Tourette’s Syndrome – Symptoms, Causes, Treatment, Facts, Diagnosis

What is Tourette’s Syndrome?

Tourette’s syndrome (TS), also called Tourette’s, Gilles de la Tourette syndrome or Turret’s syndrome, is a progressive neuropsychiatric condition involving motor and phonic tics. It occurs during childhood and may retain until adulthood, but with less severity as the child grows. It is an inherited disorder affecting men most often. Motor tics are the sudden, repetitive, non-rhythmic movements of the body during motor activity. On the other hand, phonic tics are the sudden utterances of word or involuntary sounds.

A Young Boy with Tourette Syndrome

Tourette’s syndrome develops during childhood and may be persistent until adulthood. Most patients have the syndrome becoming less severe during development and Tourette’s syndrome during adulthood may no longer be significant.

Tourette’s syndrome is now considered a neuropsychiatric condition as opposed to the notion before that people having Tourette’s syndrome are bizarre. People with Tourette’s wereconsidered bizarre before because of uttering of socially inappropriate languages.

The incidence of Tourrete’s in children and teens is roughly 4%. Patients often experience common tics such as eye blinking, sniffing, coughing, facial movement and clearing of the throat.

Incidence of Tourette’s syndrome

The incidence of Tourette’s syndrome is usually higher in children than in adults. Tourette’s syndrome is not specific to certain races. However, it is more evident in males occurring 4 times higher than the incidence in females.

As discussed earlier, tics usually fade in adulthood and it starts to lessen and become less severe during adolescence. Up to 25% of children become tic free as they enter adolescence. Another 50% has lesser tics and the remaining 25% have persistent tics until adulthood. With the 25% persistent tics, 5% of which develop into chronic tics. On the other hand, there are patients with transient tics, which are characterized by a short period of tics.

Tourette’s syndrome Symptoms, Facts

The occurrence of tics is the most common characteristics of Tourette’s syndrome. Tics are characterized as intermittent and unpredictable during activities. They are highly individualized, which means that people with Tourette’s syndrome have different kinds of tics. Tics also wax and wane, which means that the tics may increase or decrease in severity. However, some people may experience bouts of tics.

The specific tics experienced by the patient include:

Motor Tics

• Facial Movements
• Sniffing
• Eye blinking
• Throat clearing

A Boy Exhibiting Motor Tics of the Eye

Motor tics occur on the areas of the body with a lot of muscles such as in the upper trunk, hands, and face.

Phonic Tics

• Repeating or uttering of words stated by others or echolalia
• Repeating of own words or palilalia
• Uttering of socially unacceptable words or languages or taboo phrases called coprolalia

Coprolalia is the most popular characteristic of Tourette’ syndrome and is the one that catches attention of other people. Coprolalia may not be evident for all people with Tourette’s syndrome. The occurrence of coprolalia is also not a diagnostic criterion for Tourette’s syndrome.

Characteristics of the Tics

The tics are often non-rhythmic and may be suppressed by the individual. The tics are usually unwanted and the patient tries to avoid them. The suppressible characteristic of the tics is due to the occurrence of an urge or premonitory signs before the occurrence of the tic. The individual may be able to identify this urge and try to suppress the tic. Once the patient suppresses the tic, it results to a very high tension from within. The performance or allowing the tic reduces the pressure. The most common premonitory urges experienced by patients include discomfort in the throat as well as in the shoulders.

Once the client releases the tics, it brings relief and reduced tension. However, because of embarrassment in front of other people, individuals suppress them. The build-up of tension as a result of suppression may result to mental exhaustion. The presence of the premonitory urge and the awareness of the tics make them semi-voluntary.

Premonitory urge usually develops as the child grows and may not be present initially. Diagnosis becomes difficult when the patient tries to control the tics. Observation of the patients during play and activities may allow the patient not to control the tics because they know that they are not being assessed.

Causes and Risk Factors for Tourette’s syndrome

The exact mechanism of the occurrence of the condition is still unknown. The risk factors associated with it include environmental and genetic factors.

Environmental Causes

Environmental factors do not directly cause Tourette’s syndrome, but may predispose to the exacerbation or the development of the condition when genetic factors are present. The most common risk factor is exposure to streptococcal infections.

Genetic Predisposition

Genetics is the common cause of Tourette’s syndrome. This condition is passed to children, usually the males. Males have a higher expression of the disease, which makes it evident to them. Inheritance of Tourette’s syndrome is up to 50% of offspring. There is variable expression of the genes leading to some members manifesting it and some may not.

Diagnosis of Tourette’s syndrome

The primary diagnostic procedure for Tourette’s syndrome is physical examination and history taking. These are analyzed using the Diagnostic and Statistical Manual of Mental Disorders. The DSM IV criteria for Tourette’s syndrome include:

1. One or more phonic or vocal tics
2. Multiple motor tics
3. Tics occur for more than a year
4. Tic free condition is at most 3 months
5. Tics occurred before 18 years of age
6. Absence of other medical conditions leading to tic

Tourette’s syndrome Treatment

The treatment of Tourette’s syndrome focuses on the control of symptoms because the condition may not be treated and it may fade when the child reaches adulthood. These include:

Pharmacologic therapy

Medications such as neuroleptics, antihypertensive and OCD medications can be given to control the tics. Antihypertensive medications include clonidine. This reduces the muscle tension thereby reduces tic manifestations.

Cognitive Behavioral therapy

Cognitive behavioral therapy involves the controlling of the mind to avoid performance of the tics. This involves the effective control of the tics when premonitory urge arises. This also teaches the patients on how to reduce the tension when tics are suppressed in order for them not to result in performing the tics.

Prognosis of Tourrete’s Syndrome

Despite being a neuropsychiatric disorder, Tourette’s does not affect the learning abilities and IQ of a person. It may also fade away without any treatment. Tourette’s does not cause medical conditions and may not affect the life expectancy. The only complication of the condition is social isolation because of fear of embarrassment. The person usually is able to live a normal life when the tics eventually fade away.