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Tourette Syndrome
Also called Tourette's Syndrome
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Tourette syndrome is a peculiar neurological condition in which the affected individuals display strange movement or make strange sounds with little control over the behaviors, which are called tics. The tics can involve shoulder shrugging, jerking movements of the head or blurting out obscenities. It often begins in childhood between the ages of 7 and 10. It is about 3-4 times more common in males than in females. There is no cure for Tourette syndrome but, with treatment, a person can live out a normal life. In fact, there are many who have Tourette syndrome in childhood that outgrow it in adolescence.
The tics can be simple tics or complex tics. Simple ticks involve simply a few muscle groups while complex tics are coordinated patterns of behavior. Tics can be motor, such as eye blinking or can be vocal, in the saying of a word or words. Motor tics usually start before vocal tics but the disease has diverse presentations.
Some simple motor tics involve head jerking, eye blinking, eye darting, shoulder shrugging, sticking of one's tongue out, and flexing of the finger or fingers. Complex motor tics involve touching other people, touching the nose, obscene gestures, smelling things, flapping the arms, and hopping around. Simple vocal tics include hiccupping, yelling, clearing the throat and barking. Complex vocal tics include changing the intonation of the voice, repeating statements over and over again, using expletives or copying another's words or phrases.
Tics can get worse during times of anxiety and stress and vary in frequency over time. They can happen while one is awake or asleep. There is often a premonition or urge to have the tic before the tic is then performed. Sometimes the sufferer can wait with an urge until it is a more appropriate time for the tic to be displayed. It feels to the sufferer that the urge is like an itch or tingling sensation that cannot be passed up. When the tic is expressed, the symptom of the urge is relieved.
Not every sufferer of Tourette syndrome has the same tics-either from one another or at different times in their life.
Not all tics represent Tourette syndrome. Some tics last only a month or a few months and then disappear. Speak to your doctor if your child has tics to see if this might involve Tourette syndrome or a benign form of tic.
The cause of Tourette syndrome is not yet known but it appears to be related to genetics. Certain genes have been identified as being related to Tourette syndrome but it is likely a combination of environmental and genetic factors. There may be abnormalities in the neurotransmitters of the brain, including dopamine and serotonin that play a role in the development of Tourette syndrome.
There is no specific test for Tourette syndrome but it is definable according the Diagnostic and Statistical Manual of Mental Disorders or DSM. The criteria to diagnose Tourette syndrome include having vocal and motor tics together but not necessarily at the same time. The onset must occur before the age of 18 and the tics must occur several times per day or at least every day for up to a year. There can't be a break in tics for three months out of that year. Medications or other medications cannot be the cause of the tics.
Because other things can mimic Tourette syndrome, the doctor may check out the patient for other health conditions such as doing an MRI of the brain or a CT scan of the brain.
There is no cure for Tourette syndrome. There are medications and other things that can be used to reduce the degree and severity of the tics. There are drugs that block dopamine in the system, such as Orap and fluphenazine. These can control tics to some degree but have side effects including gaining weight and feeling a dullness of the mind. The person can have botulinum toxin injected into the affected muscle to block a facial tic. Medications like Concerta and Ritalin stimulate the brain and improve attention for those who also have ADHD interfering with their Tourette syndrome. Catapres or clonodine can help impulse control and attacks of rage. Antidepressants like Prozac and others have had some usefulness in the treatment of tics from Tourette's syndrome.
Psychotherapy can help control the depression and anxiety that can accompany Tourette syndrome and can teach those who have it to control some of their urges, at least for a period of time. Debilitating tics need to be treated with deep brain stimulation, which involves a neurostimulator that is battery operated and that helps decrease tics. This is rarely used medical device and needs more study in order to be useful to more people with Tourette syndrome.