Tourette syndrome – Definition
Tourette syndrome (TS) is a chronic, neurological disorder that is a member of a larger group of primary tic disorders. It is characterized by motor and vocal tics. Both motor and vocal tics must be present, though not necessarily at the same time. Tics must be present for more than one year, and its onset must be prior to age 18. Tics are rapid, involuntary movements or sounds that occur repeatedly.
Tourette syndrome – Causes
The cause of TS is unknown. However, brain chemicals, called neurotransmitters, are likely involved. Dopamine and serotonin are most likely involved. In addition, stress and tension often increase tics.
In many cases, TS is inherited. However, some patients may have milder tic disorders or obsessive-compulsive symptoms with no tics. Sometimes there are no symptoms.
Some people with TS have no known family history of TS, tics, or obsessive-compulsive symptoms. Researchers are studying whether other factors, such as birth-related issues, infections, and autoimmune problems, may contribute to TS.
Tourette syndrome – Risk Factors
Tell your doctor if you have any of these risk factors:
- Family history of TS, other tic disorders, or obsessive-compulsive disorder
- Sex: male (three to four times more likely to be affected)
There are many secondary causes of tics including:
- Hereditary disorders
- Carbon monoxide poisoning
- Traumatic brain injury
- Cerebral infections
- Illegal drugs
Tourette syndrome – Symptoms
Symptoms range from mild-to-severe, but most cases are mild. They can occur suddenly, and the length of time they last can vary. Tics may temporarily decrease with concentration or distraction. During times of stress, they may occur more often.
Tics are divided into motor and vocal, and then subdivided into simple and complex. The following are common examples:
- Motor tics
- Simple — eye blinking, facial grimacing, head jerking, arm or leg thrusting
- Complex — jumping, smelling, touching things or other people, twirling around
- Vocal tics
- Simple — throat clearing, coughing, sniffing, grunting, yelping, barking
- Complex — saying words or phrases that do not make sense in a given situation, saying obscene or socially unacceptable words (called coprolalia)
Many people with TS also have one or more of the following problems:
- Compulsions and ritualistic behaviors
- Attention deficit disorder with or without hyperactivity (ADD or ADHD)
- Learning disabilities
- Difficulties with impulse control
- Sleep disorders
While tics may occur throughout life, older teens may find that symptoms improve. In less than 10%-40% of cases, people have remission from symptoms.
Tourette syndrome – Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Some doctors may order an magnetic resonance imaging (MRI) scan, computed tomography (CT) scan, electroencephalogram (EEG), or blood tests to rule out other disorders.
Tourette syndrome – Treatment
Education (eg, learning more about the condition) and therapy are often parts of the treatment plan. In some cases, medicine may be needed.
Education and Therapy
- Learning about TS is a very important part of treatment. Education can also be helpful for your family, friends, and coworkers.
- Behavior therapy can help people with TS learn to substitute their tics with other movements or sounds that are more acceptable.
- Cognitive behavioral therapy can help reduce obsessive-compulsive symptoms.
- Psychotherapy can help people with TS and their families cope with the disorder.
In addition, relaxation, biofeedback, and exercise can reduce help to reduce stress.
- Several medicine can help control tics, including:
- Clonidine (Catapres), pimozide (Orap), risperidone (Risperdal), and haloperidol (Haldol)
- Newer antipsychotic medicines, such as aripiprazole (Abilify) and ziprasidone (Geodon)
- Obsessive-compulsive symptoms may be treated with:
- Fluoxetine (Prozac), clomipramine (Anafranil), sertraline (Zoloft), or other similar medicines
- Symptoms of ADHD may be treated with:
- Stimulants, such as methylphenidate (Ritalin), pemoline (Cylert), dextroamphetamine sulfate (Dexedrine), or tricyclic antidepressants
Tourette syndrome – Prevention
There is no known way to prevent TS.