Tourette Syndrome

These tics characteristically wax and wane, can be suppressed temporarily, and are typically preceded by an unwanted urge or sensation in the affected muscles.

This disorder most often begins between the ages of six and 15 but may occur as early as age two or as late as age 20.

TS is found among all social, racial and ethnic groups and has been reported in all parts of the world. It is three to four times more frequent among males than among females.

The tics of Tourette’s begin in childhood and tend to subside with maturity. Thus, a diagnosis may no longer be warranted for many adults, and observed prevalence rates are higher among children than adults.

As children pass through adolescence, about one-quarter become tic-free, almost one-half see their tics diminish to a minimal or mild level, and less than one-quarter have persistent tics. Only 5 to 14% of adults experience worse tics in adulthood than in childhood.

Tourette's does not adversely affect intelligence or life expectancy.

The exact cause of Tourette's is unknown, but it is well established that both genetic and environmental factors are involved. A person with Tourette's has about a 50% chance of passing the gene(s) to one of his or her children, and, not everyone who inherits the genetic vulnerability will show symptoms. Even close family members may show different severities of symptoms, or no symptoms at all.

The hallmark signs of Tourette syndrome are frequent, repetitive and quick involuntary movements also called tics. They can range from mild to severe, and most commonly occur on the face, followed by the arms, legs or trunk.

Verbal tics (vocalizations) usually occur with the movements, but later may replace one or more movement tics. These vocalizations include grunting, throat clearing, shouting and barking.

Tics are classified as:

• Simple — sudden, brief and repetitive tics involve a limited number of muscle groups
• Complex — distinct, coordinated patterns of movements that involve several muscle groups

The spectrum of tics that people experience is diverse. Common motor tics seen in Tourette Syndrome are:

Simple tics:

• Eye blinking
• Head jerking
• Shoulder shrugging
• Eye darting
• Nose twitching
• Mouth movements

Complex tics:

• Touching or smelling objects
• Repeating observed movements
• Stepping in a certain pattern
• Obscene gesturing
• Bending or twisting
• Hopping

Common vocal tics seen in Tourette syndrome include:

Simple tics:

• Grunting
• Coughing
• Throat clearing
• Barking

Complex tics:

• Repeating one's own words or phrases
• Repeating others' words or phrases
• Using vulgar, obscene or swear words

In addition, tics can vary in type, frequency, and severity; occur while sleeping; and, usually, worsen if you're ill, stressed, anxious, tired or excited.

They can change over time, typically worsen in the early teenage years and improve during the transition into adulthood.

Before the onset of motor or vocal tics, people likely experience an uncomfortable bodily sensation (premonitory urge) such as an itch, a tingle or tension. The expression of the tic brings relief. With great effort, some people with Tourette syndrome can temporarily stop or hold back a tic.

Not all tics indicate Tourette syndrome. Many children develop tics that go away on their own after a few weeks or months. But whenever a child shows unusual behavior, it's important to identify the cause and rule out serious health problems.

In extreme cases, verbal tics also may include the involuntary use of obscene words or socially unacceptable words and phrases (known as coprolalia) or obscene gestures (copropraxia).

This condition can be quite embarrassing and can cause people with Tourette Syndrome to have problems with socialization and acceptance by peers.

It is estimated that tics disappear in a person's early 20s in 70% of cases.

There are no specific tests for diagnosing Tourette's. It is not always correctly identified because most cases are mild and the severity of tics decreases for most children as they pass through adolescence. Extreme Tourette's in adulthood, though sensationalized in the media, is a rarity.

In most cases, medication for tics is not necessary. Education is an important part of any treatment plan, and explanation and reassurance alone are often sufficient treatment.

Many individuals with Tourette's go undiagnosed or never seek medical care.

Among those who are seen in specialty clinics, attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) are present at higher rates. These co-occurring diagnoses often cause more impairment to the individual than the tics; hence, it is important to correctly identify associated conditions and treat them.

There are many types of medications prescribed for those whose symptoms interfere with life functions, work or school.

Because these medications have potentially serious side effects, patients should adhere to their physician’s dosage instructions and contact them if there are any issues.

Another option, Deep Brain Stimulation (DBS), has emerged as a potential option for select Tourette syndrome patients whose motor and/or vocal tics significantly impact the quality of life despite maximal use of other treatment options.

Researchers have had mixed success probing into several areas in the brain of people with TS. DBS has the potential to control abnormal instructions that occur deep within the brains of people with TS.

DBS has positive results in some TS patients and the public has generally reacted favorably. However, it has raised many questions for patients and their families to consider. Please discuss DBS with your physician and consider all consequences.

This information was provided by the specialists at Semmes Murphey Clinic. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatment.