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Tourette Syndrome

Definition :
People with Tourette syndrome display unusual movements or sounds over which they sometimes have little or no control. For instance, they may repeatedly blink their eyes, shrug their shoulders or jerk their heads. In rare cases, they might even blurt out obscenities.

These kinds of movements and sounds are called tics, and for people with the disorder, they can be extremely distressing. With great effort and concentration, people with Tourette syndrome can sometimes stop themselves from having these tics or hold back the tics until they find a place where it's less disruptive to express them. But most tics must be expressed eventually — it's the nature of the disease.

The condition is named for the French neurologist who first described it in 1885. It's also known as Tourette's syndrome and Gilles de la Tourette's syndrome. Although you may think Tourette is a type of mental illness, it's actually a neurological disorder.

An estimated 1 to 2 percent of American children and adults have Tourette syndrome. However, this may be underestimated because people with mild tics may not even realize they have the disorder. Males are about three to four times more likely than females to develop Tourette.

Although there's no cure, people with Tourette syndrome can live a normal life span, and many don't need treatment when symptoms aren't troublesome. In fact, many children outgrow Tourette syndrome after adolescence.

Causes :
The exact cause of Tourette syndrome isn't known, and there's no known way to prevent it. Theories about the causes of Tourette include :
  • Genetics. Some studies of twins and families suggest that Tourette may be an inherited disorder. No specific gene has been found, but researchers are zeroing in on target genes.
  • Brain structure abnormalities. Some imaging studies show that some regions of the brain are abnormal, including the basal ganglia, the frontal lobes and the cortex.
  • Brain chemical abnormalities. Certain neurotransmitters in the brain may play a role, including dopamine and serotonin.
  • Infections. Some research suggests that there's a link between childhood streptococcal infections and Tourette, but this remains controversial.

Risk Factor :
Some factors may increase the risk of developing Tourette syndrome. These may include :

  • Having a family history of the disorder or other tic disorders
  • Being male
  • Premature birth

When to seek medical advice :
Signs and symptoms of Tourette syndrome almost always begin in childhood, usually showing up between ages 7 and 10. Motor tics usually begin before vocal tics do. Depending on the severity of the symptoms, children themselves may notice the tics, or parents, family members or friends may see them.

If you notice your child displaying unusual movements or behavior, pay a visit to your pediatrician. Not all tics indicate that someone has Tourette syndrome. Many children develop tics that last for a few weeks or months and then go away on their own.

But whenever a child shows unusual behavior, a medical evaluation is important to identify the cause and rule out serious health problems.

Symptoms :
Tics are the hallmark sign of Tourette syndrome. Symptoms range from very mild to severe and debilitating.

The first sign of Tourette is often a facial tic, such as eye blinking. But the spectrum of tics that people experience is amazingly diverse, and there's no typical case.

Tics involve movement (motor tics) and sound (vocal tics). They're classified in two ways:

  • Simple tics, which are sudden, brief and repetitive and involve a limited number of muscle groups
  • Complex tics, which are distinct, coordinated patterns of movements involving several muscle groups
Some of the more common tics seen in Tourette syndrome
Motor tics
Simple tics Complex tics
Eye blinking Touching the nose
Head jerking Touching other people
Eye darting Smelling objects
Finger flexing Obscene gestures
Sticking tongue out Flapping the arms
Vocal tics
Simple tics Complex tics
Hiccuping Using different voice intonations
Yelling Repeating one's own words or phrases
Throat clearing Repeating others' words or phrases
Barking Obscene language

Some people with Tourette experience sensory symptoms or tics before the onset of motor or vocal tics. Sensory tics may include sensations of pressure, tickling, warmth, cold, pain or other feelings.

Tics can vary in type, frequency and severity over time. They may worsen during periods of high stress and anxiety, fatigue, illness, recent head injury or excitement. They can even occur during sleep. People may develop different tics over time. For most people with Tourette, the symptoms are at their worst during the teenage years and then sometimes get better during the transition to adulthood.

Diagnosis :
There's no specific test that can diagnose Tourette syndrome. Instead, doctors must rely on the history of the person's symptoms to diagnose the disorder. To diagnose Tourette, both motor and vocal tics must be present for at least a year. That's because some tics are transient — lasting a few months before going away on their own.

Even so, diagnosis may be delayed because families and even doctors are sometimes unfamiliar with the symptoms, or the symptoms may mimic other problems. Eye blinking may be initially confused with vision problems, for instance, while sniffing may be attributed to allergies. Because the symptoms are sometimes incorrectly attributed to psychological or behavioral problems, your doctor may recommend seeing a psychiatrist.

Because tics and movement problems can be the result of other serious health conditions, your doctor may suggest having tests to rule out other problems. These tests include blood tests or neuroimaging studies, such as magnetic resonance imaging (MRI), computed tomography (CT) scans or electroencephalogram (EEG) scans.

Complications :
People with Tourette syndrome have a normal life span and often lead a healthy, active, happy life. The complications that Tourette may cause are usually psychosocial. That is, they can negatively affect self-image, social relationships, and school or work situations.

In addition, it's not unusual for people with Tourette to develop some mental health problems, including attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorders, depression and anxiety disorders.

Treatment of Tourette syndrome is intended to help control bothersome tics and to help cope with psychosocial aspects of the condition. There's no cure for Tourette. When tics aren't severe, treatment may be unnecessary.

Treatment options include :

  • Medications. Some medications can be used to help control or minimize tics. These may include certain antipsychotic medications, antidepressants, stimulant medications and central adrenergic inhibitors. But none eliminates symptoms completely, and the side effects may outweigh any benefits gained.
  • Psychotherapy. Psychotherapy can be helpful for two reasons. It can help with accompanying problems, such as ADHD, obsessions, depression and anxiety. Therapy can also help people cope emotionally.
  • Brain surgery. In a very limited number of cases, brain surgery has been done in an attempt to stop severe symptoms by removing certain areas of brain tissue. Brain surgery is experimental and is not offered at every medical center.
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