Tourette Syndrome

Tourette (or Tourette’s) syndrome is a neurological disorder that causes repeated, involuntary physical tics and vocal outbursts. It is the most severe of the tic syndromes. Tics are quasi-voluntary muscles spasms. They consist of abrupt intermittent twitches of a group of muscles. Most frequent forms are blinking, sniffing, grimacing, shoulder movements and head movements. The exact cause of this disorder is unknown.

According to the National Institute of Neurological Disorders and Stroke, symptoms of the disease usually appear between the ages of three and nine (NINDS). Tourette’s begins with small muscles tics in the head and neck. Eventually, other tics will appear in the trunk and limbs. Patients with this disorder usually develop vocal tics along with their physical ones.

About 200,000 people in the United States exhibit severe symptoms of Tourette’s syndrome. As many as one in 100 may experience milder tics (NINDS). Tourette’s affects males three or four times as often as females, and symptoms are generally the most severe during the late teen years.

The precise cause of Tourette syndrome is unknown, so there is no way to prevent it. Researchers believe that Tourette syndrome may be caused by an inherited genetic defect. The genes involved in Tourette syndrome are still being identified, but for some patients, the cause of Tourette is almost certainly genetic. Familial clusters have been identified which lends evidence to a genetic cause. An abnormality may exist in the basal ganglia, the part of the brain that contributes to the control of motor movements.

Tourette is a highly complex syndrome. It involves abnormalities in various parts of the brain and the electrical circuits that connect them. Chemicals in the brain that transmit nerve impulses (neurotransmitters), including dopamine and serotonin and norepinephrine, may also play a role.

Symptoms can vary from child to child. Symptoms typically worsen during periods of excitement, stress, or anxiety.

Common symptoms of Tourette include:

• involuntary movements of the face, arms, legs, or trunk
• movements that occur frequently, rapidly, and repetitively
• repetitive thought patterns
• repetitive use of words
• stuttering
• sticking out the tongue
• abnormal walking patterns
• teeth grinding
• grimacing
• throat clearing
• touching of the genital area
• compulsive uttering of obscenities

If the following symptoms are present in a child under 18, it usually means that he or she has Tourette’s:

• multiple involuntary motor and verbal tics (not always present at the same time)
• tics that are present several times a day, almost every day for longer than one year
• tics that are not caused by medications or other underlying medical conditions
• symptoms that cause problems in social, educational, and other areas of the child’s development

Doctors may order MRI imaging scans or blood tests to make sure that another disease, such as a seizure disorder, is not causing the symptoms. Tourette patients often suffer from other, simultaneous conditions, including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, learning disabilities, sleep disorders, and anxiety disorders.

If your tics are not severe, you may not need treatment. If your tics are severe or lead you to harm yourself—or if you are one of the 10 percent of patients whose tics worsen during adulthood—there are several treatments available:

Therapy

Tourette patients may receive psychotherapy (one-on-one counseling with a licensed mental health professional). Psychotherapy can also help ease symptoms of ADHD, OCD, and anxiety. Hypnosis, relaxation techniques, guided meditation, and deep breathing may be utilized during therapy sessions.

Patients may also find help in group therapy, where they will receive counseling with others in the same age group who are also dealing with Tourette.

Medications

• Neuroleptic drugs, such as haloperidol, may block dopamine receptors in the brain. These drugs help to control tics. Side effects include weight gain and mental fogginess. The antipsychotic, chlorpromazine, also known as thorazine has been used. Anti-parkinsonian drugs may also be helpful as they are involved in dopamine pathways.
• Botox injections in the affected muscles may help with simple motor and vocal tics.
• Stimulant medications, such as Ritalin, may reduce symptoms of ADHD without increasing tics.
• Blood pressure medications, such as clonidine, may help to control rage attacks and also help with impulse control. Side effects are sedation and sleepiness.
• Antidepressants, such as Prozac, may help to control obsessive-compulsive behavior.

Neurological Treatments

Deep brain stimulation is another form of treatment for children with severe tics. A battery-operated device is implanted in the child’s brain to stimulate parts of the brain that control movement. The effectiveness of this treatment for Tourette patients is still being investigated. Another method of deep brain stimulation is to implant electrical wires in the brain and sending electrical stimuli. to those areas. This treatment has been useful in some very difficult to treat cases but patients should be made full aware of the risks and benefits.

Many patients find that their tics improve as they reach their late teens and twenties. Though the condition is chronic, some patient’s symptoms stop spontaneously and entirely in adulthood.

Tourette does not decrease intelligence or life expectancy. However, even as symptoms decrease with age, conditions such as depression, panic attacks, and anxiety may persist and need continued treatment.

Children with this condition often feel alone and isolated. Their inability to control outbursts makes them reluctant to participate in normal activities. Support groups and group therapy can help with depression and social isolation. Family members should learn as much as possible about the disease to help the child cope.