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Conservative use of drug therapy
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A psychological approach that emphasizes the present and future of the patient, rather than the past.
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Emphasis on nutrition and physical exercise
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Family participation, if appropriate
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Psychoeducation for patients and relatives
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The Facts About Tourette's Syndrome
What is Tourette's Syndrome?
Tourette's Syndrome (TS) is a disorder characterized by tics. A tic is a sudden, rapid, recurrent motor movement or vocalization. The current psychiatric diagnostic manual (DSM-IV), indicates the following diagnostic criteria:
- Both multiple and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently.
- The tics occur many time day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.
- The disturbance causes marked distress or significant impairment in social, occupational, or other important areas of functioning.
- The onset is before 18 years.
- The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g. Huntington's disease or postviral encephalitis)
TS is considered an obsessive-compulsive "spectrum disorder" as these disorders or symptomatology are often seen together. Research, in fact, indicates that OCD may be an alternate expression of the TS gene. When these disorders are overlapping, it may be difficult to distinguish between a compulsive behavior and a tic as they may present in nearly identical manners. For example, obsessive-compulsives may not have a specific obsession or thought that leads to a compulsive behavior. Instead, they may describe a "not right" or "uncomfortable" feeling (similar to the "urge" described before a tic) that leads them to engage in the behavior.
What are the Symptoms?
Tics may be classified as simple or complex and vocal or motor. Simple motor tics include eye blinking, head jerking, shoulder shrugging, and facial grimacing. Simple vocal tics include throat clearing, barking and other noises, coughing, sniffing and tongue clicking. Complex motor tics include jumping, touching other people or things, retracing steps, smelling, twirling, and self-injurious behavior including hitting or biting oneself. Complex vocal tics include uttering words or phrases out of context and copralalia (vocalizing socially unacceptable words or phrases).
Individuals with TS generally experience a premonitary urge that propels them into the tic or series of tics. Tics are experienced as irresistable, and although the individual has some control to delay the tic, eventually it must be expressed. Very often, the individual will seek a secluded spot to release the tics after delaying them in school or at work. Tics generally increase as a result of tension or stress, and decrease with relaxation or when focused on a task.
In addition to obsessive-compulsive symptoms, individuals with TS manifest other problems such as attention deficit disorder (ADD), impulse control difficulties, defiant and angry behaviors, learning disabilities, and sleep disorders.
Who suffers from Tourette's Syndrome?
TS occurs in approximately 4-5 individuals per 10,000. It is 4-5 times more common in males than females. The age of onset is usually during childhood or early adolescence. In many cases, the severity, frequency, and variability of the symptoms diminish during adolescence and adulthood and, in some cases, may disappear entirely by adulthood.
The cause of TS has not been established. Research suggests that the disorder stems from the abnormal metabolism of at least one brain chemical or neurotransmitter called dopamine. Other neurotransmitters are also likely to be involved. Genetic studies indicate that a vulnerabilty for TS is transmitted in an autosoma dominant pattern. "Vulnerability" implies that the child acquires the genetic predisposition for developing TS. This does not mean that everyone with this vulnerability will come to express symptoms of TS. Penetrance in female gene carriers is approximately 70% while penetrance in male gene carriers is approximately 99%.
What Treatments are Available?
The vast majority of individuals with TS are nor disabled by their tics, and therefore do not require treatment. For those who do require treatment, medication is most effective. Drugs that have been shown to control tics include Haldol, Orap, Proxlin, Catapres, and Klonopin. Dosages of these medications may vary for each patient. Generally, the medications may vary for each patient. Generally, the medication is started at a low dose and gradually increased until the point where symptom-control is maximized and side-effects are minimized.
Various forms of psychotherapy may also be recommended for TS. Behavior therapy aimed at reversing the habit of tics as well as various relaxation techniques have been found to be somewhat effective in reducing symptoms of TS. Since TS symptoms may provoke ridicule and rejection by peers, therapy targeting self-esteem issues may also be helpful. Family therapy to help parents and siblings of the affected individual understand and deal with their loved one may also be beneficial. In addition, therapies targeting other problems associated with TS including obsessive compulsive symptoms, ADD, impulsive and aggressive behaviors, and learning disabilities may be necessary. Neuropsychological testing may be beneficial in identifying specific weaknesses.
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