Tourette Syndrome Facts

Tourette syndrome (TS) disorder causes the individual to have repetitive movements and sounds (called tics), which cannot be easily controlled. Tics may include grunting, blinking eyes, darting eyes, mouth twitching, shoulder shrugging, head jerking, barking, coughing, throat clearing, nose twitching, or the individual may blurt out unusual sounds. Complex tics result in repeating words or phrases or using that are vulgar, obscene or saying swear words.

A tic is a sudden, often brief sound or movement. These are the hallmark signs of tourette syndrome. Some are mild and other severe. The severe symptoms may cause a problem with communication, quality of life or even daily functioning.

The more severe cases of this syndrome cause people to touch or smell objects. The may repeat observed movements, step in a particular pattern, use obscene gestures, or they may bend or twist.

Typically, tics begin in children between the ages of 2 to 15 years of age. The average age is about 6 year old. Male children are 3 to 4 times more likely to get tourette’s syndrome. If you observe your child with any type of tic, see your pediatrician. Not every tic indicates Tourette syndrome. Doctors typically do not diagnose a patient with Tourette syndrome until they have had both vocal and motor tics for a period of one year.

Several neuroimaging studies are typically ordered to rule out other conditions, which may be confused with Tourette syndrome. Neuroimaging studies include: MRI, CAT scan, EEG (electroencephalogram) or some blood tests.

Samuel J. Comroe recently appeared on America’s Got Talent as a comedian, and he has Tourette syndrome. He came in fourth in the final talent show, and he is very funny. This man has dealt with his TS symptoms, and he has made the best of his situation.

The cause of this disorder is unknown, but it does tend to run in families, so there is a genetic component. Researchers also believe there is an environmental component, but they do not have any specifics.

Mayo Clinic defines the tics into simple tics or complex tics. Simple tics use a limited number of muscle groups. The complex tics are more coordinated patterns of movement involving several additional muscle groups.

Tics may involve movement or sounds, however, the spectrum of tics a patient may experience is diverse. Patients tend to get motor tics before vocal tics develop. Tics can vary in intensity and may worsen during stressful or excited times. They can occur during sleep. They often get worse during teen years and improve as the teen reaches adulthood. It is possible for a person with TS to hold back or stop a tic, but it takes great effort.

There is no cure for this disorder, but there are available treatments for some of the symptoms. However, many patients do not need treatment when their symptoms are not a problem. Tics frequently lessen as teens age, and the symptoms may be controlled much better for young adults.

Medications that are used with more severe cases include:

• Haldol (haloperidol), Fluphenazine, Risperdal (risperidone) and (Orap) may control tics. Side effect may include weight gain or involuntary repetitive movements.
• Botulinum (Botox) injections, which is injected into the most affected area.
• ADHD medication includes stimulants, such as Metadate CD (methylphenidate) and Ritalin, however, sometimes ADHD medications may exacerbate the tics.
• Catapres, Kapvay and Intuniv (guanfacine) are usually prescribed for hypertension but they are sometimes prescribed impulse control or rage attacks.
• Medications for seizures or epilepsy, such as Topamax (topiramate) may also be used for TS.
• Several types of antidepressants, such as Prozac or Sarafem may control symptoms of anxiety, sadness and OCD.

These medications along with psychotherapy or behavior therapy may be tried in order for the patients to live a fully functioning life. The most common side effects of these medications include: sedation, weight gain and cognitive dulling.

Deep brain stimulation (DBS) is being used at Mayo Clinic by neurosurgeons as a treatment for TS patients who do not respond to other treatments, yet have the more complex tics.

Researchers have found some specific abnormalities in particular areas of the brain that include the basal ganglia, the frontal lobes and the brain’s cortex and the circuits that interconnect these areas. The NIH is currently studying the brain and nervous system of patient with TS.

This research also includes the neurotransmitters, which include serotonin, dopamine and norepinephrine. They are responsible for communication between these regions of the brain. TS has such a complex presentation, with varying types of tics that the cause is also complex. The epidemiological studies currently estimate the TS prevalence is higher than previously thought, and it has a wider range of clinical severities.

Other neurobehavioral problems may occur with this condition. The worst effect may be motor tics that result in punching oneself in the face or perhaps some inappropriate words that are considered socially inappropriate. It may be coprolalia, which is saying swear words or other unacceptable phrases. Only 10% to 15% of people with TS have coprolalia.

Associated Conditions Include:

• Anxiety disorders
• Learning Disabilities
• Impulsivity - attention-deficit/hyperactivity disorder (ACHD)
• Autism spectrum disorder
• Learning disabilities
• Depression
• Sleep disorders
• Pain related to tics, headaches are the most frequent complaints
• Problems with managing anger

Reading, writing, and arithmetic may be a problem for children with this disorder. It is obviously difficult for some children as their tics are frequent when they are in school.

People with Tourette syndrome frequently lead normal, active lives; however, TS can lead to a harmful self-image due to the social and behavioral challenges that may occur. Numerous clinical studies are being completed by scientists to discover the cause of this disorder and the treatments.

• https://www.tourette.org/about-tourette/overview/what-is-tourette/?gclid=CjwKCAjwio3dBRAqEiwAHWsNVRSDVI6NPzJJktw4Nyzty3esS9frx-i3-qCLxiXADokxavb5003fQxoCK6gQAvD_Bw
• https://www.mayoclinic.org/diseases-conditions/tourette-syndrome/symptoms-causes/syc-20350465
• https://www.cdc.gov/ncbddd/tourette/treatments.html