Tourette Syndrome

Table of Contents

    What Is Tourette Syndrome?

    Tourette Syndrome (TS) is one of a group of disorders of the developing nervous system called tic disorders. Put simply, tics are movements that patients can’t control. Patients with Tourette’s experience a combination of motor and vocal tics.

    Tourette’s is considered a neuropsychiatric disorder which is a neurologic disorder that can affect a patient’s behavior.

    The cause of TS and tics is unknown, however, both conditions are usually hereditary.

    Facts About Tics and Tourette Syndrome

    • Tics in children are relatively common — as many as one in five children may have tics at some point in their childhood.
    • The symptoms of Tourette Syndrome typically begin to appear between the ages of 4-6 and are often most severe between 10-12.
    • Tourette’s is much more common in males than females.
    • By definition, Tourette’s must begin before age 18, must include more than one tic, and must include a vocal tic.
    • More than 50% of Tourette patients also have associated behavioral issues.
    • Most patients experience the worst TS symptoms in their early teens, but the tics typically lessen and become controlled by the late teens to early 20s.
    • For some patients, TS can become a chronic condition with symptoms lasting well into adulthood. 

    What’s the Difference Between Tics and Tourette Syndrome?

    People (usually children and teenagers) with tics typically have an urge or need to do a movement and will experience a sense of relief after completing the movement. Unlike some other movement disorders, tics can lack rhythm or purpose.

    Tics may be categorized as either simple or complex, and not all people with tics have Tourette Syndrome.  A diagnosis of Tourette Syndrome requires a patient to have more than one tic including a vocal tic, for more than one year and must begin before the age of 18.

    Simple Tics

    Simple tics can appear suddenly and usually last for weeks or months. Simple tics are typically motor tics and can include:

    • Eye blinking
    • Raising the eyebrows
    • Shoulder shrugging
    • Turning or jerking the head or neck

    Complex Tics

    Complex motor tics include more purposeful movements such as:

    • Grimacing
    • Tapping
    • Walking in a specific pattern or circling
    • Jumping
    • Kicking or punching

    Complex Vocal Tics

    • Making multiple sounds
    • Echolalia, which is the repeating syllables, words, or phrases
    • Coprolalia, which is saying socially taboo words or phrases

    You Are More Than Your Symptoms

    Movement disorders are incredibly complex diseases affecting multiple systems in the body. At Neurology Solutions, we believe that these challenging diseases require a comprehensive approach that treats the whole patient— not a list of symptoms. 

    What It’s Like to Live With Tourette’s

    People with Tourette Syndrome often experience behavioral symptoms such as ADHD, OCD, and anxiety. There can also be a social or emotional impact on TS patients — this is often made worse by the fact that TS patients are usually children. 

    Thankfully, tics and TS are often temporary and tend to disappear as patients get older, often disappearing completely once the patient reaches adult age.

    TS Is Considered a Neuropsychiatric Disorder

    A neurological disorder such as Tourette’s Syndrome that may affect the patient’s behavior is known as a neuropsychiatric disorder. More than 50% of TS patients have associated behavioral issues such as Attention Deficit Hyperactivity Disorder (ADHD) and/or Obsessive-Compulsive Disorder (OCD). 

    Other Neurobehavioral Disorders Associated with TS

    While ADHD and OCD are the most common disorders associated with Tourette’s, TS patients may also experience a number of other disorders. These disorders include anxiety, learning disabilities, sleep disorders, impulsive behavior, conduct issues, social skills deficits, and sensory processing issues. 

    Our Approach to Treating Tourette’s and Tics

    Our main focus is to provide the best quality of life for everyday living. Therefore, we take a patient-specific focus on treating TS and tics. Some patients with mild TS require no treatment. In more severe cases or cases where the TS symptoms interfere with daily functioning, medications can be an effective treatment. 

    Medications for Tourette’s and Tics

    • Baclofen, a muscle relaxer, helps reduce tics, as well as an improved general sense of well-being in patients with TS.
    • Blood pressure medications such as clonidine, propranolol, and guanfacine might help control behavioral symptoms such as anxiety, impulse control problems, and rage attacks. Propranolol may also improve tics.
    • Tetrabenazine may be recommended, which works by blocking dopamine, to improve tics. However, this can result in, or worsen, depression.
    • Other medications that block dopamine, such as Fluphenazine, Haldol (haloperidol), and Risperdal (risperidone), have also been used to improve tics. However, these can result in involuntary movements.
    • Botulinum toxin may be used for vocal tics in some cases.
    • Topamax (topiramate) is an anti-seizure medication that has shown to be beneficial in some cases of TS.
    • Stimulants, like those used in ADHD, may help increase attention and concentration. However, these medications can exacerbate tics in some patients. If suffering from depression and/or anxiety then medications to treat these symptoms may be used.

    Additional Treatments for Tourette’s and Tics

    For severe tics that don’t respond to other treatments, deep brain stimulation (DBS) may be recommended. DBS involves implanting a medical device, similar to a pacemaker, as well as leads in the brain to deliver electrical stimulation to targeted areas that control movement. 

    Cognitive Behavioral Therapy for tics may be indicated to help monitor tics and identify urges, which then allows you to learn to voluntarily move in a way that’s incompatible with the underlying tic. This is known as habit-reversal training. Psychotherapy can help you cope with Tourette’s, as well as any obsessions, depression, or anxiety you may experience.

    Therapy may also be recommended as an adjunct treatment.

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