typically benefit third-party developers or directly drive sales of their games. However, at the same time, these first-party games, and second-party and third-party games, elevated the GameCube.


title: GameCube

text: Sales of many cross-platform games—such as sports franchises released by Electronic Arts—were far below their PlayStation 2 and Xbox counterparts, eventually prompting some developers to scale back or completely cease support for the GameCube. Exceptions include Sega's family friendly "Sonic Adventure 2" and "Super Monkey Ball", which reportedly yielded more sales on GameCube than most of the company's games on the PlayStation 2 and Xbox. In June 2003, Acclaim Entertainment CEO Rod Cousens said that the company would no longer support the GameCube, and criticized it as a system "that don't deliver profits". Acclaim would later rescind his claims, by saying the company would elevate support for the system. This decision was made unclear after the company filed for bankruptcy in August 2004. In September 2003, Eidos Interactive announced to end support for the GameCube, as the publisher was losing money from developing for Nintendo's console. This led to several games in development being canceled for the system. Eidos's CEO Mike McGravey would say that the GameCube was a "declining business". However, after the company's purchase by the SCi Entertainment Group in 2005, Eidos resumed development for the system and released "" and "". Several third-party games originally intended to be GameCube exclusives—most notably Capcom's "Viewtiful Joe" and "Resident Evil 4"—were eventually ported to other systems in an attempt to maximize profits following lackluster sales of the original GameCube versions.


title: GameCube

text: In March 2003, now-defunct UK retailer Dixons removed all GameCube consoles, accessories and games from its stores. That same month, another UK retailer Argos, cut the price of the GameCube in their stores to £78.99, which was more than £50 cheaper than Nintendo's SRP for the console at the time. However, in October of that year, they did eventually re-stock their supply of consoles after a price drop was ordered which caused the console sales to outpace the PlayStation 2 for a week.


title: GameCube

text: With sales sagging and millions of unsold consoles in stock, Nintendo halted GameCube production for the first nine months of 2003 to reduce surplus units. Sales rebounded slightly after a price drop to US$99.99 on September 24, 2003 and the release of "" bundle. A demo disc, the "GameCube Preview Disc", was also released in a bundle in 2003. Beginning with this period, GameCube sales continued to be steady, particularly in Japan, but the GameCube remained in third place in worldwide sales during the sixth-generation era because of weaker sales performance elsewhere, though its fortunes would change for the better in America and Europe.


title: GameCube

text: Iwata forecasted to investors that the company would sell 50 million GameCube units worldwide by March 2005, but by the end of 2006, it had only sold 21.74 millionfewer than half. However, it had the highest attach rate of any Nintendo console at 9.59 and was profitable, even more than Xbox with higher sales rates.


title: GameCube

text: With the GameCube, Nintendo failed to reclaim the market share lost by its predecessor, the Nintendo 64. Through its generation, GameCube hardware sales remained far behind its direct competitor the PlayStation 2, and slightly behind the Xbox, though there would be times when the GameCube would upstage its rival consoles. The console's family-friendly appeal and lack of support from certain third-party developers skewed the GameCube toward a younger market, which was a minority of the gaming population during the sixth generation. Many third-party games popular with teenagers or adults, such as the blockbuster "Grand Theft Auto" series and several key first-person shooters, skipped the GameCube entirely in favor of the PlayStation 2 and Xbox. However, many gaming journalists and analysts from the 2000s noted that Nintendo's primary focus on younger audiences, and its family-friendly image, was the biggest advantage and disadvantage at a time when video games were aimed at more mature audiences. Nintendo was successful with games aimed at a more mature audience.


title: GameCube

text: , the GameCube had a 13% market share, tying with the Xbox in sales but far below the 60% of the PlayStation 2. However, with slow sales and tough competition, Nintendo's position improved. The American market share for the GameCube had gone up from 19% to 37% in one year alone due to price cuts and high-quality games. By Christmas of 2003, Nintendo of America's president George Harrison reported that the company's price cuts down to just under $100 quadrupled sales in the American market. GameCube's profitability never reached that of the PlayStation 2 or Game Boy Advance. However, it was more profitable than the Xbox.


title: GameCube

text: GameCube's first two years had slow sales and struggles, and by 2004 and 2005 vastly improved to a 32% share of the hardware market in Europe. Due to price drops, which saved it in the American markets, and high-quality games from various developers, such as "Pokémon Colosseum" and "Resident Evil 4", the GameCube improved to put Xbox down to third place. The top three European countries for GameCube success included the UK, France, and Germany, and modestly in Spain and Italy. Though falling behind the PlayStation 2 in Europe, the GameCube was successful and profitable there.


title: GameCube

text: Many games that debuted on the GameCube, including the "Pikmin" series, "Chibi-Robo!", "Metroid Prime", and "Luigi's Mansion" became popular and profitable Nintendo franchises or subseries.


title: GameCube

text: GameCube controllers have limited support on Wii U and Switch, to play "Super Smash Bros. for Wii U", and "Super Smash Bros. Ultimate" respectively, via a USB adapter.


title: GameCube

text: Regarding concerns about the correlation between violence and video games, a 2009 study by Iowa State University found that certain games like "Super Mario Sunshine" and "Chibi-Robo!", which were GameCube exclusives, would help players learn positive skills about helping others, empathy, and cooperation.


title: Lee Dong-wook

text: Lee Dong-wook (; born November 6, 1981 ) is a South Korean actor, host, model and entertainer. He is best known for his leading roles in the television dramas "My Girl" (2005), "Scent of a Woman" (2011), "The Fugitive of Joseon" (2013), "Hotel King" (2014), "" (2016–2017), "Life" (2018), "Touch Your Heart" (2019), "Hell Is Other People" (2019), "Tale of the Nine Tailed" (2020), and "Bad and Crazy" (2021) in the titular role. He is also the host of the talk show "Strong Heart" (2012-2013), boy group survival reality show "Produce X 101" (2019), and his own American-style talk show "Wook Talk" (2019).


title: Lee Dong-wook

text: Lee made his acting debut in 1999 in an MBC single-episode drama after winning the grand prize in the V-NESS model contest the same year. The PD of the drama saw Lee, and proceeded to cast him in the teen drama "School 2". Lee started to gain recognition with his performance in "School 3".


title: Lee Dong-wook

text: Lee hit stardom with 2005 romantic comedy "My Girl". The drama series became a hit during its run both domestically and across Asia, and made Lee a Korean Wave star. The same year he enrolled in Joongbu University, majoring in media and broadcasting arts.


title: Lee Dong-wook

text: He has since starred in noir "Bitter Sweet Life" (2008), courtroom dramedy "Partner" (2009), melodrama "Scent of a Woman" (2011), baseball rom-com "Wild Romance" (2012), period thriller "The Fugitive of Joseon" (2013), and revenge drama "Hotel King" (2014), in which he reunited with "My Girl" co-star Lee Da-hae.


title: Lee Dong-wook

text: Lee and comedian Shin Dong-yup took over as MCs of talk show "Strong Heart" from April 2012 to January 2013. Lee also joined the reality show "Roommate", which aired from 2014 to 2015.


title: Lee Dong-wook

text: From 2016 to 2017, Lee starred alongside Gong Yoo in Kim Eun-sook's fantasy-romance drama "" playing a grim reaper. The drama was a hit, and along with its success, helped in the resurgence of Lee's acting career.


title: Lee Dong-wook

text: In 2019, Lee starred in the romance comedy drama "Touch Your Heart" alongside "Guardian" co-star Yoo In-na, playing a workaholic lawyer. The same year, he was confirmed as the host for "Produce X101", the fourth season of survival audition program "Produce 101". He then starred as the main antagonist in the thriller drama "Hell Is Other People" as a dentist in the morning but a psychopath in the evening. He also started hosting his own talk show, "Wook Talk", to celebrate his 20th anniversary since debut.


title: Lee Dong-wook

text: In 2020, Lee was cast in the fantasy drama "Tale of the Nine Tailed" as a nine-tailed fox who used to be a mountain god, and is now working as a civil servant. He is also confirmed to appear in the romantic comedy "Single in Seoul" alongside Im Soo-jung.