What is tourette syndrome?

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A disorder characterized by recurrent, multiple motor tics and one or more vocal tics that causes stress and impairs social functioning.
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Causes and Symptoms

Tourette syndrome is a disorder marked by multiple motor tics , involuntary vocalizations, and significant impairment of social functioning, often resulting in low self-esteem. For a diagnosis of Tourette syndrome, the symptoms must persist for a period of at least one year, although they may decrease or subside during that time for brief periods of three months or less. Onset must be prior to eighteen years of age. The motor and vocal tics manifested must not be a consequence of drug use or the result of a previously existing medical condition such as Huntington’s chorea.

Definitive causes for Tourette syndrome remain under investigation. Research in the late 1990s and early 2000s included an exploration of genetic factors that might cause a susceptibility to the disorder and studies of the frequency of the disorder in subsequent generations within families. Studies in brain chemistry were also conducted.

Tourette syndrome differs from a disease in that sufferers manifest a number of symptoms that occur together. Symptoms may be seen in sequence or in combination. Simple motor or vocal tics are most often first noticed in children between the ages of two and seven, but initial symptoms may not be seen until the teenage years. Typically, the first symptoms noticed are simple motor tics such as eye blinking, tongue protrusion, facial grimacing, or other movements in the head area, such as grunting, coughing, throat clearing, or unusual vocalizations.

Complex motor tics include such behaviors as involuntary touching, knee bends, touching of objects in sequence, or other repetitive behaviors. Although many patients first display eye blinks, the anatomical location, severity, and frequency of the tics may change over time. As a child matures, the tics may involve other areas of the body, such as the torso or the limbs.

The social implications of this disorder are as important as the physical ones for a child with Tourette syndrome. Such motor tics as touching inappropriately and involuntary utterances and outbursts can be disastrous to both self-image and social standing. Palilalia, echolalia, coprolalia, copropraxia, and bizarre behaviors brought about by involuntary compulsions cause affected children much anxiety. That their symptoms may mimic or coexist with other disorders is another concern. Although some children may outgrow the disorder in their twenties, generally Tourette syndrome is a lifelong disorder. With concentration and relaxation techniques, tics may be delayed or suppressed for brief periods, but they present ongoing problems for those living with Tourette syndrome.

Treatment and Therapy

By the turn of the twenty-first century, physical treatment for Tourette syndrome involved a combination of relaxation techniques and medication therapy. Counseling has also proven useful in conjunction with other treatments, by helping patients to deal with the social and emotional effects of this disorder. Relaxation techniques such as visualization of a calm setting and a variety of related therapies have proven successful in reducing the number and severity of the tics. Touch therapy and related techniques such as stroking and rocking have been helpful in reducing stress, as have some forms of massage.

Music is another effective means of relaxing the mind and the body. Some researchers have recommended that musical selections with a beat close to one’s resting heartbeat are the most effective in reducing stress levels. Musical instruments and other forms of creative expression have proved to be effective tools against stress and associated tics. Hobbies, diaries, written expression, and counseling have all been used effectively to treat the physical and emotional symptoms of Tourette syndrome.

A number of medication therapies are also being used. The blood-pressure medication clonidine has been helpful in the treatment of tics, with some side effects. Antiseizure medications have also had success, but with undesirable side effects. Children also suffering from related disorders such as Attention-deficit disorder (ADD) have been treated successfully with Ritalin. Drugs such as Anafinil and Prozac have proven useful in treating obsessive-compulsive disorder and other anxiety disorders sometimes seen in conjunction with Tourette syndrome. Dopamine blockers such as fluphenazine and haloperidol have also been shown to reduce tics, but these medications can also cause unwanted side effects.

Perspective and Prospects

Treatment and understanding have evolved substantially since 1885 when Georges Gilles de la Tourette first identified Tourette syndrome, which was thought to be a psychological disorder influenced by environmental factors. Many significant gains have been made since the 1980s in the clinical and scientific understanding of this complex disorder. Research in the late 1990s and early 2000s explored connections between brain chemistry and Tourette syndrome, with some studies indicating that abnormal dopamine and serotonin levels in the brain may be a factor. The role of genetics in the transmission and manifestation of the disorder has also been studied extensively, although the specific genes involved in Tourette syndrome are still being identified. Promising new medications continue to be developed as well.

Bibliography:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric, 2000.

Brill, Marlene Targ. Tourette Syndrome. Brookfield, Conn.: Millbrook Press, 2002.

Cohen, Donald J., Ruth D. Bruun, and James F. Leckman, eds. Tourette’s Syndrome and Tic Disorders. New York: John Wiley & Sons, 1988.

Conelea, Christine, et al. "The Impact of Tourette Syndrome in Adults: Results from the Tourette Syndrome Impact Study." Community Mental Health Journal 49, no. 1 (2013): 110–120.

Koplewicz, Harold S. “Tourette Syndrome.” In It’s Nobody’s Fault: New Hope and Help for Difficult Children and Their Parents. New York: Three Rivers Press, 1997.

Kushner, Howard I. A Cursing Brain? The Histories of Tourette Syndrome. Rev. ed. Cambridge, Mass.: Harvard University Press, 2000.

Parker, James N., and Philip M. Parker, eds. The Official Parent’s Sourcebook on Tourette Syndrome. San Diego, Calif.: Icon Health, 2002.

Rosenblum, Laurie. "Tourette Syndrome." Health Library, April 3, 2013.

Shimberg, Elaine Fantle. Living with Tourette Syndrome. New York: Simon & Schuster, 1995.

"Tourette Syndrome." Mayo Clinic, August 10, 2012.

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