Tourette Syndrome
all information

Tourette Syndrome

(TS)

Pronounced: tuh-RET SIN-drohm

En Español (Spanish Version)

Definition

Tourette syndrome (TS) is a chronic, neurological disorder that is a member of a larger group of primary tic disorders. It is characterized by motor and vocal tics. 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 prior to age 18. 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 may be milder tic disorders or obsessive-compulsive symptoms with no tics. Sometimes there are no symptoms.

Genetic Material

Chromosome_DNA

© 2008 Nucleus Medical Art, 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 and autoimmune problems, may contribute to TS as well.

TS is one of the conditions grouped under the category Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal (or PANDAS). Studies suggests that, in some children, PANDAS are associated with Group A streptococcal or strep throat.

Researchers are studying whether the risk of PANDAS can be decreased by rapid treatment or prevention of strep infections. Also, studies need to be done to find out if some children are at a higher risk because of their genetic make-up. Overall, strep infection is common. So, if PANDAS are caused by the infection, then it's likely to occur rarely.

Other than this possible connection, the cause of tics is unknown. 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

Tell your doctor if you have any of these risk factors:

  • Family history of TS, other tic disorders, or obsessive-compulsive disorder
  • Sex: male (three to four times more likely to be affected)
  • Strep infection (may be a risk in some children)

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 the length of time they last can vary. 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. In less than 10%-40% of cases, people have remission from symptoms.

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 scan , CT scan , EEG, or blood tests to rule out other disorders.

Treatment

Most people with TS do not need medical treatment.

If you have a tic that disrupts daily activities, there are treatments—the most common being medication. However, the side effects may reduce how well the medication works.

No single treatment is helpful for all people with TS, and treatment may not completely eliminate symptoms.

Medications

  • Several medications can help control tics, including:
    • Clonidine (Catapres), pimozide (Orap), risperidone (Risperdal), and haloperidol (Haldol)
    • Newer antipsychotic medications, such as aripiperazole (Abilify) and ziprasadone (Geodon)
  • Obsessive-compulsive symptoms may be treated with:
    • Fluoxetine (Prozac), clomipramine (Anafranil), sertraline (Zoloft), or other similar medications
  • Symptoms of ADHD may be treated with:
    • Stimulants such as methylphenidate (Ritalin), pemoline (Cylert), dextroamphetamine sulfate (Dexedrine), or 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 exercise can reduce the stress that often makes symptoms worse.
  • Psychotherapy can help people with TS and their families cope with the disorder. In tic disorders associated with PANDAS, intravenous immunoglobulin therapy has been used with some success in a small number of patients, but is still considered experimental.

Prevention

There is currently 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
www.tourette.ca

References:

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

Jankovic, J. Tourette Syndrome. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation. Medlink website. Available at: http://www.medlink.com. Accessed May 12, 2008.

Mell LK, Davis RL, Owens D. Association between streptococcal infection and obsessive-compulsive disorder, Tourette's syndrome, and tic disorder. Pediatrics . 2005;116:56-60.

Menkes JH. Textbook of Child Neurology . 3rd ed. Lea and Febiger; 1985.

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

Samuels MA, Feske KF. Office Practice of Neurology . Philidelphia, PA: Chuchill Livingstone; 2003.

Tourette syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Accessed May 23, 2008.

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



Last reviewed March 2008 by J. Thomas Megerian, MD, PhD, FAAP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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