Summary about Disease
Gilles de la Tourette Syndrome (Tourette's or TS) is a neurological disorder characterized by repetitive, sudden, involuntary movements or vocalizations called tics. These tics can range from mild to severe, and their frequency and intensity can vary over time. TS is not a degenerative condition, and most people with TS have a normal life expectancy.
Symptoms
Symptoms include both motor and vocal tics.
Motor Tics: These involve movements such as eye blinking, head jerking, shoulder shrugging, facial grimacing, or more complex actions like touching objects or stepping in a certain pattern.
Vocal Tics: These involve sounds, such as throat clearing, sniffing, grunting, barking, repeating words or phrases (echolalia or palilalia), or, rarely, using obscene words (coprolalia). Tics are often preceded by an urge or sensation, which is relieved by performing the tic. Tics can be suppressed for short periods of time, but this can cause a buildup of tension or discomfort. Tics can worsen with stress, anxiety, fatigue, or excnt.
Causes
The exact cause of Tourette's syndrome is unknown, but it is believed to involve a combination of genetic and environmental factors. Research suggests abnormalities in certain brain regions, including the basal ganglia, frontal lobes, and cortex, and the neurotransmitters (dopamine, serotonin, and norepinephrine) that relay messages between nerve cells. Tourette's is considered to be inhereted but the exact gene or genes have not been identified.
Medicine Used
There is no cure for Tourette's syndrome, but medications can help to manage the symptoms.
Neuroleptics (Antipsychotics): Haloperidol, pimozide, risperidone, aripiprazole are used to block dopamine receptors in the brain.
Alpha-Adrenergic Agonists: Clonidine and guanfacine are used to treat high blood pressure but can also help reduce tics.
Botulinum Toxin (Botox) Injections: Can be injected into specific muscles to relieve simple motor or vocal tics.
ADHD Medications: Stimulants (methylphenidate, amphetamine) can worsen tics in some individuals with TS, but alpha-agonists (guanfacine, clonidine) or non-stimulants (atomoxetine) are often used to manage ADHD symptoms without significantly exacerbating tics.
Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) can be used to manage comorbid obsessive-compulsive disorder (OCD) or anxiety. Behavioral therapies like Comprehensive Behavioral Intervention for Tics (CBIT) are also commonly used.
Is Communicable
No, Tourette's syndrome is not communicable. It is a neurological disorder, not an infectious disease.
Precautions
There are no specific precautions to prevent Tourette's syndrome, as the cause is not fully understood. Genetic counseling may be helpful for families with a history of TS. Early diagnosis and intervention can help manage symptoms and improve quality of life. Creating a supportive environment at home and school is crucial for individuals with TS.
How long does an outbreak last?
Tourette's syndrome is a chronic condition, not an outbreak. Symptoms typically begin in childhood and can fluctuate in severity throughout a person's life. For many, tics tend to peak during the early teen years and improve in adulthood, although some individuals may continue to experience significant symptoms.
How is it diagnosed?
Tourette's syndrome is diagnosed based on the following criteria, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):
Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently.
The tics may wax and wane in frequency but have persisted for more than one year since the first tic onset.
Onset is before age 18 years.
The disturbance is not attributable to the physiological effects of a substance (e.g., stimulants) or another medical condition (e.g., Huntington's disease, postviral encephalitis). There is no specific blood test or brain scan to diagnose Tourette's syndrome. A doctor will conduct a thorough medical history and neurological examination.
Timeline of Symptoms
Onset: Typically between ages 4 and 12, with an average onset around 6 years old.
Early Tics: Often involve the face, head, or shoulders, such as eye blinking, facial grimacing, or head jerking.
Progression: Tics tend to increase in frequency and severity during the preteen and early teen years. New tics may develop, and existing tics may change.
Peak: Tics often peak in severity during early adolescence.
Adulthood: For many individuals, tics tend to decrease in severity during adulthood. However, the course of the condition varies, and some individuals continue to experience significant symptoms throughout their lives.
Important Considerations
Co-occurring Conditions: Tourette's syndrome often co-occurs with other conditions, such as ADHD, OCD, anxiety, learning disabilities, and behavioral problems. Managing these co-occurring conditions is an important part of treatment.
Social and Emotional Impact: TS can significantly impact a person's social and emotional well-being. Tics can lead to embarrassment, social isolation, bullying, and low self-esteem. Support groups, counseling, and therapy can be helpful.
Education and Advocacy: Educating others about Tourette's syndrome can help reduce stigma and promote understanding and acceptance. Advocacy efforts can help ensure that individuals with TS have access to the resources and support they need.
CBIT: Comprehensive Behavioral Intervention for Tics is a type of therapy with no medication used to treat Tourette's syndrome. It includes habit reversal training to help reduce the number and severity of tics.