Tourette’s Syndrome

Tourette syndrome (TS) is a neurological disorder. It is characterized by tics, which are repetitive, involuntary movements and vocalizations.

The early symptoms of Tourette’s syndrome are almost always noticed first in childhood, between the ages of 7 and 10 years. Tourette syndrome occurs in people from all ethnic groups; males are affected about three to four times more often than females.

Although Tourette syndrome can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood.

Signs and Symptoms

The presence of tics is the first sign. Tics can be:

Simple tics: They are sudden, brief, repetitive movements that involve a limited number of muscle groups. For example; eye blinking, facial grimacing, shoulder shrugging, and head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing, sniffing or grunting sounds.

Complex tics: Complex tics are coordinated patterns of movements involving several muscle groups. For example; facial grimacing combined with a head twist and a shoulder shrug. Some 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.

Before a tic, an urge can sometimes be felt in the affected group of muscles. Patients may need to complete a tic in a certain way in order to relieve the urge or decrease the sensation.

Tics are often worse with excitement or anxiety and better during calm, focused activities. Tics are significantly diminished during sleep.

Diagnostic Signs

There are no lab tests to diagnose Tourette syndrome. We look for the following signs to confirm the diagnosis;

Presence of one or more motor tics and one or more vocal tics.
Tics occur many times a day, nearly every day, for a period of more than 1 year. During this period, there must not have been a tic-free period of more than 3 months.
Onset of tics should have been before age 18.
The patient has no other brain problem that could be a likely cause of the symptoms.

Course

Tics come and go over time, varying in type, frequency, location and severity. The first symptoms usually occur in the head and neck area and may progress to include muscles of the trunk and extremities. Motor tics generally precede the development of vocal tics and simple tics often precede complex tics. Tics peak in severity before the mid-teen years with improvement for the majority of patients in the later years. Only 10 percent of those affected have a progressive or disabling course that lasts into adulthood.

Associations of Tourette Disorder

The syndrome may be linked to problems in certain areas of the brain. Some problem with production and working of the chemical messengers in the brain (dopamine, serotonin, and norepinephrine) is linked with this disorder.

Other Facts

Tourette’s syndrome is different from obsessive-compulsive disorder (OCD). There is a difference in the basic pathophysiology.

Treatment

Patients of this syndrome with very mild symptoms are not treated, because the side effects of the medications may be worse than the symptoms of turrets disorder. For severe cases, medications are given for symptomatic relief.

Medications include:

Anti-seizure drugs
Medication to keep blood pressure under check, if required.
Botulinum toxin injections can be given to control some motor tics, especially on the face.
Dopamine blockers, (such as fluphenazine, haloperidol, pimozide and risperidone) can help control or reduce tics, but they have side effects.
Deep brain stimulation by Electric therapy is still in its research phase.

With medications, patients usually have normal intelligence and live a normal-length life.

Patients with Tourette can have behavioral problems. They include:

Anger control issues
Attention deficit hyperactivity disorder (ADHD)
Impulsive behavior
Poor social skills