TOURETTE SYNDROME – SYMPTOMS, CAUSES, AND TREATMENT
Tourette syndrome is a disorder that includes repetitive movements or unwanted sounds (tics) that cannot be easily controlled. For example, you may repeatedly blink your eyes, shrug your shoulders or blurt out unusual sounds or offensive words.
Tics typically show up between ages two and fifteen, with the average being around six years of age. Males are approximately three to four times more likely than females to develop Tourette syndrome.
Though there is no cure for Tourette syndrome, treatments are available. Many people with Tourette syndrome do not require treatment when symptoms are not troublesome. Tics often decrease or become controlled after the teen years.
SYMPTOMS
Tics — unexpected, brief, intermittent movements or sounds — are the hallmark sign of Tourette syndrome. They could range from mild to severe. Severe symptoms may significantly intrude with communication, daily functioning, and quality of life.
Tics are classified as:
- Simple tics – These sudden, brief and repetitive tics include a limited number of muscle groups.
- Complex tics – These distinct, coordinated patterns of movements include several muscle groups.
Tics could also involve movement (motor tics) or sounds (vocal tics). Motor tics generally start before vocal tics do. However, the spectrum of tics that people experience is diverse.
COMMON MOTOR TICS SEEN IN TOURETTE SYNDROME
| Simple Tics | Complex Tics |
|---|---|
| Eye blinking | Touching or smelling objects |
| Head jerking | Repeating observed movements |
| Shoulder shrugging | Stepping in a specific pattern |
| Eye darting | Obscene gesturing |
| Nose twitching | Bending or twisting |
| Mouth movements | Hopping |
Common vocal tics seen in Tourette syndrome
| Simple Tics | Complex Tics |
|---|---|
| Grunting | Repeating one’s own words or phrases |
| Coughing | Repeating others’ words or phrases |
| Throat clearing | Using vulgar, obscene, or swear words |
| Barking |
In addition, tics could:
- Vary in type, frequency, and severity
- Worsen if you are sick, stressed, anxious, tired, or excited
- Occur during sleep
- Change over time
- They worsen in the early teenage years and improve during the transition into adulthood
Before the beginning of motor or vocal tics, you will likely experience an uncomfortable bodily sensation (premonitory urge) like an itch, a tingle, or tension. Expression of the tic provides relief. With great effort, some people with Tourette syndrome could temporarily stop or hold back a tic.
WHEN SHOULD YOU SEE A DOCTOR?
Consult your child’s pediatrician if you notice your child displaying involuntary movements or sounds.
Not all tics suggest Tourette syndrome. Many children develop tics that go away on their own after several weeks or months. But whenever a child shows unusual behavior, it is important to identify the cause and rule out severe health problems.
CAUSES
The precise cause of Tourette syndrome is unknown. It is a complex disorder likely caused by a combination of hereditary (genetic) and environmental factors. Chemicals in the brain that transmit nerve impulses (neurotransmitters), involving dopamine and serotonin, may play a role.
RISK FACTORS
Risk factors for Tourette syndrome include:
- Family history – Having a family history of Tourette syndrome or other tic disorders may increase your risk of developing Tourette syndrome.
- Sex – Males are approximately three to four times more likely than females to develop Tourette syndrome.
COMPLICATIONS
People with Tourette syndrome usually lead healthy, active lives. However, Tourette syndrome frequently involves behavioral and social challenges that could harm your self-image.
Conditions often related to Tourette syndrome include:
- Attention-deficit/hyperactivity disorder (ADHD)
- Obsessive-compulsive disorder (OCD)
- Autism spectrum disorder
- Learning disabilities
- Sleep disorders
- Depression
- Anxiety disorders
- Pain associated with tics, particularly headaches
- Anger-management issues
DIAGNOSIS
There is no specific test that could diagnose Tourette syndrome. The diagnosis is based upon the history of your signs and symptoms.
The criteria used to diagnose Tourette syndrome include:
- Both motor tics and vocal tics are present, but not necessarily at the same time
- Tics happen several times a day, nearly every day or intermittently, for more than a year
- Tics start before age 18
- Tics are not caused by medications, other substances, or another medical condition
- Tics should change over time in the location, frequency, type, complexity, or severity
A diagnosis of Tourette syndrome may be overlooked because the signs could mimic other conditions. Eye blinking may be initially related to vision problems or sniffling attributed to allergies.
Both motor and vocal tics could be caused by conditions other than Tourette syndrome. To rule out other causes of tics, your doctor may recommend:
- Blood tests
- Imaging studies like an MRI
TREATMENT
There is no cure for Tourette syndrome. Treatment is aimed at controlling tics that intrude with everyday activities and functioning. When tics are not severe, treatment may not be necessary.
Medication
Medications to help control tics or reduce symptoms of associated conditions include:
- Medications that block or lessen dopamine – Fluphenazine, haloperidol (Haldol), risperidone (Risperdal), and pimozide (Orap) could help control tics. Possible side effects involve weight gain and involuntary repetitive movements. Tetrabenazine (Xenazine) may be recommended, although it might cause severe depression.
- Botulinum (Botox) injections – An injection into the affected muscle may help relieve a simple or vocal tic.
- ADHD medications – Stimulants like methylphenidate (Metadate CD, Ritalin LA, others) and medications containing dextroamphetamine (Adderall XR, Dexedrine, others) could help increase attention and concentration. However, for some people with Tourette syndrome, medications for ADHD could exacerbate tics.
- Central adrenergic inhibitors – Medications like clonidine (Catapres, Kapvay) and guanfacine (Intuniv) — typically prescribed for high blood pressure — may help control behavioral symptoms like impulse control problems and rage attacks. Side effects might include sleepiness.
- Antidepressants – Fluoxetine (Prozac, Sarafem, others) may help control symptoms of sadness, anxiety, and OCD.
- Antiseizure medications – Recent studies indicate that some people with Tourette syndrome respond to topiramate (Topamax), which is used to treat epilepsy.
Therapy
- Behavior therapy – Cognitive Behavioral Interventions for Tics, including habit-reversal training, could help you monitor tics, identify premonitory urges and learn to voluntarily move in a way that is incompatible with the tic.
- Psychotherapy – In addition to helping you cope with Tourette syndrome, psychotherapy could help with accompanying problems, like ADHD, obsessions, depression, or anxiety.
- Deep brain stimulation (DBS) – For severe tics that do not respond to other treatments, DBS may help. DBS includes implanting a battery-operated medical device in the brain to deliver electrical stimulation to targeted areas that control movement. However, this treatment is still in the early research stages and requires more research to determine if it is a safe and effective treatment for Tourette syndrome.
If you or anyone you know is suffering from Tourette syndrome, our expert providers at Specialty Care Clinics will take care of your health and help you recover.
Call us on (469) 545-9983 to book an appointment with our specialists.