• Tourette Syndrome

    (TS)

    Definition

    Tourette syndrome (TS) is a chronic, neurological disorder that is a member of a larger group of primary tic disorders. TS is characterized by motor and vocal tics. Tics are rapid, involuntary movements or sounds that occur repeatedly. Both motor and vocal tics must be present, though not necessarily at the same time. Tics must be present for more than one year, and its onset must be before age 18.

    Causes

    The cause of TS is unknown. However, brain chemicals, called neurotransmitters, are likely involved. Dopamine and serotonin are most likely involved. In addition, stress and tension often increase tics.
    In many cases, TS is inherited. However, some patients may have milder tic disorders or obsessive-compulsive symptoms without tics. Sometimes there are no symptoms.
    Genetic Material
    Chromosome DNA
    In most cases, TS is inherited through genes, which make up DNA.
    Copyright © Nucleus Medical Media, Inc.
    Some people with TS have no known family history of TS, tics, or obsessive-compulsive symptoms. Researchers are studying whether other factors, such as birth-related issues, infections, and autoimmune problems, may contribute to TS.

    Risk Factors

    Factors that may increase your risk of TS include:
    • Family history of TS, other tic disorders, or obsessive-compulsive disorder
    • Sex: males are three to four times more likely to be affected
    There are many secondary causes of tics including:

    Symptoms

    Symptoms range from mild-to-severe, but most cases are mild. They can occur suddenly and vary in the amount of time that they last. Tics may temporarily decrease with concentration or distraction. During times of stress, they may occur more often.
    Tics are divided into motor and vocal, and then subdivided into simple and complex. The following are common examples:
      Motor tics
      • Simple—eye blinking, facial grimacing, head jerking, arm or leg thrusting
      • Complex—jumping, smelling, touching things or other people, twirling around
      Vocal tics
      • Simple—throat clearing, coughing, sniffing, grunting, yelping, barking
      • Complex—saying words or phrases that do not make sense in a given situation, saying obscene or socially unacceptable words—called coprolalia
    Many people with TS also have one or more of the following problems:
    While tics may occur throughout life, older teens may find that symptoms improve.

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. Some doctors may order a magnetic resonance imaging (MRI) scan , computed tomography (CT) scan , electroencephalogram (EEG) , or blood tests to rule out other disorders.

    Treatment

    Education and therapy are often parts of the treatment plan. In some cases, medicine may be needed.

    Education and Therapy

    • Learning about TS is a very important part of treatment. Education can also be helpful for your family, friends, and coworkers.
    • Behavior therapy can help people with TS learn to substitute their tics with other movements or sounds that are more acceptable.
    • Cognitive behavioral therapy can help reduce obsessive-compulsive symptoms.
    • Psychotherapy can help people with TS and their families cope with the disorder.
    In addition, relaxation, biofeedback, and exercise can reduce help to reduce stress.

    Medications

      Several medicines can help control tics, including:
      • Clonidine, pimozide, risperidone, and haloperidol
      • Antipsychotic medicines, such as aripiprazole and ziprasidone
      Obsessive-compulsive symptoms may be treated with:
      • Fluoxetine, clomipramine, sertraline, or other similar medicines
      Symptoms of ADHD may be treated with:
      • Stimulants, such as methylphenidate, pemoline, dextroamphetamine sulfate, or tricyclic antidepressants

    Prevention

    There is no known way to prevent TS.

    RESOURCES

    National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

    Tourette Syndrome Association http://www.tsa-usa.org

    CANADIAN RESOURCES

    About Kids Health http://www.aboutkidshealth.ca

    Tourette Syndrome Foundation of Canada http://www.tourette.ca

    References

    Bruun RD, Cohen DJ, Leckman JF. Guide to the Diagnosis and Treatment of Tourette Syndrome . Bayside, NY: Tourette Syndrome Association; 1984.

    Jankovic J. Tourette Syndrome. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation; 2009.

    Menkes JH. Textbook of Child Neurology . 3rd ed. Baltimore, MD: Lea and Febiger; 1985.

    NINDS tourette syndrome information page. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/tourette/tourette.htm . Updated October 19, 2012. Accessed March 14, 2013.

    Samuels MA, Feske KF. Office Practice of Neurology . Philadelphia, PA: Churchill Livingstone; 2003.

    Tourette syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 3, 2012. Accessed March 14, 2013.

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