Tourette's Syndrome

Genetic disorder DNA

What is Tourette’s syndrome?

Tourette’s syndrome is a type of tic disorder. Tics are uncontrollable movements or involuntary sounds made by a person which is usually caused by some issue in the nervous system. Tic disorders such as Tourette’s syndrome are generally childhood-onset neurodevelopmental issues. Tic disorders are of  3 types – Tourette’s syndrome , Chronic Tic Disorder, and Provisional tic disorder. Tourette’s syndrome is defined as a tic disorder with involuntary movements (motor). Chronic tic disorder could be either motor or vocal. And Provisional tic disorder comprises of both types of tics. 
 
Tourette’s syndrome is said to onset when an individual has experienced at least 2 motor tics and 1 vocal tic within one year. Chronic Tic disorder patients show only one type of tic for a longer period of time. Provisional tic is supposed to occur if there are tics but for a shorter duration of time. 
 
People with Tourette’s may seek a secluded spot to release their symptoms, or there may be a marked increase in tics after a period of suppression at school or at work. 
 

What could be the cause of Tourette’s syndrome?

Genetic disorder DNATourette’s syndrome exact cause is still unknown. In fact, none of the Tic disorders have any known cause as such. It has been observed to have genetic origins. In most cases, Tourette’s syndrome is passed through heriditary. Scientists have reasons to believe that the exact cause or causes of Tourette’s syndrome can be best explained as a series of complex interactions between genetic and other environmental factors. 

Having said that, the areas of brain that could be associated with Tourette’s syndrome  have been recently identified. The part of brain linked with the tics of Tourette’s syndrome is actually the basal ganglia, the section of brain responsible for controlling bodily movements.

The difference between the nerve cell and neurotransmitters in normal human beings and individuals with Tourette’s syndrome can provide the missing link in understanding the real cause of Tourette’s syndrome.

What are the main signs and symptoms of this condition?

These are the main symptoms exhibited by a person with Tourette’s syndrome :
 
Physical tics can manifest in the form of 
– Blinking
– Eye rolling
– Sudden jerks in limbs
– Shrugging shoulder
– Jumping
– Twirling
– Touching other people 
 
Vocal tics can be seen in the form of 
– Unexplained coughing
– Grunting
– Whistling
– Clicking noises
– Animal sounds
– Saying words involuntrailty
– Repeating a sound/phrase
 
The severity and frequency of these tics can vary and generally tend to be high during 
 
– Fatigue
– Illness
Anxiety
– Stress
 
People with Tourette’s syndrome can also show behavioral symptoms such as 
 
– Antisocial mannerisms
– Episodes of sudden rage
– Socially inappropriate behavior
 
Individuals with Tourette’s syndrome often get a feeling or a sensation much like the one gets before sneezing, just before they experience a tic. These can be in the form of :
 
– Burning sensation in the eyes
Sore throat
– Itchy feeling in the joints
 
In some cases these tics can be controlled, but it can get exhausting trying to control or limit them. With concentration and practice it is possible to control tics to some extent. The frequency of these tics reduce if the individual is engrossed or engaged in some activity like reading a book.  Children may be less aware of the premonitory urge associated with tics than are adults, but their awareness tends to increase with maturity. Most cases of Tourette’s in older individuals are mild and almost unnoticeable
 
Other complex motor tics may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting. Simple vocal tics may include throat-clearing, sniffing/snorting, grunting, or barking. More complex vocal tics include words or phrases.  Perhaps the most dramatic and disabling tics include motor movements that result in self-harm such as punching oneself in the face. 
 

How is Tourette’s syndrome diagnosed?

This condition is diagnosed by a neurologist. There are no specific tests or scans to diagnose this condition. However, MRIs and CT-scans would be required to rule out other neurological conditions that may present similar symptoms of involuntary movements. The condition is diagnosed as Tourette’s syndrome if there have been a number of cases of tics in the past one year and the onset of these tics have happened before the age of 18.

This condition is frequently misdiagnosed or underdiagnosed owing to the similarity of symptoms with many other neurological disorders and high variance in severity and frequency of tics. The diagnosis mainly includes finding about the family history of the patient for Tourette’s syndrome and ruling out other causes of tics.

Can Tourette’s syndrome be treated?

In many cases, Tourette’s syndrome presents as a benign condition and doesn’t require any treatment at all.There is no cure for Tourette’s syndrome. Treatment protocol mainly includes medications that can bring down the severity of the involuntary motions and/or vocals.Neuroleptics (drugs that may be used to treat psychotic and non-psychotic disorders) are the most consistently useful medications for tic suppression; a number are available but some are more effective than others (for example, haloperidol and pimozide). 
 
Many neuroleptic side effects can be managed by initiating treatment slowly and reducing the dose when side effects occur. The most common side effects of neuroleptics include sedation, weight gain, and cognitive dulling.  Neurological side effects such as tremor, dystonic reactions (twisting movements or postures), parkinsonian-like symptoms, and other dyskinetic (involuntary) movements are less common and are readily managed with dose reduction.
 
Discontinuing neuroleptics after long-term use must be done slowly to avoid rebound increases in tics and withdrawal dyskinesias. 

Is it possible to prevent the onset of Tourette’s syndrome?

adhd adultSince this condition is largely genetic, there are no preventive methods for Tourette’s syndrome. Although there is no cure for Tourette syndrome, the condition in most people improves in the late teenage phase and early 20s. As a result, some may actually become free from the symptoms or no longer need medication for tic control.

Although Tourette syndrome is generally lifelong and chronic, it is not a degenerative condition, unlike many other neurological disorders. Individuals with Tourette syndrome  have a normal life expectancy and this condition does not impair intelligence or cognitive skills. Although tic symptoms tend to decrease with age, it is possible that the comorbid neurobehavioral disorders such as ADHD, OCD, depression, generalized anxiety, panic attacks, and mood swings can persist or even increase and cause impairment in adult life.

Facts

  • Tourette’s syndrome is reported in almost 1% of all school-age children and teenagers.
  • Tourette’s syndrome  is named after Gilles de la Tourette, a French neurophysician who first published a paper on this disease.
  • In the USA, 1 out of every 160 children have been diagnosed with this condition.

Facts

  • This condition is 3 to 4 times more common in boys than in girls.
  • It has been observed that Tourette’s syndrome is comorbid with ADHD and OCD. 
  • In the past, Tourette’s syndrome was treated as a largely bizzare condition and similar to coprolalia (where one utters obscene or derogatory words). 

Facts

  • Studies have found that 8% of young people with autism had comorbid Tourette syndrome, while a second found that 20% of Swedish school-age children with Asperger syndrome also met full criteria for Tourette syndrome, with 80% having tics of some kind or another. 

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Dos and Don'ts

Dos
  • If the child’s tic severity is too high, he/she should be placed in an educational institute that meets the child’s needs.
  • Beware of the side-effects the medications can cause. 
  • Learn about all the environmental triggers that can cause tics such as stress or excitement.

 

Don'ts
  • Stop medications abruptly or change dosage without consulting the doctor
  • Refrain from getting proper professional help in case the symptoms become worse. 

 

 

 

 

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