What is Tourette syndrome (TS)?

Tourette’s syndrome, often known as ‘Tourette syndrome,’ is a neurological illness characterized by a variety of bodily tics as well as at least one vocal tic. A few people with Tourette’s syndrome mistakenly say things that are inappropriate or obscene.

A tic is an uncontrollable movement or sound that a person experiences. Eye blinking, coughing, throat clearing, sniffing, facial, head, or limb movements, or producing strange sounds are all examples.

People with obsessive-compulsive disorder (OCD), autism spectrum disorder (ASD), or attention deficit hyperactivity disorder (ADHD) are more likely to have tics.

According to the Tourette Association of America, Tourette’s syndrome affects 1 out of every 160 children in the United States.

Damage or abnormalities in the brain’s basal ganglia have been related to the condition.

Tourette syndrome

a boy having Tourette syndrome

The following are some important points to remember concerning Tourette’s syndrome:

  • A person with Tourette’s syndrome will have physical and vocal tics lasting more than a year.
  • It is a neurological disorder with symptoms that are made worse by stress.
  • Treatment includes medication and behavioral therapy.
  • Tourette’s does not have serious complications. However, it may be accompanied by other conditions, such as ADHD, and these can cause learning difficulties.

Tourette’s syndrome is one of several tic disorders that can cause both transitory and chronic tics. Tics can appear at any age. However, it is most common in children between the ages of six and eighteen.

Tics usually get less severe during adolescence and early adulthood. Tourette’s, on the other hand, might worsen as a person grows older.

The frequency and intensity of both mild and significant tics tend to change for most people. When a person is under physical, emotional, or mental stress, tics may become more frequent and strong.

The majority of people with Tourette’s have a normal IQ and life expectancy.

Symptoms

A tic is the most common symptom of Tourette’s syndrome. This might range from being scarcely detectable to being severe enough to make everyday life difficult.

The initial indicator could be a facial tic, such as eye blinking. Each individual, however, is unique.

A tic could be:

  • Physical: Motor movements include blinking or jerking the head or another part of the body.
  • Phonic: The person may utter sounds, such as grunts or squeaks, and words or phrases.

There are two main classifications:

  • Simple tic: This may involve moving just one muscle, or uttering a single sound. Movements are sudden, short lived, and often repetitive.
  • Complex tic: The physical movements are more complex, and the phonic tics may include long phrases. Complex tics involve several muscle groups.

Tourette’s syndrome is characterized by a combination of phonic and physical tics that might be simple or complex.

Simple physical tics

The following are some examples of simple physical tics:

  • eye blinking
  • eye darting
  • grinding the teeth
  • head jerking
  • neck twisting
  • nose twitching
  • rolling the eyes
  • rotating the shoulders
  • shoulder shrugging
  • sticking the tongue out

Simple phonic tics

Examples of simple phonic tics may include:

  • barking sounds
  • blowing
  • clearing the throat
  • coughing
  • grunting
  • hiccupping
  • sniffing
  • squeaking
  • yelling and screaming

Complex physical tics

Examples of complex physical tics may include:

  • copropraxia, or making obscene gestures
  • echopraxia, or miming the movements of other people
  • flapping
  • head shaking
  • hitting things
  • jumping or hopping
  • kicking things
  • shaking
  • smelling objects
  • touching oneself or others

Complex phonic tics

Examples of complex phonic tics include:

  • varying one’s voice intonation
  • echolalia, or repeating what other people say
  • paliphrasia, or saying the same phrase over and over again
  • coprolalia, which means uttering or shouting obscene words or phrases

Advanced warnings

Most people will experience unusual or uncomfortable sensations before the onset of a tic.

Types of advanced warning include:

  • a burning feeling in the eyes that is only alleviated by blinking
  • increasing tension in the muscles that can only be alleviated by stretching or twitching
  • a dry throat that is only alleviated by grunting or clearing the throat
  • itching in a limb or joint, where the only relief is achieved by twisting it

Situations that may cause tics to worsen include:

  • anxiety or stress
  • fatigue, or tiredness
  • illness, especially a streptococcal infection
  • excitement
  • a recent head injury

The Tourette Association of America’s Medical Advisory Board was asked by Medical News Today (MNT) what advice they would give to parents who suspect their child has Tourette’s.

They told us:

“Tourette Syndrome is characterized by motor and vocal tics longer than 12 months. If this is the case, then start with a visit to the child’s primary care physician for an evaluation. Talk to him or her to see if the tics are causing pain or discomfort, bothering him or her, or affecting schoolwork or desired activities.”

The Association offers tools for parents and educators, as well as information on how to find advocacy and support organizations, for people with Tourette’s and parents of children with the condition.

Tourette’s causes and risk factors

There is no known etiology for Tourette’s syndrome. However, it appears to be caused by a problem with the basal ganglia, the brain region that controls involuntary movements, emotion, and learning.

Experts believe that problems in the basal ganglia could lead to an imbalance in the amounts of brain neurotransmitters, which carry messages from one cell to the next. Tics can be caused by abnormal neurotransmitter levels that impede normal brain activity.

The basal ganglia are affected by Parkinson’s disease, Huntington’s disease, and other neurologic diseases.

Tourette’s syndrome is thought to be inherited and to have a genetic basis. A person with a tic is more likely to have one themselves if they have a close relative with one.

It also appears to be more common among prematurely born babies.

Another notion is that tics are caused by a childhood sickness. Tourette’s symptoms have been connected to infection with group A streptococcal bacteria.

It’s possible that the bacteria trigger the immune system to create antibodies that interact with brain tissue, resulting in brain alterations. This could have repercussions in terms of treatment. More research, however, is required.

Tourette syndrome diagnosis

Because there is no current test for Tourette’s, doctors must rely on signs, symptoms, and medical and family history to make a diagnosis.

The following criteria must be present for a Tourette’s diagnosis, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition:

  • Two or more motor tics (such as blinking or shrugging shoulders) and at least one vocal tic (such as humming, clearing the throat, or yelling out a word or phrase) are present, however they do not always occur simultaneously.
  • Tics have been present for at least a year. Tics can happen several times a day (typically in bouts), almost every day, or on and off.
  • Tics started before the person turned 18 years old.
  • The person is experiencing symptoms that are unrelated to any medications or other drugs they may be taking, or to any other medical condition they may be experiencing (such as seizures, Huntington disease, or postviral encephalitis).

Other conditions that could produce similar symptoms include:

  • allergies, if there is coughing and sniffing
  • dystonia, a neurological condition that includes involuntary movements and prolonged muscle contraction, leading to twisting body motions, abnormal posture, and tremor
  • restless leg syndrome, if movements affect the legs
  • problems with vision, if the patient blinks a lot

These and other medical disorders can be ruled out by blood testing, skin tests, eye exams, and imaging studies.

Tourette syndrome treatment

Medication and non-pharmacological treatments are commonly used in treatment. Surgery may be a possibility in some circumstances.

Antihypertensives, muscle relaxants, and neuroleptics are examples of medications.

Antihypertensives

Antihypertensives are drugs that are used to treat high blood pressure, sometimes known as hypertension. They may, however, aid patients with mild to moderate Tourette’s symptoms by controlling neurotransmitter levels.

Clonidine is one such example. Diarrhea or constipation, dry mouth, headaches, dizziness, and fatigue are all possible side effects.

Muscle relaxants

Spasticity, or when muscles become overly stiff, is treated with muscle relaxants, which helps regulate physical tics. Baclofen and clonazepam are two examples. Drowsiness and dizziness are two common side effects.

Patients taking muscle relaxants should avoid drinking alcohol and should not drive or operate heavy machinery.

Neuroleptics

Neuroleptics work by blocking dopamine’s actions in the brain. They can be administered orally or intravenously. They can help with symptoms ranging from mild to severe. Slow-release neuroleptics are injected every 2 to 6 weeks in some cases.

Drowsiness, blurred vision, dry mouth, reduced libido, tremors, spasms, twitching, and weight gain are all possible side effects. There are some neuroleptics that have more side effects than others.

Patients should notify their doctor if side effects become an issue. They might be able to take alternative neuroleptics.

Non-pharmacological treatments

People with Tourette’s are frequently treated with behavioral treatment. It can aid in the modification of the patient’s behavior patterns.

Comprehensive behavioral intervention for tics (CBIT), a type of cognitive behavioral therapy (CBT), has been shown in studies to benefit children and adults with Tourette’s syndrome. The goal of therapy is to treat symptoms by changing habits.

The concept of habit reversal is based on the following:

  • patients are unaware of their tics
  • the purpose of tics is to alleviate uncomfortable sensations before they occur

The therapist assists the patient in keeping track of their tics’ pattern and frequency. Any sensations that cause the tics are likewise pinpointed.

Once the patient is aware of the tic, they can devise a less obvious method of alleviating the unpleasant sensations it is causing. A competing answer is what this is referred to as.

If a person feels the need to grunt or clear their throat because of an unpleasant sensation in their throat, they can learn to soothe the sensation by taking a series of deep breaths instead.

The type of CBT used to lessen chronic tics in people with Tourette’s syndrome can also affect the way their brains work, according to a 2015 study.

Another study released in 2015 indicated that GABA, a brain neurotransmitter, may assist people with Tourette’s syndrome treat their tics.

Relaxation therapy is frequently used in habit reversal therapy. Tics might become more severe and frequent as a result of stress or anxiety. Deep breathing and visualization can help alleviate anxiety, which can lead to fewer and milder tics.

Are there any other options for treatment?

Self-hypnosis, according to an older study, may be useful. According to anecdotal evidence, a variety of dietary components, such as a larger intake of vitamin B or vitamin D, may also be beneficial. However, research has not backed up these claims.

The Medical Advisory Board of the Tourette Association told MNT:

“There is no evidence at present for the use of any alternative therapies for the treatment of Tourette. Simply put, these have not been studied yet for Tourette.”

Exercise and a well-balanced diet, on the other hand, can assist to reduce stress and improve one’s sense of well-being, which can help to minimize the severity and frequency of tics.

Surgery

Adult patients with severe symptoms who have failed to respond to previous therapies are usually candidates for surgery.

Limbic leucotomy

A limbic leucotomy is a procedure in which a small portion of the limbic system is burned away using an electric current or a pulse of radiation. This system is in charge of certain emotions, behaviors, and memories. A limbic leucotomy may partially or completely fix the condition.

Deep brain stimulation (DBS)

Electrodes are permanently implanted in parts of the brain known to be connected to Tourette’s in DBS. They’re linked to small generators that have been implanted in the body.

The electrodes receive an electronic pulse from the generator, which stimulates different parts of the brain. This may aid in the management of Tourette’s symptoms.

DBS’s long-term effects have yet to be proven.

Managing Tourette’s Syndrome

Participating in competitive sports, playing a fun computer game, or reading an interesting book are all activities that can help you manage your tics. However, for certain people, overexcitement can be a trigger, therefore some activities might have the opposite effect.

Many people, for example, learn to control their tics at work or school. Suppressing tics, on the other hand, may raise tension until the tic can be vented.

Tic types, frequency, and severity may fluctuate over time. Tics are more acute throughout the adolescent years. They do, however, generally improve throughout early adulthood.

Tourette syndrome complications

The intelligence of a person with Tourette syndrome is unaffected. However, if the person additionally has ADHD, OCD, or ASD, learning difficulties may occur.

Bullying at school can be difficult for a child with or without these additional issues, making schooling both socially and academically difficult.

Schools can help by informing kids about the disorder so that they can better comprehend a classmate who suffers from it.

Because the basal ganglia are involved in habit learning, people with Tourette’s may have difficulty doing so. Writing, reading, and arithmetic skills may be affected.

A child with Tourette syndrome may require extra educational assistance.

Conclusion

Tourette’s syndrome is a condition characterized by at least one verbal tic as well as a variety of bodily tics. The illness can strike at any age. It normally begins between the ages of six and eighteen.

There is no known cause for Tourette’s syndrome. It appears, however, to be caused by a dysfunction in the basal ganglia. Involuntary movements, movement, and learning are all controlled by this part of the brain.

Medication and non-pharmacological treatments are commonly used in treatment. Surgery is a possibility in some cases.

Competitive sports, playing a fun computer game, or reading a good book can all aid in the management of the condition. It is important to note, however, that for certain people, overexcitement can also be a trigger.

Sources

  • https://www.tourette.org/about-tourette/overview/living-tourette-syndrome/bullying-issues/
  • https://www.sciencedaily.com/releases/2010/07/100712162541.htm
  • https://www.medicalnewstoday.com/articles/175009
  • https://www.cdc.gov/ncbddd/tourette/diagnosis.html#TS
  • https://www.tourette.org/about-tourette/overview/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3514747/
  • https://www.tourette.org/resources/overview/
  • https://www.sciencedaily.com/releases/2015/06/150625081617.htm
  • https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tourette-Syndrome-Fact-Sheet