TOURETTE SYNDROME

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What is Tourette Syndrome?

Tourette Syndrome (TS) is a neurological disorder, which most often begins between the ages of 2 and 21 and lasts throughout life. TS are NOT degenerative and people with TS can expect to live a normal life span.

Tourette's syndrome is a problem with the nervous system that causes people to make sudden movements or sounds, called tics that they can't control. For example, someone with Tourette's might blink or clear their throat over and over again. Some people may blurt out words they don't intend to say.

Treatments can control tics, but some people don’t need any unless their symptoms really bother them.


What are the symptoms?

TS is characterised by rapid, repetitive and involuntary muscle movements and vocalisations called "tics", and often involves behavioural difficulties. The term "involuntary", used to describe tics, is a source of confusion since it is known that most people with TS do have some control over their symptoms. What is often not recognised is that the control which can be exerted, from seconds to hours at a time, only delays more severe outbursts of symptoms.

Tics are experienced as a build-up of tension, are irresistible and eventually must be performed. Typically tics increase as a result of tension or stress and decrease with relaxation or concentration on an absorbing task. TS symptoms have long been misconstrued as a sign of behavioural abnormality or "nervous habits", which they are not.

How are tics classified?

Symptoms can vary from one person to another. The symptoms include uncontrollable tics and spontaneous vocal outbursts. They usually first appear between ages 4 and 6, starting with small muscle tics of the head and neck. Eventually, other tics may appear in the trunk (torso) or limbs.

People diagnosed with Tourette syndrome often have both a motor tic and a vocal tic. Motor tics involve movement, while vocal tics involve sounds or speech.

The symptoms tend to worsen during periods of:

  • excitement.

  • stress.

  • anxiety.

Symptoms are generally most severe during your early teen years. Tics are classified by type, as in motor or vocal, such as involuntary speech disorder. Further classification includes simple or complex tics. Simple tics usually involve only one muscle group and are brief. Complex tics are coordinated patterns of movements or vocalizations that involve several muscle groups.

Do people with TS have all of these symptoms or just some of them?

People with TS rarely have all of these symptoms. Most people will exhibit some or many symptoms over a long period of time and in varying degrees: mild, moderate or severe. In milder cases a person may have just a few tics or twitches, which may be confined to the face, eye and shoulder areas. In more severe cases several areas of the body may be affected.

The symptoms wax and wane, in some cases from day to day but more commonly over 3 to 4 month periods. The waxing and waning pattern can sometimes be frightening to people with TS who may find it difficult to understand the sudden intensification or waning of symptoms.

Are there behaviour problems which may occur frequently in addition to tics?

Yes, but not always. Additional problems may include:

Obsessive Compulsive Disorder (OCD), in which the person feels that something must be done over and over. Examples include touching an object with one hand after touching it with the other to "even things out" and repeatedly checking to see that the flame on the stove is turned out. Children sometimes repeat a sentence or action many times until it is "just right". OCD can include counting rituals, obsessive preoccupations or thoughts which are unpleasant.

Attention Deficit &/or Hyperactivity Disorder (ADD/ADHD) may include difficulty in concentrating, being easily distracted, failing to finish tasks, acting on impulse, not seeming to listen, shifting constantly from one activity to another, needing a great deal of supervision, being unable to sit still, calling out and lack of self-control. Adults may have residual signs of ADD such as overly impulsive behaviour and concentration difficulties. Learning Difficulties such as dyslexia, arithmetic and perceptual difficulties, handwriting problems.

Behavioural problems may include compulsive and repetitive behaviours, attention problems, sleep difficulties, depression, poor self-esteem, poor school performance, social isolation, school and social phobia. Some commonly observed problems include oppositional/defiant behaviour, aggressive and uncooperative behaviours.

Treatment

Many times, tics are mild and don't need to be treated. If they become a problem, your doctor may prescribe medicine to help them. It can take a while to find the right dose that helps control tics but avoids side effects, so be patient as you and your doctor work through it.

Medications can include:

  • Haloperidol (Haldol), fluphenazine (Prolixin), and pimozide (Orap), which work on a brain chemical called dopamine to control tics.

  • Clonidine (Catapres) and guanfacine (Tenex, Intuniv)), high blood pressure drugs that can also treat tics.

  • Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and other antidepressants, which can relieve anxiety, sadness, and obsessive-compulsive symptoms.

Along with medicine, you may want to consider talk therapy. A psychologist or counselor can help you learn how to deal with the social issues your tics and other symptoms may cause.

Behavior therapy may also help. A specific kind, called habit-reversal training, teaches you how to recognize that a tic is coming and then move in a way that stops it.

Taking Care of Yourself

Often the hardest part of living with Tourette's is dealing with the embarrassment or frustration of having tics you can't control.

While you're getting help from your doctor, you can do a few other things to feel better: Get support. Your family, friends, health care team, or a support group can help you meet the challenges of Tourette's.

Stay active. Play sports, paint, or volunteer. These activities will take your mind off your symptoms.

Relax. Read a book, listen to music, meditate, or do yoga. Low-key activities you enjoy can combat the stress that can lead to tics.

Educate yourself. Learn everything you can about your condition, so you'll know what to do when you have symptoms.

Summary

Tourette’s syndrome is a disorder that involves at least one vocal tic, and various physical tics. The condition can emerge at any age. However, it usually begins between the ages of 6 and 18 years.

The exact cause of Tourette’s syndrome is unknown. However, it seems to stem from a problem in the basal ganglia. This part of the brain is responsible for involuntary movements, emotion, and learning.

Treatment usually includes medication and non-pharmacological treatments. Rarely, surgery may also be an option.

Competitive sports, playing an enjoyable computer game, or reading an interesting book may all help to manage the condition. However, it is important to note that overexcitement can also be a trigger for some people.

REFERENCE

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention

American Psychiatric Association. Diagnostic and statistical manual of mental disorders: , fifth edition: DSM-5. Washington, DC; 2013.

Bloch, MH, Leckman, JF. Clinical course of Tourette Syndrome. J Psychosom Res. 2009; 67(6): 497-501.

Centers for Disease Control and Prevention. Prevalence of diagnosed Tourette Syndrome in persons aged 6-17 years – United States, 2007. MMWRpdf icon Morb Mortal Wkly Rep. 2009; 58(21): 581-5.

Bitsko, RH, Holbrook, JR, Visser, SN, Mink, JW, Zinner, SH, Ghandour, RM, Blumberg, SJ (2014). A National Profile of Tourette Syndrome, 2011-2012. J Dev Behav Pediatr 35(5), 317-322.

Health Encyclopedia. Grief and Loss. University of Manchester Medical Center https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85&contentid=P0 0604

Prigerson HG, Shear MK, Reynolds CF III. Prolonged grief disorder diagnostic criteria: helping those with maladaptive grief responses. JAMA Psychiatry. June 20, 2022. https://www.psychiatrictimes.com/view/prolonged-grief-disorder-helping-those-withmaladaptive-grief-responses

Robertson MM (March 2000). "Tourette syndrome, associated conditions and the complexities of treatment". Brain (Review).

Bloch MH, Leckman JF (December 2009). "Clinical course of Tourette syndrome". J Psychosom Res (Review). 67 (6): 497–501. doi:10.1016/j.jpsychores.2009.09.002


Infographic Sources:

Mayo Clinic, “Complicated Grief”

Verywell, “DABDA: The 5 Stages of Coping With Death”

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