Tourette Syndrome [Awareness]

To understand and name something is often half the battle.  An understanding of Tourette Syndrome can help us to serve people who painfully struggle with this particular challenge.

What is Tourette syndrome?

Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition in an 86-year-old French noblewoman.

The early symptoms of TS are almost always noticed first in childhood, with the average onset between the ages of 7 and 10 years. TS occurs in people from all ethnic groups; males are affected about three to four times more often than females.

It is estimated that 200,000 Americans have the most severe form of TS, and as many as one in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics or transient tics of childhood. Although TS can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood.

What are the symptoms?

Tics are classified as either simple or complex. Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. Some of the more common simple tics include eye blinking and other vision irregularities, facial grimacing, shoulder shrugging, and head or shoulder jerking.  Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds.

Complex tics are distinct, coordinated patterns of movements involving several muscle groups. Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug. Other complex motor tics may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting. Simple vocal tics may include throat-clearing, sniffing/snorting, grunting, or barking. More complex vocal tics include words or phrases.

Perhaps the most dramatic and disabling tics include motor movements that result in self-harm such as punching oneself in the face or vocal tics including coprolalia (uttering swear words) or echolalia (repeating the words or phrases of others). Some tics are preceded by an urge or sensation in the affected muscle group, commonly called a premonitory urge. Some with TS will describe a need to complete a tic in a certain way or a certain number of times in order to relieve the urge or decrease the sensation.

Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics, for example tight collars may trigger neck tics, or hearing another person sniff or throat-clear may trigger similar sounds. Tics do not go away during sleep but are often significantly diminished.

What is the course of TS?

Tics come and go over time, varying in type, frequency, location, and severity.  The first symptoms usually occur in the head and neck area and may progress to include muscles of the trunk and extremities. Motor tics generally precede the development of vocal tics and simple tics often precede complex tics.  Most patients experience peak tic severity before the mid-teen years with improvement for the majority of patients in the late teen years and early adulthood. Approximately 10 percent of those affected have a progressive or disabling course that lasts into adulthood.

Can people with TS control their tics?

Although the symptoms of TS are involuntary, some people can sometimes suppress, camouflage, or otherwise manage their tics in an effort to minimize their impact on functioning. However, people with TS often report a substantial buildup in tension when suppressing their tics to the point where they feel that the tic must be expressed. Tics in response to an environmental trigger can appear to be voluntary or purposeful but are not.

What causes TS?

Although the cause of TS is unknown, current research points to abnormalities in certain brain regions (including the basal ganglia, frontal lobes, and cortex), the circuits that interconnect these regions, and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells. Given the often complex presentation of TS, the cause of the disorder is likely to be equally complex.

What disorders are associated with TS?

Many with TS experience additional neurobehavioral problems including inattention; hyperactivity and impulsivity (attention deficit hyperactivity disorder—ADHD) and related problems with reading, writing, and arithmetic; and obsessive-compulsive symptoms such as intrusive thoughts/worries and repetitive behaviors. For example, worries about dirt and germs may be associated with repetitive hand-washing, and concerns about bad things happening may be associated with ritualistic behaviors such as counting, repeating, or ordering and arranging.

People with TS have also reported problems with depression or anxiety disorders, as well as other difficulties with living, that may or may not be directly related to TS.  Given the range of potential complications, people with TS are best served by receiving medical care that provides a comprehensive treatment plan.

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Source for this post: http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm#147223231

Great site at: http://tsa-usa.org/

Tourette Syndrome: Know The Basics

“Dropping F Bombs”

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Tourette’s disorder, or Tourette syndrome

(TS) as it is frequently called, is a neurologic syndrome. The essential feature of Tourette’s are multiple tics that are sudden, rapid, recurrent, non-rhythmic, stereotypical, purposeless movements or vocalizations.

 
 What are the symptoms of Tourette syndrome?
 
  • Both multiple motor and one or more vocal tics are present at some time during the illness, although not necessarily simultaneously
  • Occurrence many times a day nearly every day or intermittently throughout a span of more than one year
  • Significant impairment or marked distress in social, occupational, or other important areas of functioning.
  • Onset before the age of 18.

 Symptoms can disappear for weeks or months at a time and severity waxes and wanes.

  

What are the first tics that may be characteristic of Tourette’s syndrome?

Usually, the facial tic, such as rapid blinking of the eyes or twitches of the mouth, may be the first indication a parent has that their child may have Tourette’s syndrome. Involuntary sounds, such as throat clearing and sniffing, or tics of the limbs may be an initial sign in other children.

  

Are any other symptoms associated with Tourette’s syndrome?

Approximately 50 percent of patients meet criteria for attention deficit hyperactivity disorder (ADHD) and this may be the more impairing problem. Approximately one-third of patients meet criteria for obsessive-compulsive disorder (OCD) or have other forms of anxiety. Learning disabilities are common as well as developmental stuttering. Social discomfort, self-consciousness and depressed mood frequently occur, especially as children reach adolescence.

 

Yelling and irrational

What causes these symptoms?

Although the cause has not been definitely established, there is considerable evidence that Tourette’s syndrome arises from abnormal metabolism of dopamine, a neurotransmitter. Other neurotransmitters may be involved.

 

Can Tourette’s syndrome be inherited?

Genetic studies indicate that Tourette’s syndrome is inherited as an autosomal dominant gene but different family members may have dissimilar symptoms. A parent has a 50 percent chance of passing the gene to one of his or her children. The range of symptomatology varies from multiple severe tics to very minor tics with varying degrees of attention deficit-disorder and OCD.

  

Are boys or girls more likely to have Tourette’s syndrome?

The sex of the child can influence the expression of the Tourette’s syndrome gene. Girls with the gene have a 70 percent chance of displaying symptoms, boys with the gene have a 99 percent chance of displaying symptoms. Ratios of boys with Tourette’s syndrome to girls with Tourette’s syndrome are 3:1. 

  

How is Tourette’s syndrome diagnosed?

No blood analysis, x-ray or other medical test exists to identify Tourette’s syndrome. Diagnosis is made by observing the signs or symptoms as described above. A doctor may wish to use a CAT scan, EEG, or other tests to rule out other ailments that could be confused with TS. Some medications cause tics, so it is important to inform the professional doing the assessment of any prescribed, over-the-counter, or street drugs to which the patient may have been exposed.

  

What are the benefits of seeking early treatment of Tourette syndrome symptoms?

When a child’s behavior is viewed as disruptive, frightening, or bizarre by peers, family, teachers, or friends, it provokes ridicule and rejection. Teachers and other children can feel threatened and exclude the child from activities or interpersonal relationships. A child’s socialization difficulties will increase as he reaches adolescence. Therefore, it is very important for the child’s self-esteem and emotional well-being that treatment be sought as early as possible.

  

What treatments are available for Tourette syndrome?

Not everyone is disabled by his or her symptoms, so medication may not be necessary. When symptoms interfere with functioning, medication can effectively improve attention span, decrease impulsivity, hyperactivity, tics, and obsessive-compulsive symptomatology. Relaxation techniques and behavior therapy may also be useful for tics, ADD symptoms, and OCD symptoms. 

  

How does Tourette syndrome affect the education of a child or adolescent with Tourette syndrome?

Tourette syndrome alone does not affect the IQ of a child. Many children who have Tourette syndrome, however, also have learning disabilities or attention deficits. Frequently, therefore, special education may be needed for a child with Tourette syndrome. Teachers should be given factual information about the disorder and, if learning difficulties appear, the child should be referred to the school system for assessment of other learning problems.

  

What is the course of Tourette syndrome?

Some people with Tourette syndrome show a marked improvement in their late teens or early twenties. However, tics as well as ADD and OCD behavior, may wax and wane over the course of the life span.   

  

Reviewed by Charles T. Gordon, III, M.D., 2003

 

For more help go to: http://www.nami.org/   and  http://www.tsa-usa.org/

 

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