Tourette Syndrome

Tourette Syndrome (TS) is a chronic, neurological disorder. It is characterized by tics. Tics are rapid, involuntary movements or sounds that occur repeatedly.

Causes

In most cases TS is inherited through a gene (or genes). However, some expressions of the gene(s) may be milder tic disorders or obsessive-compulsive symptoms with no tics. Sometimes there are no symptoms A small number of TS cases have no known family history of TS, tics, or obsessive-compulsive symptoms. Researchers are studying whether other factors, such as birth-related issues and autoimmune problems, may contribute to TS as well. The cause of the tics has not yet been determined. However, studies show that several brain chemicals, called neurotransmitters, are involved. Dopamine and serotonin are the most likely. In addition, stress and tension often increase tics.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Family history of TS, other tic disorders, or obsessive-compulsive disorder
  • Sex: Male (Tics occur three to four times more often in males with the TS gene(s) than in females with the gene.)

Symptoms

Symptoms range from mild to severe, but most cases are mild.
Tics are divided into motor and vocal tics and then subdivided into simple and complex tics. The following are common examples of tics:
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, coprolalia (saying obscene or socially unacceptable words)
Many people with TS also have one or more of the following problems:
  • Obsessions
  • Compulsions and ritualistic behaviors
  • Attention deficit disorder with or without hyperactivity (ADD or ADHD)
  • Learning disabilities
  • Difficulties with impulse control
  • Sleep disorders

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. TS is diagnosed by observing the symptoms and reviewing when they began and how they progressed. There are no blood or neurological tests to diagnose TS. Some doctors may order an MRI, CT scan, EEG, or blood tests to rule out other disorders.

Treatment

Most people with TS do not need medical treatment. For people whose tics disrupt daily activities, there are treatments that can help manage symptoms. The most common is medication. However, the side effects may limit the effectiveness of medications. No single treatment is helpful for all people with TS, and none completely eliminate symptoms.
Medications
  • Several medications can help control tics, including clonidine (Catapres) pimozide (Orap), risperidone (Risperdal), and haloperidol (Haldol).
  • Obsessive-compulsive symptoms may be treated with Prozac, Anafranil Zoloft, or other similar medications.
  • Symptoms of ADHD may be treated with stimulants such as Ritalin, Cylert or Dexedrine, or with tricyclic antidepressants.
Other treatments
  • 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.
  • Relaxation, biofeedback, and/or exercise can reduce the stress that often exacerbates symptoms.
  • Psychotherapy can help people with TS and their families cope with the disorder.

Prevention

There are currently no known ways of preventing TS.