Understanding Tourette Syndrome

April 10, 2023 | Divyanshi Singh | Neurology

Tourette Syndrome is a neurological disorder named after Georges Gilles de la Tourette, a French neurologist who described nine patients with childhood-onset tics, some accompanied by uncontrollable noises and expressions, features of attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), poor impulse control, and other comorbid behavioral issues in 1885.

What is Tourette Syndrome?

Tourette syndrome (TS) is a hereditary neurological condition characterized by childhood-onset tics and concomitant behavioral issues. Tics are spontaneous or semi-voluntary motions (motor tics) or noises that are abrupt, short, and intermittent, and are the clinical characteristic of TS (phonic or vocal tics). Blinking, nose twitching, and head and limb jerking are examples of motor tics. Sniffing, throat clearing, grunting, coughing, and the usage of obscene words or phrases are characteristics of phonic tics. Tics can be intentionally repressed for brief periods of time, and they can be aggravated by stress, excitement, or exhaustion.

What disorders are linked to TS?

While many persons with TS just have tics, it’s very uncommon for them to have other problems as well (i.e. “TS Plus”). Obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), learning impairments, impulse control issues, and anxiety and mood disorders are all frequent disorders linked with TS.

Who is at risk for TS?

TS was formerly considered to be uncommon, owing to the fact that health experts were unfamiliar with the condition. It affects people of all races and ethnicities, with males three to four times more likely than females to be afflicted.

Manifestations have a wide range of severity and frequency over the course of the disease, as well as a large range of severity and frequency among individuals. Tics usually develop between the ages of 3 and 8, and 50% of patients are tic-free by the age of 18. In school populations, prevalence rates have been estimated to range between 0.7 percent and 4.2 percent. The underlying pathology appears to be a developmental abnormality of synaptic neurotransmission. Tourette syndrome may potentially arise in a subgroup of individuals as a result of basal ganglia dysfunction caused by post-streptococcal immunity, according to some data.

Symptoms:

  • Hyperactivity
  • Nervousness
  • Habits
  • Allergies
  • Asthma
  • Dermatitis
  • And other diseases are frequently mistakenly attributed to patients

How is TS diagnosed?

History and observation of tics, as well as a family history of comparable symptoms, are used to diagnose TS. The appropriate education of patients, family members, and teachers is the first step in management. When symptoms are functionally debilitating, medication is explored.

The Tourette Syndrome Classification Study Group (TSCSG) developed the following criteria for definitive TS to help in diagnosis:

  1. At some point throughout the illness, both numerous motor and one or more phonic tics must be present, although not necessarily at the same time; 
  2. Tics must occur often during the day, virtually every day, or seldom over the course of more than a year;
  3. The number, frequency, kind, complexity, and severity of tics must fluctuate throughout time; 
  4. The onset must occur before the age of 21; 
  5. Other medical problems cannot explain spontaneous motions and sounds;
  6. A trustworthy examiner must personally observe motor and/or phonic tics at some point during the disorder, or they must be documented on videotape or cinematography. And other such diagnostic criteria are intended to help with proper diagnosis, genetic linkage studies

What treatments are available?

Tics can be treated using a number of different methods. The appropriate education of patients, family members, teachers, and other persons who interact with the patient is the first step in the care of patients with TS. Drug treatment and cognitive behavior therapy are two examples (CBT). Because there are a variety of medications that have been proven to manage TS symptoms, and people react to medicines differently, pharmacological therapy should be left in the hands of specialists who have extensive expertise with TS, when symptoms begin to interfere with peer relationships, interpersonal relationships, academic or work performance, or everyday activities, medication is typically explored. Neuroleptics, central nervous system (CNS) stimulants, and selective serotonin uptake inhibitors are some of the medications used to treat TS patients (SSRIs). CBT employs learning-based techniques to raise tic awareness, reduce or eliminate tics, and manage stresses that may exacerbate tics. Therapy for illnesses linked with TS, such as OCD and ADHD, may, nevertheless, be a higher priority than treatment for tics.

Environmental factors.

Home, school, or workplace environments that are well-informed and support maintaining a healthy sleep schedule, an exercise routine that is consistent, special skills (eg: exceptional social skills, athletic skills, musical abilities, academic gifts). The more people are educated about TS, the less social stigma exists.

Resources.

Tourette has a partner network in India (https://tourette.org/about-us/partner-network/international/). The National Tourette Syndrome Association (NTSA) is a non-profit organization (www.tsa-usa.org) and Plus Tourette Syndrome (www.tourettesyndrome.net) also provides help and information.