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Tourette's syndrome is also called Tourette syndrome or Gilles de la Tourette syndrome and is a condition of unusual, repetitive behaviors and the making of sounds, known as tics. If you have Tourette syndrome, you have no control over the urge to have tics. Common tics you may have include repetitive words, such as profanities, throat-clearing, blinking behaviors, spinning behaviors or movements of the hands or arms. It occurs in 1 percent of individuals and is related to having ADHD, obsessive compulsive disorder, anxiety, and depression.
The symptoms of Tourette syndrome usually begin in childhood between the ages of 7 to 10 years of age. It affects boys three to four times as much as girls and about 200,000 individuals have the most severe type of the disease. Tourette syndrome tends to worsen in the teen years and then tends to get better over time so that it disappears in adulthood at some point in time.
The symptoms of Tourette syndrome can be simple tics or complex tics. Simple tics involve a single muscle group and involve eye blinking, facial grimaces, shoulder shrugging, or jerking of the head or shoulders. Complex tics are more significant and can involve a combination of muscle groups. There can be shoulder shrugging accompanied by head jerking, vocalizations that are more complex, hopping, jumping, sniffing, barking or grunting. Words or phrases are not uncommon in complex tics. Tics are preceded by a strong urge to do the tic that can be held off for a short period of time with practice. Only the doing of the tic actually relieves the strong urge to do the tic.
Things like excitement or anxiety can contribute the formation of tics and when you are calm or focused, the tics are less. Other triggers for tics include having a tight collar around your neck (for neck tics). Tics tend to decrease during sleep but do not go away altogether. Tourette syndrome tends to wax and wane over time and begin usually in the head and neck area. Motor tics occur before the vocal tics and simple tics tend to precede complex tics. Tics worsen before the mid-teens and then go away, although ten percent of individuals have a progressive course that continues into adulthood.
The exact cause of Tourette syndrome is not known but some research indicates abnormalities in the frontal lobes, basal ganglia or cortex of those who suffer from the disease. Neurotransmitters including dopamine, norepinephrine and serotonin seem to be related to the development of Tourette syndrome. Patients with Tourette syndrome have related disorders of inattention, impulsivity and hyperactivity, consistent with ADHD. They can have learning disorders as well. Obsessive compulsive behavior is related to having Tourette syndrome and they may worry about germs and dirt, repetitively washing their hands or doing other ritualistic behaviors.
The diagnosis of Tourette syndrome is made after the child has had the symptoms of TS for at least a year. Other psychiatric conditions may coexist with Tourette's symptoms. There aren't any blood or lab tests that can diagnose the disease and it is specifically a function of a thorough history and physical examination. In situations of mild tics, it may be years before the tics are recognizable as Tourette syndrome. Some kids can have single tics that are not Tourette syndrome at all but represent only one tic that does not progress to multiple tics.
Because the tics of Tourette syndrome are not dangerous, they are not often treated, especially if mild. Neuroleptic medications are often used for complex or severe tics with some suppression of the tics noted. These can include haloperidol and pimozide, both neuroleptics. No specific medication works for all cases so different medications may need to be tried to control the tics. There can be side effects with neuroleptics that need to be taken into account when taking these medications. Parkinsonian-like symptoms are negative side effects of neuroleptic medications. Dystonic reactions (twisting of the neck or body) are also side effects of neuroleptics that make them less than great medications for some patients to take. Tardive dyskinesia is a permanent side effect of neuroleptic medications that should be avoided at all costs.
Alpha adrenergic medications have been tried in Tourette syndrome, including clonidine and guanfacine. They are blood pressure medications that both work against Tourette syndrome. Stimulant medication used to treat ADHD also seems to block the tics in Tourette syndrome. Obsessive compulsive medications, such as clomipramine, fluoxetine and paroxetine, among others, help some patients with Tourette syndrome. Psychotherapy is helpful in patients with TS in order to help them cope with the symptoms and to block the urges until a more appropriate time.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here