Description

Tourette (too-RET) syndrome is a disorder that involves repetitive movements or unwanted sounds (tics) that can't be easily controlled. For example, you might repeatedly blink your eyes, shrug your shoulders or blurt out unusual sounds or offensive words.

Tics typically show up between ages 2 and 15 years, with an average of around 6 years of age. Males are about three to four times more likely than females to develop Tourette syndrome.

Although there is no cure for Tourette syndrome, treatments are available. Many people with Tourette syndrome do not need treatment when symptoms are not troublesome. Tics tend to decrease or be controlled after the years of adolescence.

Symptoms

Tics — sudden, brief, intermittent movements or sounds that are the hallmark of the sign of Tourette syndrome. Can vary from mild to severe. The severe symptoms can significantly interfere with communication, daily functioning and quality of life.

Tics are classified as:

  • Simple tics. These sudden, brief, repetitive tics involve a limited number of muscle groups.
  • Complex tics. These distinct, coordinated patterns of movements involving several muscle groups.

Tics may also involve movement (motor tics) or sounds (vocal tics). Motor Tics usually begin before the vocal tics do. But the spectrum of the tics that people experience is diverse.

In addition, the tics can be:

  • Vary in type, frequency and severity
  • Worse if you are sick, stressed, anxious, tired or excited
  • Occur during sleep
  • The change in time
  • Worse in the early years of adolescence, and improve during the transition to adulthood

Before the appearance of motor or vocal tics, it is likely that the experience of an uncomfortable bodily sensation (the premonitory urge) as an itching, tingling or tension. The expression of ict brings relief. With great effort, some people with Tourette syndrome can temporarily stop or retain a tic.

When to see a doctor

Consult your child's pediatrician if you notice that your child display of involuntary movements or sounds.

Not all tics indicate the Tourette syndrome. Many children develop tics that disappear after a few weeks or months. But, when a child shows an unusual behavior, it is important to identify the cause and to rule out serious health problems.

Causes

The exact cause of Tourette syndrome is not known. It is a complex disorder probably caused by a combination of heredity (genetic) and environmental factors. The chemicals in the brain that transmit nerve impulses (neurotransmitters), such as dopamine and serotonin, may play a role.

Risk factors

Risk factors for Tourette syndrome are:

  • The history of the family. Having a family history of Tourette syndrome or other tic disorders may increase the risk of developing Tourette syndrome.
  • Sex. Males are about three to four times more likely than females to develop Tourette syndrome.

Complications

People with Tourette syndrome often lead a healthy, active life. However, Tourette's syndrome often involves social behavior and the challenges that may damage your self-image.

Conditions are often associated with Tourette syndrome are:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Obsessive-compulsive disorder (OCD)
  • Autism spectrum disorder
  • Learning disabilities
  • Sleep disorders
  • Depression
  • Anxiety disorders
  • The pain associated with tics, especially headaches
  • The anger management problems

Diagnosis

There is no specific test that can diagnose Tourette syndrome. The diagnosis is based on the history of your signs and symptoms.

The criteria used to diagnose Tourette syndrome are:

  • Both motor tics and vocal tics are present, although not necessarily at the same time
  • The Tics occur several times a day, nearly every day or intermittently, during more than a year
  • Tics begin before age 18
  • The Tics are not caused by drugs, substances, or any other medical condition
  • Tics must change with the time in the location, frequency, type, complexity or severity

A diagnosis of Tourette syndrome can be overlooked because the symptoms can mimic other conditions. Flicker of the eyes could be initially associated with vision problems, or sobbing attributed to allergies.

Both motor and vocal Tics can be caused by conditions other than Tourette syndrome. To rule out other causes of tics, your doctor might recommend:

  • Blood tests
  • Imaging studies such as magnetic resonance imaging

Treatment

There is No cure for Tourette's syndrome. The treatment is aimed at controlling tics that interfere with everyday activities and functioning. When tics aren't severe, treatment might not be necessary.

Medicine

Medications to help control tics or reduce the symptoms of associated conditions include:

  • Medications that block or decrease dopamine. Fluphenazine, haloperidol (Haldol), risperidone (Risperdal) and pimozide (Orap) may help control tics. Possible side effects include weight gain, involuntary repetitive movements. Tetrabenazine (Xenazine) could be recommended, although it can cause severe depression.
  • Botulinum (Botox) injections. An injection into the affected muscle can help to alleviate a simple or vocal tic.
  • Medications for ADHD. Stimulants such as methylphenidate (Metadate CD, Ritalin LA, and others), and medications that contain dextroamphetamine (Adderall XR, Dexedrine, others) may help increase attention and concentration. However, for some people with Tourette's syndrome, medications for ADHD may exacerbate tics.
  • Central adrenergic inhibitors. Medications such as clonidine (Catapres, Kapvay), and guanfacine (Intuniv) — prescribed for high blood pressure — may help control behavioral symptoms, such as impulse control problems, and the fury of the attacks. Side effects may include drowsiness.
  • Antidepressants. Fluoxetine (Prozac, Sarafem, others) may help control the symptoms of sadness, anxiety, and obsessive-COMPULSIVE disorder.
  • Anti-seizure medications. Recent studies suggest that some people with Tourette's syndrome respond to topiramate (Topamax), which is used for the treatment of epilepsy.

Therapy

  • Behavior therapy. Cognitive Behavioral interventions for Tics, including habit reversal training, it can help you to control tics, identify premonitory, desires and learn to move voluntarily in a manner that is incompatible with the tic.
  • Psychotherapy. In addition, to help deal with Tourette's syndrome, psychotherapy can help with the accompaniment of problems, such as ADHD, obsessions, depression, or anxiety.
  • Deep brain stimulation (DBS). Severe tics that do not respond to other treatments, DBS could help. DBS involves the implantation of a battery-operated medical device in the brain to deliver electrical stimulation to specific areas that control movement. However, this treatment is still in the early stages of research and needs further investigation to determine if it is a safe and effective treatment for Tourette's syndrome.

Coping and support

Your self esteem can suffer as a result of Tourette syndrome. You may be embarrassed about their tics and hesitate to participate in social activities, such as appointments or to go out in public. As a result, you are at greater risk of depression and substance abuse.

To deal with Tourette's syndrome:

  • Remember that the tics tend to reach their peak in the decade of the teens, and improve as you get older.
  • Reach out to others dealing with Tourette syndrome for information, coping advice, and support.

Children with Tourette syndrome

The school may pose special challenges for children with Tourette syndrome.

To help your child:

  • Be your child's advocate. To help educate teachers, school bus drivers and others with whom your child interacts regularly. An educational environment that meets the needs of your child — such as tutoring, no time limit the test to reduce the stress, and the smaller classes — can help.
  • Feed your child's self-esteem. Support to the personal interests and friendships, which can both help to build the self-esteem.
  • Find a support group. To help you deal with the problems, and find a local in Tourette syndrome support group. If no, consider starting one.

Preparing for your appointment

If you or your child has been diagnosed with Tourette's syndrome, you may be referred to specialists, such as:

  • Doctors who specialize in brain disorders (neurologists),
  • Psychiatrists or psychologists

It is a good idea to be well-prepared for your appointment. Here's some information to help you prepare, and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do in advance, such as restrict your diet.
  • Write down any symptoms you or your child is experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you or your child is taking.
  • Make a video recording, if possible, of a typical ict to show the doctor.
  • Write questions to ask their doctor.

Your time with your doctor is limited, so preparing a list of questions that can help you ensure the best use of the time. A list of questions from most important to least important in case time runs out. For Tourette's syndrome, some basic questions to ask your doctor include:

  • What treatment, if any, is necessary?
  • If medication is recommended, what are the options?
  • What types of behavior therapy could help?

Do not hesitate to ask questions during your appointment anytime you don't understand something or you need more information.

What to expect from your doctor

Your doctor may ask you a series of questions. Be ready to answer them may allow time later to cover other points you want to address. Your doctor may ask:

  • When did the symptoms begin?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Tourette syndrome