Tourette's syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 24, 2016
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Tourette's syndrome (TS), or Tourette's disorder, is named after French neurologist Dr. Georges Gille de la Tourette, who treated nine patients with the disorder in the 1800s. TS is a tic disorder, causing tics and outbursts, and is more common among males than females. While there is no cure, in many instances, it can be managed.

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Definition & Facts

Tourette's syndrome is a neurological disorder characterized by involuntary tics and vocalizations and often the compulsive utterance of obscenities. The disorder can be spotted as early as two years old, and is often diagnosed by the time a person is 21 years old.

It is possible to outgrow Tourette's, and it can carry symptoms that are mild, moderate, or severe. In some cases, the symptoms are debilitating. Males are about three times as likely to have it as females. Approximately 100,000 Americans suffer from Tourette's.

Symptoms & Complaints

Tourette's disorder is mostly characterized by tics. Tics are involuntary, quick, intermittent movements and sounds that are sometimes preceded by a sensation, such as a tingle. Tics can range from hardly noticeable to loud and interruptive, both for the person suffering, as well as the people around him/her.

There are two types of tics: motor and vocal. Motor tics, or tics that involve movement, can range from mild to severe. Examples of mild motor tics are jerking of the arm or the head, eye blinking, shoulder shrugging, and mouth movements. Severe motor tics might involve unusual repetitive movements, obscene gestures, and touching and/or smelling objects at socially inappropriate places and times.

The other type of tic, the vocal tic, involves sounds like, grunting, barking, coughing, and throat clearing. More severe vocal tics may include repeating words or phrases, and yelling obscenities or swearing.

Causes

Experts are still unsure of the cause of Tourette's disorder. It is possibly a combination of genetic factors and environmental factors. Recently, scientists have discovered that Tourette's may be caused by abnormalities in certain regions of the brain (including the frontal lobe, cerebral cortex, and basil ganglia), the interconnecting circuits of those regions, and the neurotransmitters that help the nerve cells' communication with each other. When damaged, serotonin, dopamine, and norepinephrine (neurotransmitters of the brain) can cause the tics that characterize Tourette's.

Oftentimes, a person with Tourette's does not suffer from TS as a sole disorder. They might also have attention deficit hyperactive disorder (ADHD), obsessive-compulsive disorder (OCD), or autism. It is also common for those with Tourette's to deal with learning disabilities, sleep disorders, anxiety disorders, and depression. Their tics can cause headaches, and it is not rare for them to experience aggression. Since Tourette's is so complex, it is likely that the cause(s) are equally so.

Diagnosis & Tests

Tourette's can be self-diagnosed. There is no blood test, lab test, X-ray, or other definitive, physical test, to determine whether or not an individual suffers from Tourette's. A diagnosis is based purely on symptoms. However, health care professionals use certain metrics to determine if the disorder is present.

First, the patient has have experienced tics when they were younger than 18 years old. At least motor tics must be present and at least one vocal tic must be present. In addition to the tics being present, they have to occur throughout the day, mostly everyday, for at least a year. Finally, the tics must not be caused by another source, such as medications or other medical conditions, for example.

While diagnostic testing cannot determine whether Tourette's is present in a patient, it can help to determine if the tics are caused by another health problem. It is quite normal for a patient to have Tourette's without being diagnosed for a substantial period of time. This is because tics may be mistaken for something different, or because many people self-diagnose and skip a formal diagnosis from a doctor or specialist.

Treatment & Therapy

Since symptoms of Tourette's do not usually cause impairment, there is no prescription medication to offer patients. There is, however, a speciality in occupational therapy called "comprehensive behavioral intervention for tics," or CBIT. It does not involve drugs, and it entails four components.

Initially, the therapist teaches the patient to be more mindful, or aware, or their tics. After that, the therapist teaches the patient methods to encourage other behaviors to substitute for the tics. Third, the therapist helps the patient to modify activities that can bring on tics, in order to reduce them. Finally, together, they focus on the fact that particular environments can cause tics, so it is beneficial to try to avoid such environments. This is called “functional intervention," and teaches the patient practical ways to help his/her symptoms subside.

CBIT can also involve anger management, since many people with Tourette's deal with anger due to their condition. However, treatment may be completely unnecessary, as many people outgrow the syndrome with age.

Prevention & Prophylaxis

Presently, experts have found that there is no way to prevent TS. However, early detection and treatment can reduce the tics and make them easier to deal with, which, in turn, can reduce several problems that accompany the disorder. Due to the nature of Tourette's, fortunately, a diagnosis does not have to be the end of an enjoyable, mostly normal life.

In fact, the hit show American Ninja Warrior highlighted a female competitor who suffers from both TS and obsessive-compulsive disorder, although "suffers" may not be the right word, because she hasn't let it keep her from competing on the biggest stage of her life. With care, Tourette's can be managed through therapy and careful attention.

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