Tourette Syndrome (TS) is a neuro developmental disorder characterized by repeated involuntary movements (motor tics) and uncontrollable sounds (vocal or phonic tics).
Symptoms range from very mild to quite severe and the majority of cases also have other co-morbid conditions with significant impact on their lives. The first symptoms of TS are usually facial tics - commonly eye blinking. Other motor tics may appear later, such as head jerking, neck stretching, foot stamping, or body twisting and bending. It is not uncommon for a person with TS to continuously clear his or her throat, cough, sniff, grunt, yelp, bark, or shout. A person with TS may touch other people excessively or repeat actions obsessively and unnecessarily. A few patients with TS demonstrate self-harming behaviours such as lip and cheek biting and head banging. Similarly, involuntary swearing (coprolalia) can occur in a subgroup of people with TS. People with TS can sometimes suppress tics for a short time, but eventually tension mounts to the point where the tic escapes. Tics typically fluctuate with a waxing and waning course and would usually worsen in stressful situations and improve when the person relaxes or is absorbed in an activity.
Tourette syndrome often is accompanied by other behavioural or emotional problems. For example, attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) are very common. Learning difficulties, sleep abnormalities, depression and anxiety, impulse control and conduct problems also occur regularly.
The most dramatic symptoms are easy to notice, but the disorder often is hard to recognize. People with mild to moderate tics may be too embarrassed to discuss their problems. Parents and teachers usually pay more attention to behaviour, learning and attention problems. Sometimes tics are mistaken for other medical problems. For example, people might consult an allergist for sniffling or an eye doctor for unusual eye movements.
TS is part of a spectrum of conditions known as Tic Disorders. TS is diagnosed by observing the symptoms and evaluating family history when:
- The person has multiple motor tics and one or more vocal tics
- Tics occur most days for at least one year
- The person was not free of tics for more than three months during the past year
- Symptoms began before age 18
- The tics are not caused by another illness, a substance or a medication.
The doctor also will ask questions about the impact of the tics on daily life, and about the other problems that commonly occur with Tourette's, such as obsessions, compulsions, attention and learning problems, anxiety and changes in mood.
The symptoms of TS generally appear before the individual is 18 years old. Males are more often affected than females.
The majority of people with TS require no medication, but medication is available to help when symptoms interfere with functioning or cause distress and can help reduce the frequency and/or intensity of tic symptoms. Commonly used medications in TS include Neuroleptics or medicines that block dopamine system in the brain (newer drugs are selective in the way they block dopamine and may also affect other neurotransmitters such as serotonin) and those that stimulate alpha-2-adrenergic system (previously used as antihypertensive drugs). Medication can have long and short-term side effects and hence it is important to weigh the benefits and disadvantages. Use of stimulants can be helpful when there are also Attention Deficit Hyperactivity Disorder symptoms but careful monitoring for any increase in tick symptoms is recommended. Relaxation techniques and biofeedback may be useful in alleviating stress. Other treatments used in TS include behaviour therapy techniques such as Habit Reversal Therapy (HRT) that is used in the Comprehensive Behavioural Intervention for Tics (CBIT). In extremely severe and debilitating cases not responding to other treatments, Deep Brain Stimulation (DBS) can be helpful.
There is no cure for TS; however, the condition in many individuals improves as they mature. Individuals with TS can expect to live a normal life span. Although TS is generally lifelong and chronic, it is not degenerative. In a few cases, complete remission occurs after adolescence.
Further Information and Support
Read More at Virtual Medical Centre
Tourette Syndrome Association Australia (TSAA)
PO Box 1173, Maroubra NSW 2035
Tel (02) 9382 3726
Fax (02) 9382 3764
Better Health Channel (Australia)
www.betterhealth.vic.gov.au (Look under Topics)
Disability Online (Australlia)
Tourette Syndrome Association - USA
National Institute of Neurological Disorders and Stroke - USA
Worldwide Education & Awareness for Movement Disorders (WE MOVE) - USA
Reviewed February 2018 by Professor Valsa Eapen, Tourette Syndrome Association of Australian inc.