Tourette’s Syndrome

Overview

Tourette’s syndrome (TS) is a neurological disorder that triggers sudden involuntary movements which may be rapid, repetitive, or both. Individuals with TS also produce certain sounds, known as vocal ‘tics’. These urges to move or utter mouth sounds are involuntary because they are hard to control or suppress. The repetitive movements may manifest differently in various people, showing up in twitches of the shoulders, constant fluttering of eyelashes, and blurting out unusual, and sometimes even offensive words.

These tics may start showing up at a tender age, affecting the lives of children even at ages between 2- 10 years. They may or may not come under control upon crossing over the teen years. While there is no specific cure for Tourette’s syndrome, its symptoms can be controlled or managed efficiently with proper medication and focused medical care.

What is Tourette’s Syndrome?

Tourette’s syndrome (TS) is a condition that affects the nervous system under development and is categorised within the ‘tic disorders’ section. The movement-related tics are known as motor tics while the sound-based tics are called phonic tics. They may vary from person to person, in severity, frequency, location and type.

The initial symptoms start showing up in the neck and head area, in children between the ages of 5 – 10 years. The average age at which Tourette's syndrome symptoms become evident is at the 6-year mark.

Tics shall progress in effect from the initially affected areas to other body parts, including the muscles in one’s arms, legs and torso. Medical research shows that motor tics typically develop before phonic or vocal tics.

Boys are generally more affected by Tourette’s syndrome than girls. The symptoms peak in terms of effect on an individual during their early teen years and usually become controlled with the advent of the late teens and early 20s. However, that may not be the case for everyone. While not considered to be a degenerative condition, TS may manifest into a chronic condition with symptoms lasting even through adulthood.

Types of Tics

Tourette’s syndrome is associated with two types of tics developing at different stages of the growing child’s life, namely:

Motor Tics

Motor tics may be sudden and uncontrollable. Essentially, they are movements or twitches resulting from non-suppressible urges. For example, the person with TS may exaggerate certain motions like, constantly blinking their eyes, grimacing, jerking their head, or shrug their shoulder. There are simple as well as complex tics experienced by the affected people, with the former involving just one muscle group being affected and the latter firing up a series of movements.

Phonic Tics

Phonic tics include sudden mouth sounds and may also involve repetitive humming, sniffing or throat clearing. Simple vocal tics are usually limited to the already mentioned sounds while complex phonic tics cause the person to swear (a condition known as coprolalia), call people out or repeat other people’s words.

Symptoms of Tourette’s Syndrome

Tics are the recognisable symptoms associated with Tourette’s syndrome and may be experienced differently by various people. Some simple motor tics include repetitive blinking of the eyes, jerking of the head, shoulder shrugging, mouth movements, nose twitching, and eye darting, among others.

However, the tics may also get complicated which causes affected people to smell and touch stuff out of nowhere, witness a movement and repeat it, make awkward or offensive gestures, step in a specific way and maintain a pattern, hop about, bend or twist suddenly, and more.

Some simple vocal tics include mindless grunting, coughing, clearing of throat, or even barking. However, it gets much more complex when one starts to repeat their own words, pick up and repeat others’ spoken phrases, swear or use inappropriate words.

Causes of Tourette’s Syndrome

No specific, isolated cause is associated with the development of Tourette's syndrome. It is essentially a complex disorder that results from the combined effects of genetics and environmental factors. Neurotransmitters, or the brain ‘chemicals’ that transmit nerve pulses like serotonin and dopamine, may have a role in causing TS. Males are more at risk of developing Tourette’s syndrome as compared to females. Plus, a family history with cases of TS or other tic disorders puts one at risk of developing it too.

Tourette’s Syndrome Diagnosis and Tests

Healthcare professionals diagnose Tourette's by analysing the concerned child's medical history and the symptoms they’re experiencing. They may also ask a few questions, including one about whether or not the tics are causing any issues at school or other social problems.

No specific tests are conducted to diagnose Tourette's syndrome. But upon requirement, blood tests, an EEG, or an MRI, may be recommended to determine the existence of any underlying health issues. Healthcare professionals typically test for obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and/or other problems associated with learning or general behaviour of the child, as they sometimes accompany Tourette's syndrome as a complication.

Tourette’s Syndrome Management and Treatment

There is no specific treatment for Tourette’s syndrome. However, there are medications available that can help bring the tics under control. The tics will not be completely cured or eliminated but pacified to a certain degree. Symptoms of TS vary from person to person. While the tics may not affect some kids' social lives that much, they may cause some to come across accidents or general inconvenience.

So, certain people may have to opt for treatment while others don't. Behavioural therapy may be recommended which will include habit reversal and comprehensive behavioural intervention for tics. If underlying health issues are detected, medicines combatting them will also be prescribed.

Preventive Measures for Tourette’s Syndrome

There are no preventive measures that can be undertaken to completely avoid TS. However, early detection and spontaneous treatment measures shall help control the tics and contain their effects on the diagnosed as they step into early adulthood.

Myths and Facts Related to Tourette’s Syndrome

Here are some popular myths associated with Tourette’s syndrome and the facts to prove them wrong:

Myth 1: Everyone with Tourette’s Syndrome Swears and Uses Obscene Language
Fact: It is not true that everyone with TS swears or uses obscene language (coprolalia). A lot of people do not showcase this symptom that’s otherwise a part of vocal tics, at all. People with TS cannot be generalised under one type of behaviour. Only 10% of people diagnosed with Tourette's syndrome show signs of coprolalia.

Myth 2: People with Tourette's Syndrome Can Control Their Movements and Vocal Sounds if They Want to
Fact: No, people with TS cannot control their sudden movements or vocal tics even if they wish to, for the most part. They are a result of brain function and structure alteration. Therefore, they cannot be controlled.

Myth 3: Tourette’s Syndrome is Caused by An Unhappy and Stressful Childhood
Fact: The development of TS is not a result of the impact of an unhappy/stressful childhood. While stress may lead to the worsening of tics, it cannot be the sole causative factor at any point. Theories about the causes of TS typically lead back to genetics in combination with other perinatal, prenatal, environmental and autoimmune factors.