Tourette Syndrome – Symptoms, Treatment, Facts, Causes

What is Tourette syndrome?

Tourette syndrome (TS) is a neuropsychiatric disorder characterized by phonic tic and motor tics. Tourette syndrome is also called Turrets syndrome, Gilles de la Tourette syndrome (GTS) or Tourette’s. It is an inherited disorder that initially occurs during childhood. Motor tics involve repetitive, sudden, non-rhythmic body movements while vocal or phonic tics involve sudden utterances from minor muscle groups.

Motor tics result during muscle movements. On the other hand, vocal tics are involuntary sounds that result from the movement of air along the nasal passages, oral cavity and throat. The appearance of tics usually wax and wane and can also be suppressed temporarily.

A Child with Tourette syndrome Exhibiting Motor Tics

Turret’s was considered a peculiar or bizarre condition because of uttering of socially inappropriate known as coprolalia. With the long-term study of Tourette syndrome, it is now considered a condition and not a bizarre characteristic.

Tourette syndrome commonly arises during childhood, with the severity and gravity of the condition becoming milder as the child grows. The incidence of Turret’s in children and adolescents is up to 3.8%. The most common tics experienced by children include coughing, eye blinking, sniffing, throat clearing and facial movements. Turrets syndrome is uncommon in adults, but it can cause severe tics when it occurs.

Epidemiology

Tourette syndrome incidence is higher in children than in adults. The tics usually subside with age and the diagnosis is not usually made in adults because of mild symptoms. When children enter adolescence, the tics usually fade. In fact, almost 25% of case becomes tic free during adolescence, more than 50% has milder symptoms and only less than 25% has persistent condition.

Turrets does not affect specific race, but is up to 4 times more evident in males than in females. Tics may be chronic or transient. Chronic tics comprise up to 5% of cases and most cases are transient.

Pathophysiology

Tics result from the defects on the basal ganglia, thalamus, frontal cortex, subcortical regions and cortical regions. Because of these, there is a dysfunction in the connections of the cortex and subcortex in the brain.

Tourette syndrome Symptoms & Facts

Tics are the most eminent sign of Tourette syndrome. It occurs unpredictably and intermittently during motor activities. Tics usually wax and wane meaning that the severity and frequency of tics may increase or decrease. The tics are highly individualized. Aside from waxing and waning, tics may also present in bouts.

Other symptoms of Tourette syndrome include:

Vocal Tics

• Coprolalia- This is the most popular symptom of Tourette syndrome because it usually catches the attention of many people. Coprolalia involves the uttering of socially unacceptable words or taboo phrases. However, this may not be present in all patients and is not considered a diagnostic criterion for Turret’s.
• Echolalia– This involves the uttering of words stated by other people.
• Palilalia– Palilalia involves the repetition of own words

Motor Tics

• Repetitive eye blinking
• Repetitive throat clearing
• Sniffing
• Facial movements

Motor tics usually appear on areas of the body with a lot of muscles such as in the midline area of the torso.

The symptoms of Turrets are usually non-rhythmic, suppressible and unwanted unlike other movement disorders such as dyskinesia, myoclonus, choreas, and dystonia. The urge for tics is usually foreseen by the patient and is usually unwanted. The urge for a tic is similar to the feeling of sneezing, where there is increased tension, energy and pressure. Patients usually release it to decrease the tension. These premonitory urge may include:

• Disorder in the shoulder
• Feeling of something in the throat

Because of the feeling of urge and the awareness of the occurrence of the tic, Tourette syndrome is considered semi-voluntary because the patient has the ability to suppress it. However, suppressing of tics frequently results in build-up of tension and possible mental exhaustion. The awareness of the premonitory urge is usually absent in children, but they are able to adapt to it as they grow. During diagnosis, children and adults may be able to suppress tics, meaning that observing the patient when they are not aware of being observed is essential.

What causes Tourette syndrome?

The exact cause of Tourette syndrome is still unknown, but genetics and environmental factors have played a role in the development of the condition.

Genetics

Tourette syndrome is inherited and most cases are of genetic in predisposition. People with Turret’s syndrome have up to 50% chance of passing the disorder to his or her children. However, Turret’s syndrome has variable expression, which means that people who may have acquired the condition may have no symptoms at all. Other members of the family may also have different severity of symptoms.  Males have higher risk of expressing the genes than females.

Environment

Presence of previous infection, environmental factors and social factors do not actually cause the condition, but may exacerbate the symptoms. One study has presented that post-streptococcal infections may have resulted in tics or obsessive compulsive disorder.

Diagnosis

The diagnosis of Turret’s involves the use of the Diagnostic and Statistical Manual of Mental Disorders. DSM IV criteria for Turrets include:

• Multiple motor tics
• One or more vocal tics
• Tics happen over a period of one year or more
• Absence of more than three months of tic free condition

Turrets should have occurred before 18 years of age and symptoms should occur with the absence of other associated medical conditions. Since Tourette syndrome has varied expressions, people with Turrets are often underdiagnosed. The basis of diagnosis depends on clinical manifestations.

Tourette syndrome Treatment

Tourette syndrome cannot be cured using pharmacologic managements although symptoms can be reduced using medications. The treatment for Turret’s syndrome includes:

Cognitive Behavioral Therapy

This therapy involves habit reversal involving the control of tics through cognitive interventions. This is done by teaching patients to control the mind and controlling the behaviors to prevent tics.

Pharmacologic Therapy

Neuroleptics, both typical and atypical are used for the control of tics. Examples of these drugs include haloperidol and risperidone. Clonidine and guanfacine, both antihypertensive medications may also be used. Other medications for OCDs may also be given when Turrets syndrome occur with Obsessive-Compulsive Disorder.

Prognosis

Mild cases of Turret’s do not involve treatment and may fade as the patient grows. It also does not affect the life expectancy, intelligence and learning abilities of the person.

Complications

The most common effect of Turrets is social stigma because of the occurrence of “bizarre” behaviors and people may not understand their condition. People with severe cases may also experience affectations in their academic performance.