What Is Tourette Syndrome?
Tourette syndrome is one of the tic disorders, which is a group of neurological disorders that makes a person perform involuntary repetitive movements or tics (vocal outbursts). The cause of this syndrome is still not clear. Actions like repeated eye blinking, making unusual sounds all of a sudden, sniffing, grimacing, and shoulder or head movements, which cannot be controlled easily, are commonly seen in this syndrome. They usually start at around five to ten years of age and mostly in children who are six years of age. Boys are more susceptible than girls.
Tourette syndrome was named after Dr. Georges Gilles de la Tourette, a French neurologist who described this condition first in a French noblewoman in 1885. Currently, treatments are available for this syndrome, but there is no cure. If the tics are not severe, then treatment is not necessary, as they usually lessen and can be controlled when the child crosses his or her teen years.
The National Institute of Neurological Disorders and Stroke (NINDS) estimated around 200,000 people in the U.S. experience severe symptoms of this syndrome. And around 1 in 100 people show milder symptoms.
What Are the Types of Tics Seen in Tourette Syndrome?
The two types of tics are:
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Motor Tics - Jerky body movements are called motor tics. Some examples are eye blinking, nose twitching, or arm jerking.
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Vocal Tics - Sudden and involuntary sounds that a person makes are called vocal tics. Examples include grunting, barking, or shouting a word.
These tics can either be:
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Simple - It usually only includes one or a few body parts.
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Complex - It involves several body parts.
What Are the Symptoms of Tourette Syndrome?
Symptoms occur between five to ten years of age, varying from one patient to another. This syndrome starts with small motor tics in the head or neck, which then appear in the trunk and limbs. These tics worsen during periods of excitement, anxiety, and stress and improve when the patient is calm or doing some activity.
In most patients, these tics decrease during early adulthood or might disappear. But in some rare cases, the tics become worse as they age.
What Causes Tourette Syndrome?
Tourette syndrome is believed to be caused by abnormalities in the electrical responses and other parts of the brain. The exact cause is unknown, but as the basal ganglia control the motor movements, any abnormality in it might result in TS. It is also hypothesized that problems in neurotransmitters, which are chemicals that transmit nerve impulses, can also cause this. The common neurotransmitters include dopamine, serotonin, and norepinephrine.
As the cause is not definitive, this condition cannot be prevented. Some scientists believe that a genetic defect might cause it, and they are working towards identifying the responsible genes.
What Are the Risk Factors of Tourette Syndrome?
The risk factors of Tourette syndrome include:
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A positive family history.
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Male predilection, as they are three to four times more susceptible than females.
How Is Tourette Syndrome Diagnosed?
Because the cause is unknown, there is no specific test for TS. The doctor might diagnose this condition based on the signs and symptoms. The criteria used are:
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The patient should have or had both motor and vocal tics, but might not be at the same time.
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If the patient has tics many times a day or every day for more than a year.
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If the tics started before 18 years of age.
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These tics should be independent and should not be due to some other condition, medicines, or substances.
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The intensity, location, frequency, and complexity of tics must change with time.
The signs of Tourette syndrome are often overlooked, as they can mimic other conditions. For example, sniffing can be due to allergies and eye blinking due to eyesight problems. The doctor will suggest blood imaging tests to rule out other causes of the symptoms.
The other conditions that are often associated with TS are:
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Obsessive-compulsive disorder or OCD - (a mental illness that leads to unwanted thoughts or sensations (obsessions) or the urge to do something over and over again).
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ADHD or attention-deficit hyperactivity disorder (causing attention difficulty, hyperactivity, and impulsiveness).
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Autism spectrum disorder (developmental disability causing problems with social communication and interaction and restricted or repetitive behaviors or interests).
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Sleep disorders.
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Learning disabilities.
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Anxiety disorders.
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Depression.
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Anger-management problems.
How Is Tourette Syndrome Treated?
For patients who do not have severe tics, treatment might not be needed. If the tics are severe or if they worsen with age, several treatment options are available. The treatment options include:
Behavioral Therapy or Psychotherapy - Behavioral therapy involves awareness training, competing response training, and cognitive-behavioral intervention for tics. It also helps in cases of OCD, ADHD, and anxiety.
The therapist might also try psychotherapy, which includes hypnosis, relaxation techniques, meditation, and deep breathing exercises. Group therapy might be helpful, as the patient will be with people of the same age who are also suffering from TS.
Medications - There is no medicine available to cure TS. But to relieve symptoms, the doctor might prescribe drugs such as:
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Aripiprazole, Haloperidol, and Risperidone (these drugs block dopamine receptors in the brain).
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Botox injections (to manage simple tics).
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Methylphenidate (helps reduce the symptoms of ADHD).
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Clonidine (help reduce tics and manage anger).
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Topiramate (to reduce tics).
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Cannabis (this has been shown to stop tics in adults).
Deep Brain Stimulation (DBS): It is a type of neurological therapy used for people with severe tics. Here, the doctor implants a device in the brain, which helps stimulate the parts that control movements. Its use for TS patients is under investigation.
Talk to a doctor about the risks and benefits of various treatment options before trying them. As mentioned earlier, the symptoms of most patients improve during late teens or early adulthood. And for some, the symptoms may stop suddenly. TS does not affect the intelligence or life expectancy of a person but can result in depression, panic attacks, and anxiety. Even if the symptoms improve over time, a person might still need treatment and therapies to manage complications.
Conclusion:
Tourette syndrome is a neurological disorder that can start in early childhood and usually decreases in early adulthood. Various therapies and medications are used to treat this condition, and this disorder can only be managed with the help of neurologists or psychiatrists.
