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Tourette syndrome, A Rare Complex Neuropsychiatric Condition

Tourette syndrome is a common neurodevelopmental disorder, characterized by multiple motor tics and at least one vocal (phonic) tic, with its onset in childhood. Tourette syndrome is defined as part of a spectrum of tic disorders, which includes provisional, transient and persistent (chronic) tics. These are sudden, intermittent, repetitive, unpredictable, purposeless, non-rhythmic, involuntary movements or sounds. Tics can be either simple or complex.

Considering the signs and symptoms of Tourette syndrome, it is important to understand this condition.

Tics – What are Tics?

Tics are movements or sounds that occur intermittently and unpredictably, having the appearance of normal behavior going wrong.

The history behind Tourette syndrome

The disorder is named after Dr. Georges Gilles de la Tourette, who was a pioneering French neurologist. He was the first person who described this condition in an 86-year-old French noblewoman in 1885.

Patient statistics

Tourette syndrome is estimated to affect 1 to 10 in 1,000 children. This disorder occurs in populations and ethnic groups worldwide, and it is more common in males than in females.

Genetics Behind Tourette syndrome

Evidence suggests that TS is an inherited disorder. Tourette syndrome was previously thought to have an autosomal dominant pattern of inheritance. Although there may be a few genes with substantial effects. It is also possible that many genes with smaller effects and environmental factors may play a role in the development of TS.

Symptoms of Tourette syndrome

The main symptom of Tourette’s syndrome and the most common reason for consultation is the presence of tics. These are repetitive, involuntary or semi-voluntary, short-lasting, stereotyped movements (motor tics) or vocalizations (phonic tics), of sudden presentation, usually in clusters. Some of the tics are so mild that they are not even noticeable. Some of the commonly seen tics with Tourette syndrome are:

  • Eye blinking and shoulder rotation or elevation
  • Head jerking and lip contractions
  • Abdominal contractions, and/or stretching of arms and legs
  • Jumping and kicking
  • Trunk bending or rotation
  • Socially inappropriate movements
  • Imitating gestures of other peoples
  • Other associated conditions: Along with these symptoms, attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD), depression, anxiety, and other behavioral problems can also worsen the symptoms of Tourette’s syndrome. The more severe ones can be embarrassing and can affect your social or work life.

Pathophysiology Behind Tourette syndrome

The exact cause of the syndrome is unknown, but it is believed that tics result from dysfunction in cortical and subcortical regions, the thalamus, basal ganglia, and frontal cortex. A reduced level of histamine in the H3-receptor may disrupt other neurotransmitters, which causes tics. A person with Tourette’s has about a 50% chance of passing the gene (s) to one of his or her children.

How is TS Diagnosed?

As such, there is no specific test to diagnose Tourette syndrome, but this neurological condition can be diagnosed if a person exhibits both multiple motor and one or more vocal tics over a period of one year, the motor and vocal tics need not be concurrent. There are no blood, laboratory, or imaging tests needed for diagnosis. The diagnosis is made based on observation of the individual’s symptoms and family history, and after ruling out secondary causes of tic disorders. People with Tourette often have other conditions, as well, including:

  • Attention deficit hyperactivity disorder (ADHD)
  • Obsessive-compulsive disorder (OCD)
  • Learning disability
  • Sleep disorder
  • Anxiety disorder

What are the risk factors for Tourette Syndrome?

  • Family history: The presence of family history of Tourette syndrome or other tic disorders might increase the risk of developing this condition.
  • Sex: Males are about three to four times more likely than females to develop Tourette syndrome.

What is the Treatment For Tourette Syndrome?

As such, there is no curative or preventative treatment available for this disorder. The goal of treatment for TS helps the patient to live a normal life. The available treatments are all symptomatic, as they are directed to improve the symptoms rather than eliminating the cause of the disease. Generally, medications are combined with behavioral approaches to decrease stress and anxiety.

Behavioral therapy includes

  • Behavioral therapy: It is the most recommended therapy for treating TS. This involves one-on-one counseling with a licensed mental health professional. Behavioral therapy includes awareness training, competing response training, and cognitive-behavioral intervention for tics.
  • Psychotherapy: It includes hypnosis, relaxation techniques, guided meditation, deep breathing exercises to ease the condition.

Medications

No medications can cure Tourette syndrome. However following medicines can be included to manage it:

  • Haloperidol, fluphenazine, tetrabenazine, or other neuroleptic drugs: These can help to block or dampen dopamine receptors in your brain and help control your tics. Common side effects include weight gain and mental fogginess.
  • Onabotulinumtoxina: The injections may help control simple motor and vocal tics.
  • Methylphenidate: This medication can help to reduce the symptoms of ADHD without increasing the tics.
  • Clonidine: The blood pressure medication or other similar drugs can help control rage attacks and support impulse control.
  • Fluoxetine: This and other antidepressants can help control obsessive-compulsive behavior.

How is Tourette’s Prevented?

There is no known prevention of Tourettes syndrome disorder. However, close monitoring of the patient for the early detection of emergent emotional disorders is very important. Apart from this, educating the persons may also help to create a better environment for the child and prevent emotional issues.

Final Thoughts

Overall, the condition of Tourette syndrome can be tricky and make things complicated. Following proper treatment can help one lead a normal life.

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