Tourettes syndrome

Tourette syndrome is a neurological disorder that starts in childhood and involves unusual and frequent rapid, repetitive movements or unwanted sounds that cannot be controlled (called “tics”) — you may repeatedly blink, shrug or jerk your head or unintentionally blurt out sounds or offensive words.

Before you experience tics and movements, you may feel uncomfortable body tension similar to that of an itch or tingle; this is known as a premonitory urge. Expressing it through a tic or movement will give you relief. 

Tourette tics can either be simple or complex:

• Simple motor tics — sudden, brief, repetitive and engaging a limited number of muscle groups — include eye blinks or twitching; simple vocal tics include throat clearing, grunting or barking. 
• Complex motor tics — distinct, coordinated movement patterns involving several muscle groups — include sniffing or touching objects, hopping, jumping, bending or twisting; complex vocal tics include swearing (coprolalia) or repeating words and phrases other people speak (echolalia). 

Your tics may vary in type, frequency and severity; get worse when you are tired, excited, anxious or stressed or sick; happen while you are asleep; and change over time.

The signs and symptoms normally emerge between ages 2‒12 (the average is at 7 years). Boys are three to four times more likely than girls to develop Tourette syndrome and although there is no cure, you can live a normal life span and most people do not need treatment when the symptoms aren't troublesome. The symptoms may lessen or become quiet and controlled after the teen years are over. 

You may also experience a higher propensity to other behavioral conditions, including attention deficit hyperactivity disorder (ADHD or ADD) and obsessive-compulsive behavior (OCD).

The causes of Tourette syndrome are unknown, but it is thought to be caused by abnormalities in one or more parts of the brain.

Diagnosis  of Tourette Syndrome
No specific test exists that can diagnose Tourette syndrome, so our team will use your history of symptoms to determine whether you have the disorder. We will look for four criteria to decide if you have Tourette syndrome:

• Motor and vocal tics must be present, although they do not have to occur at the same time. 
• Tics should occur several times a day, almost every day or intermittently for more than a year; your tics should not disappear for a period longer than three months.
• Tics should start before age 18.
• Medications or other substances or condition are not causing the tics.

We may recommend that you have blood tests or neuroimaging studies (such as magnetic resonance imaging) in order to rule out other causes. 

Treatment Options  for Tourette Syndrome 
Treatment is for the purpose of helping you control tics that interfere with your daily activities and functioning. If your tics aren't severe, we may recommend no treatment. 

Several drugs and therapies may be used to help control the symptoms of Tourette syndrome. Medications include those that block or deplete the neurotransmitter dopamine (haloperidol), stimulants to increase attention and concentration (dextroamphetamine), central adrenergic inhibitors to help control behavioral symptoms (clonidine), antidepressants to help with anxiety and depression (fluoxetine) and botulinum toxin (Botox®) to relax certain muscles.

We may also recommend some form of psychotherapy to help you cope with your condition, as well as behavioral therapy to help you learn how to reduce your tics by identifying the premonitory urge then moving in a way that suppresses the tic.

For severe tics, our team may recommend deep brain stimulation;  it is an implanted battery-operated neurostimulator device that sends electrical stimulation to targeted areas that control movement. It has not been determined that this treatment helps those with Tourette syndrome.