Tourette’s Syndrome

Tourette’s Syndrome General Information

Tourette’s Syndrome is the generic medical term given to an inherited neuropsychiatric disorder which typically occurs during childhood. Generally, it is associated with the presence of several abnormal occurrences in the patient’s behavior (tics) for at least 12 months. These tics are often physical (such as blinking, sniffing, throat clearing, coughing or facial movements); however the syndrome also includes at least one vocal tic. While it is most commonly associated with the compulsory uttering of obscene words, this symptom is actually present only in a small number of cases. The syndrome is relatively common, with an incidence rate of up to 10 in 1,000 children; however, once the patients pass through adolescence, the severity of the tics is known to decrease in most cases, and the presence of Tourette in adult patients is a rare occurrence.

It is common that patients affected by Tourette’s Syndrome also present one or more co-morbid conditions, such as anxiety, depression, obsessive-compulsive disorder or attention deficit hyperactivity disorder. In itself, the syndrome is part of a broad spectrum of tic disorders which is in most cases genetically inherited, however studies have yet to identify the gene responsible for the affection. A carrier parent has about 50% chances to pass the disorder to his or her children; also, children who receive the gene are not necessarily affected by this condition. Children that inherit the genetic predisposition may develop the syndrome with different degrees of severity of the symptoms, may develop related affections or may not be affected in any way. Also, studies have shown that it is more likely for male children to express tics than for females.

Tourette’s Syndrome Symptoms

As stated, Tourette’s Syndrome is generally manifested through a variety of motor and verbal tics. An affected patient may experience a number of different tics, with varying frequency and severity, and the anatomical location of the physical tics may also vary from one patient to another, and also in a single patient over time. These tics may wax and wane, meaning that the severity and frequency may change and fluctuate over time. The most common tics encountered are eye blinking, facial movements, throat clearing and sniffing.

While the most publicized verbal tic associated with Tourette’s Syndrome is coprolalia (the compulsory and spontaneous uttering of foul language or inappropriate words or phrases, present in about 15% of the cases), other verbal symptoms are echolalia and palilalia (the repeating of other people’s words, respectively one’s own).

Generally, a patient affected by Tourette’s Syndrome will present stereotypic and non-rhythmic tics that are temporarily suppressible, and these tics are often preceded by what is called a “premonitory urge” – the patient feels a sensation that needs to be relieved through performing the tic. This urge has often been compared to the need to sneeze or the need to scratch an itch, and they willingly choose to release it through performing the tic. Such sensory phenomena have been identified as the syndrome’s core symptom, although the diagnosis does not require the presence of such sensations. The tics associated with this syndrome are generally suppressible – as in, the patient can hold back the tic for a period of time, however doing so generally results in an outburst of tics afterwards.

Tourette’s Syndrome Treatment

In the treatment of patients affected by Tourette’s Syndrome, the health care specialists identify and assist the patient in managing the symptoms. In most cases, these are mild and no medication is needed. Education, reassurance and behavior therapy is typically sufficient in these cases. When required, treatment for Tourette’s Syndrome consists of treatment for the tics, in order to reduce their frequency or severity. If the patient presents any comorbid conditions, these are generally a more severe source of impairment than the actual tics, and treating these conditions takes priority.

At this time, there is no cure for Tourette’s Syndrome, and no medication has been shown to be a universal solution for all the patients. In most cases, treatment only consists of behavioral and / or psychological therapy which will assist the patient until he or she goes through adolescence, point at which the symptoms generally recede. Such therapies as cognitive behavioral therapy and biofeedback are commonly applied in less severe cases of Tourette’s. Habit reversal has also been shown to have a strong positive impact in reducing the frequency of the tics, and however, in severe cases where the symptoms may interfere with the patient’s functioning, the specialized health care professional may decide to employ medication treatment.

The most effective class of drugs that may be used to treat tic severity and frequency in Tourette’s Syndrome affected patients are the neuroleptics medication, both typical and atypical. Among these, Risperidone, Ziprasidone, Pimozide, Haloperidol and Fluphenazine are the most common. However, it should be noted that these medications may cause the appearance of long term or short term side effects in the patients, and the prescribing health care specialist should carefully consider if the benefits of the therapy outweigh the risks. Other types of medication can be prescribed in such cases as well, but while the chances for side effects to occur are smaller, their effectiveness is typically also reduced. Such alternative drugs include antihypertensive agents such as Guanfacine and Clonidine.

Medication can also be employed to assist in treating co-morbid affections that occur in patients diagnosed with Tourette’s Syndrome. Obsessive-compulsive disorders are generally treated with tricyclic antidepressants such as Clomipramine, or SSRIs such as Sertraline, Flouxetine or Fluvoxamine, while ADHD occurrences are typically treated with stimulants, however other types of medication may also be employed if stimulant medication yields no satisfactory result. In cases where medication therapy is prescribed, the patient should closely follow the drug dosage and intake schedule that the prescribing health care professional has provided.

Apart from medication and behavioral therapies, several studies have shown that several relaxation techniques can be employed in order to relieve the stress the patient may be subject to. As in many cases tic outbursts often occur on account of stress, specialists suggest that the patient takes up yoga, meditation or exercise to help reduce stress.