Tourette Syndrome: Symptoms, Causes, Risks, Complications, Diagnosis, Treatment, Prevention and Prognosis

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Book which explains about Tourette Syndrome

1Overview

Tourette syndrome is a type of Tic disorder, which are involuntary and repetitive movements. It’s a neurological disorder characterized by stereotypes, repetitive, and involuntary movements and vocalizations. The disorder was named after Dr. Georges Gilles de la Tourette, a neurologist who first described the condition in 1885.

People with Tourette syndrome may first experience the condition in their childhood. The typical onset of the disease from 3 to 9 years old. In the United States, there are about 200,000 people with severe Tourette syndrome and about 100 show milder symptoms.

Men are about three times to four times more likely to develop Tourette syndrome than women. However, at present, there is still no cure for the condition, but there are treatments available to treat and manage the symptoms of the disease.

For doctors to make a diagnosis of Tourette syndrome, a person must have many motor tics and at least one vocal tic, for nearly every day for more than one year. However, a person who experiences tics may not necessarily have Tourette syndrome. As a matter of fact, tics are common and they usually happen in children ages 9 to 11 years old, in about 10 percent of all children.

On the other hand, a full-blown Tourette syndrome is rare, happening in just less than 1 percent. Young boys are three times more affected than girls and it’s more common in kids who are diagnosed with Asperger syndrome or autism.

2Symptoms

Children can have sudden, intermittent and brief movements or vocalizations, which are the hallmark signs of Tourette syndrome. These can range from mild to severe.

Tics are classified as:

Complex tics – The distinct and coordinated patterns of movements entails several muscle groups.

Simple tics – As the name implies, these are brief and repetitive tics located on a limited number of muscle groups.

Moreover, tics can be physical movements or vocal sounds. The movements can be in the form of jerking of the head or jumping. On the other hand, vocalizations could be shouting out words, coughing or grunting.

Vocal Tics

  • Clearing the throat
  • Grunting
  • Screaming
  • Coughing
  • Squeaking
  • Sniffing
  • Blowing

Simple Physical Tics

  • Blinking
  • Twitching of the nose
  • Jerking of the head
  • Teeth grinding
  • Twisting of the neck
  • Rotating the shoulders
  • Rolling the eyes

Complicated Vocal Tics

  • Repeating the same phrase over and over (palilalia)
  • Echolalia or repeating other’s phrases
  • Coprolalia or swearing loudly

Complicated Physical Tics

  • Hitting or kicking things
  • Jumping
  • Shaking
  • Shaking the head
  • Copying movements or echopraxia
  • Copropraxia or making obscene gestures
  • Touching themselves or others

3Causes

The exact cause of Tourette syndrome is still unclear. It’s a complicated disorder caused by inherited factors and sometimes, influenced by environmental triggers. The chemicals in the brain that transmit the neurotransmitters like serotonin and dopamine.

Another theory is that it’s linked to the basal ganglia. The basal ganglia is a group of brain cells that are located in the brain, which is responsible for the regulation of the body’s movements. The basal ganglia, some studies suggest, may have a temporary problem that alters the ability to make decisions, resulting in the urge to perform a tic.

Some studies show that Tourette syndrome runs in families. A genetic mutation happens and it could disrupt the normal development of the brain, resulting in the disease.

Another theory is that the disease is linked to a childhood infection caused by the streptococcal bacteria, which is the culprit in a sore throat. When there is an acute infection, the body produces antibodies that interact with the brain tissue, and this could affect the brain’s normal functioning.

4Risk Factors

The chances of getting Tourette’s syndrome depends on the risk factors.

Sex – Being males would increase the risk of developing Tourette’s syndrome by about three to four times than women.

Family history – The disease could run in families. Having a relative or family member with the disease could mean that you are at a higher risk of developing Tourette’s syndrome.

5Complications

People with Tourette’s syndrome often have healthy lives. However, having the disease may mean having behavioral and social challenges. Moreover, there are other associated conditions that patients may have, including:

Co-occurring conditions:

  • Attention Deficit Hyperactivity Disorder (ADHD) – Attention deficit hyperactivity disorder (ADHD) is a condition that can affect kids with Tourette syndrome. It can affect about 70 percent of children with the syndrome. This is a behavioral problem that can cause issues in attention span, the ability to concentrate and ability to control impulses.
  • Obsessive-Compulsive Disorder (OCD/OCB) – About 60 percent of children with Tourette syndrome may develop obsessive-compulsive disorder (OCD). This is a long-term mental health condition wherein a person has compulsive behaviors and obsessive thoughts.

Other co-occurring conditions:

  • Learning problems
  • Behavioral problems
  • Mood problems
  • Anxiety
  • Social skills deficits and social functioning
  • Sleeping problems
  • Autism spectrum disorder
  • Depression
  • Pain related to tics
  • Anger management problems

These conditions may still continue on even when the symptoms of Tourette syndrome have disappeared when the child reaches adulthood.

6Diagnosis

The most dramatic symptoms are very easy to notice, but the disorder can be quite hard to recognize. Some individuals with mild to moderate tics may be too shy or embarrassed to tell their problems. In some cases, tics are mistaken for other medical health problems.

The disorder is usually diagnosed by observing the tics manifested. Sometimes, doctors use videos because these are helpful in observing the tics.

The first step in Tourette’s syndrome diagnosis is to rule out the other possible underlying causes of the symptoms. These include vision problems, allergies, autism spectrum disorder, and dystonia.

The doctor can use criteria used to diagnose Tourette syndrome such as:

  • Motor and vocal tics are present
  • The tics happen many times a day, intermittently or regularly for more than a year
  • Tics start before the child becomes 18 years old
  • The tics are not caused by another condition, alcohol, substance or medications

A diagnosis of Tourette syndrome can be overlooked sometimes since the signs are similar to other medical conditions. To rule out these conditions, the doctor can prescribe some blood tests and imaging studies such as a CT scan or an MRI scan.

7Treatment

At present, there is still no cure for Tourette syndrome. The currently available treatment is aimed at controlling the tics that could take a toll on the daily activities and functioning. Here are the treatment options for Tourette syndrome.

Drugs or medicines – Some medications can help control the tics and eventually, reduce the symptoms of the related conditions.

Dopamine-lowering drugs – Some medications could block or lessen the amount of dopamine. These drugs could help control tics.

The other drugs are ADHD drugs, Botulinum injections, antidepressants, central adrenergic inhibitors and anti-seizure drugs.

Non-medical treatment

Behavioral Therapy – This is a popular non-medical treatment for Tourette’s syndrome. It is designed to change the behavioral patterns of a child. Habit reversal training can help monitor tics.

The habit reversal therapy has been proven to be successful in managing Tourette’s syndrome. The process is based on two principles- tics are used to relieve uncomfortable feelings and people with the condition are usually not aware of their actions. Habit reversal is combined with relaxation techniques such as deep breathing or visualization.

Exposure and response prevention (ERP)

Exposure and response prevention (ERP) involves increasing exposure to the urge to perform tics. This way, the ability to suppress the tic response s longer.

Psychotherapy – This procedure can help with associated and linked problems such as obsessions, anxiety, depression, and ADHD.

DBS – This process involves implanting a battery-operated gadget to help deliver that needs electrical stimulation to the parts of the body that is in charge of movement control.

8Prevention

Tourette is a complicated disease and its cause has not yet fully understood. Typically, Tourette syndrome is hard to prevent. However, Lyme disease is preventable. Hence, some measures implemented to prevent Lyme disease may become helpful in reducing the risk of Tourette syndrome.

9Prognosis

Tourette syndrome is an incurable neurological condition which affects the nervous system, especially the brain. The condition leads to involuntary physical movements or noises.

This disease is not a progressive disease. This means that the person can still get treated for the condition.

The symptoms of Tourette syndrome may vary depending on the child who has it. No one can predict how long the disease will last in a person. On average, the first observable tics begin around the age of 7 years old and these usually involve the face or eyes. In some kids, the first tics are blinking, clearing the throat, sniffling or grimacing.

Motor tics appear first and the intense period of tic activity occurs between the age of 8 and 12 years old. However, even without treatment, the frequency and severity of the tics decrease through adolescence. These may also disappear by the early 20s. However, the problems linked to Tourette syndromes such as ADHD and obsessive-compulsive disorder may continue on throughout adulthood. Fortunately, even kids with severe types of Tourette syndrome may have good prognosis or outcomes.