Tourette syndrome is a neurological disorder characterized by repeated involuntary movements and vocalizations called "tics." Although not medically dangerous, it causes serious social and psychological difficulties for those who have it because of its unusual, often disabling, symptoms. Typical onset for Tourette's is between the ages of 3 and 9, with males 3 to 4 times more likely to be affected than females.
The causes of Tourette syndrome are unknown, although there seems to be a genetic component. There may also be environmental factors at work. Although the syndrome has no known cure, there are several therapeutic interventions that may be helpful. For most patients, Tourette's symptoms are most pronounced during adolescence, and diminish during adulthood.
Symptoms of Tourette Syndrome
Patients with Tourette syndrome have two sets of symptoms: motor tics and vocal tics. Tics may be simple or complex. For certain patients, tics are preceded by a sensation, called a "premonitory urge," in the affected muscle. A patient may feel a need for a tic to occur a certain number of times before the premonitory urge subsides. It is also common for one tic to fade and another to take its place.
Simple motor tics, involving a single muscle group, commonly include:
- Excessive blinking or eye movement
- Facial grimaces
- Shoulder shrugs
- Head jerks
Complex motor tics, involving more muscle groups, may include:
- Touching objects
- Sniffing objects
Complex motor tics, though involuntary, may appear volitional and, in severe cases, may be grotesque or self-injurious. One complex motor tic, called copropraxia, involves making obscene or socially unacceptable gestures.
Simple vocal tics associated with Tourette syndrome include:
More complex vocal tics often include repeated words or phrases. A particularly troubling complex vocal tic, called coprolalia, involves uttering socially inappropriate words, such as curse words. Only a relatively small percentage of patients with Tourette syndrome have coprolalia. Another complex vocal tic, called echolalia, is characterized by involuntary repetition of the word or words another person has spoken.
Although tics occur more frequently in patients with Tourette's during periods of excitement or anxiety, they may also occur during sleep. The symptoms of patients with Tourette's can also worsen and improve at certain times for unknown reasons. Tics often diminish noticeably during periods of intense concentration or involvement in an activity. In a small number of cases and under certain circumstances, tics may come under the patient's control.
Treatment for Tourette Syndrome
Tourette syndrome has several possible treatments, including medications and various kinds of psychotherapy. The most important treatment for Tourette's, however, is educating people who interact with the patient about the disorder.
The patient with Tourette syndrome needs a strong support system to eliminate any social stigma attached to the disease or its symptoms. A child who has Tourette syndrome often contends with teasing, ridicule or social rejection. Family members, friends, peers, teachers, coaches, bus drivers and neighbors should all be educated about Tourette's. Often, in an atmosphere of calm acceptance, a patient's tics diminish.
There are a few medications that make severe tics less frequent. There are also medications that may prove helpful in treating disorders, such as attention-deficient hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD), frequently associated with Tourette's. Because these medications all have side effects, which can include weight gain, fatigue, jumpiness or stiff muscles, the benefits and disadvantages of their use must be weighed on a case-by-case basis.
Several types of psychotherapy have proven helpful in treating Tourette syndrome. In addition to the support and guidance provided by a skilled therapist, various kinds of therapy are helpful in reducing its symptoms. Therapies include:
- Behavioral therapy
- Habit-reversal therapy
- Comprehensive Behavioral Intervention (CBIT)
CBIT, the newest of these therapies, shows great promise. It combines habit-reversal, in which the patient learns to substitute an action that interferes with the tic for the tic itself, with instruction on the nature of tics and effective strategies for coping with them.