What Exactly Is Tourette Syndrome?

Tourette's syndrome is a neurological condition associated with tics.

Tourette’s syndrome (TS) is a lifelong neurological disorder that starts more commonly during childhood between five and 10 years of age. Unlike degenerative diseases, people with TS live a longer life. They display normal intelligence.

People affected with TS display rapid, repetitive movements and words together known as tics over which they have no control. Typically, TS tics are triggered by stress and relaxation relieves them for a while. They are misunderstood as signs of nervousness. 

The exact cause of TS is not known, but research points to the possibility of a combination of genetic (transmitted from parents to their offspring) and external (environmental) factors in the development of TS.

Based on the nature (simple or complex) of the actions, tics in Tourette’s syndrome (TS) are of two types.

Simple tics: These involve a limited number of muscle groups and can be motor or vocal. Examples are

• Eye blinking
• Head twisting
• Facial movements
• Shoulder shrugging
• Nose twitching
• Throat clearing
• Grunting
• Sniffing
• Tongue clicking

Complex tics: These involve complex, coordinated movements of several muscle groups. These can also be motor or vocal. Examples include

• Jumping
• Twirling about
• Jerking of upper or lower limbs
• Foot stomping
• Pulling at clothing
• Hitting or biting oneself
• Uttering inappropriate words
• Repeating one’s or other people’s words

People with TS may have several combinations of the above symptoms. They may have tics that are restricted to one part of the body or those that cover all regions of the body.

The symptoms of TS may not be consistent throughout the day or over months. They may intensify and decrease suddenly throughout the day or within a span of three to four months. They may become worse as the child steps into adulthood.

Doctors do not rely on any tests such as blood tests or imaging studies such as X-rays, computed tomography scan or magnetic resonance imaging to diagnose Tourette’s syndrome (TS). Only the history, nature and duration of tics (minimum one year) is necessary to arrive at the diagnosis of TS.

Diagnostic criteria for TS (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 307.23) are as follows

• Both multiple limbs and one or more vocal tics have been present at some time during the illness, though not necessarily together.
• The tics occur many times a day (usually in bouts) nearly every day or in breaks throughout a period of more than a year. In this period, there was never a tic-free period of more than three consecutive months.
• The onset is before the age of 18 years old.
• The disturbance is not due to the direct physiologic effects of a substance (e.g., caffeine) or a general medical condition (e.g., Huntington disease or postviral encephalitis).

People with Tourette’s syndrome (TS) may suffer from additional behavioral disorders that include

• Obsessive-compulsive disorder: This is a behavioral condition in which there is a constant urge to repeat things unnecessarily. Examples include frequent, unnecessary handwashing and checking the stove repeatedly to see if it has been turned off. 
• Attention deficit and/or hyperactivity disorder (ADHD): This disorder is characterized by the inability to concentrate on the task at hand leading to poor performances in school or work. The affected people may suffer from additional problems such as depression, anxiety, social phobia, sleeping problems, inability to read and write (dyslexia), and aggressive behavior.

• Treatment with drugs is only indicated if the symptoms cause severe distress.
• Supportive treatments (behavioral therapy) can help affected people manage their day-to-day problems. These are safe and show long-lasting effects.
• The majority of people with Tourette’s syndrome (TS) require no treatment for tic suppression unless the symptoms interfere with functioning.
• Chlorpromazine, haloperidol, fluphenazine, pimozide, risperidone, olanzapine, and ziprasidone have shown to reduce tics by 50 to 80 percent, but people may need to discontinue them due to severe adverse effects.
• Habit reversal therapy is a good approach to manage symptoms. It is comprised of
  • behavioral therapy,
  • relaxation techniques, and
  • monitoring.