Tourette's Syndrome

Definition

Tourette (too-RET) syndrome is a nervous system (neurological) disorder that starts in childhood. It involves unusual repetitive movements or unwanted sounds that can't be controlled (tics). For instance, you may repeatedly blink your eyes, shrug your shoulders or jerk your head. In some cases, you might unintentionally blurt out offensive words.

Signs and symptoms of Tourette syndrome typically show up between ages 2 and 12, with the average being around 7 years of age. Males are about three to four times more likely than females to develop Tourette syndrome.

Although there's no cure, you can live a normal life span with Tourette syndrome, and many people with Tourette syndrome don't need treatment when symptoms aren't troublesome. Symptoms of Tourette syndrome often lessen or become quiet and controlled after the teen years.

Symptoms

Tics — sudden, brief, intermittent movements or sounds — are the hallmark sign of Tourette syndrome. Symptoms range from mild to severe. Severe symptoms may significantly interfere with communication, daily functioning and quality of life.

Tics are classified as either:

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

Tics involving movement (motor tics) — often facial tics, such as blinking — usually begin before vocal tics do. But the spectrum of tics that people experience is diverse, and there's no typical case.

Common motor tics seen in Tourette syndrome
Simple tics	Complex tics
Eye blinking	Touching the nose
Head jerking	Touching other people
Shoulder shrugging	Smelling objects
Eye darting	Obscene gesturing
Finger flexing	Flapping the arms
Sticking the tongue out	Hopping
Common vocal tics seen in Tourette syndrome
Simple tics	Complex tics
Hiccuping	Using different tones of voice
Yelling	Repeating one's own words or phrases
Throat clearing	Repeating others' words or phrases
Barking	Using vulgar, obscene or swear words

In addition, if you have Tourette syndrome, your tics may:

• Vary in type, frequency and severity
• Worsen if you're ill, stressed, anxious, tired or excited
• Occur during sleep
• Evolve into different tics over time
• Worsen during teenage years and improve during the transition into adulthood

Before the onset of motor or vocal tics, you'll likely experience an urge called a premonitory urge. A premonitory urge is an uncomfortable bodily sensation, such as an itch, a tingle or tension. Expression of the tic brings relief.

With great effort, some people with Tourette syndrome can temporarily stop a tic or hold back tics until they find a place where it's less disruptive to express them.

Causes

The exact cause of Tourette syndrome isn't known, and there's no known way to prevent it. Tourette is a complex syndrome, likely caused by a combination of genetic and environmental factors. Theories about the causes of Tourette include:

• Genetics. Tourette syndrome may be an inherited disorder. The specific genes involved in Tourette syndrome are still being defined, although one genetic mutation has been identified as a rare cause of Tourette syndrome.
• Brain abnormalities. Certain chemicals in the brain that transmit nerve impulses (neurotransmitters) may play a role, including dopamine and serotonin.

Risk factors

Risk factors for Tourette syndrome include:

• Family history. Having a family history of Tourette syndrome or other tic disorders may increase the risk of developing Tourette syndrome.
• Being male. Males are about three to four times more likely than females to develop Tourette syndrome.

Complications

People with Tourette syndrome have a normal life span and often lead healthy, active lives. However, having Tourette syndrome may increase your risk of learning, behavioral and social challenges, which can harm your self-image.

In addition, having Tourette syndrome means you're likely to have other related conditions, such as:

• Attention-deficit/hyperactivity disorder (ADHD)
• Obsessive-compulsive disorder (OCD)
• Learning disabilities
• Sleep disorders
• Depression
• Anxiety disorders

Treatments and drugs

There's no cure for Tourette syndrome. Treatment is intended to help control tics that interfere with everyday activities and functioning. When tics aren't severe, treatment may be unnecessary.

Medications
No medication is helpful to everyone with Tourette syndrome, none completely eliminates symptoms, and they all have side effects to be weighed against the benefits.

Possible medications to help control or minimize tics or to reduce symptoms of related conditions — such as attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD) — include:

• Drugs that block or deplete the neurotransmitter dopamine in the brain, such as fluphenazine, haloperidol (Haldol) or pimozide (Orap). Used to control tics, these medications may have side effects such as weight gain and a dulling of the mind.
• Botulinum toxin type A (Botox) injections. For simple or vocal tics, an injection into the affected muscle may help relieve the tic.
• Stimulant medications, such as methylphenidate (Concerta, Ritalin, others) and those containing dextroamphetamine (Adderall XR, Dexedrine, others). These are used to help increase attention and concentration for people with ADHD.
• Central adrenergic inhibitors, such as clonidine (Catapres) or guanfacine (Tenex). Typically prescribed for high blood pressure, these drugs may help control behavioral symptoms, such as impulse control problems and rage attacks. Side effects may include sleepiness.
• Antidepressants, such as fluoxetine (Prozac, Sarafem, others). These may help control symptoms of sadness, anxiety and OCD.

Therapies

• Psychotherapy. In addition to helping you cope with Tourette syndrome, psychotherapy or talk therapy can help with accompanying problems, such as ADHD, obsessions, depression or anxiety.
• Behavior therapy. A form of behavior therapy called habit-reversal training may help to reduce tics. With this therapy, you monitor tics and identify premonitory urges — those uncomfortable sensations that occur before the tic. You learn to respond to those urges by voluntarily moving in a way that's incompatible with the tic, which suppresses the tic.
• Deep brain stimulation. For severe tics that don't respond to other treatment, deep brain stimulation (DBS) may help. DBS consists of implanting a battery-operated medical device (neurostimulator) in the brain to deliver electrical stimulation to targeted areas that control movement. More research is needed to determine whether DBS benefits people with Tourette syndrome.

Source : Mayoclinic.com

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