Tourette Syndrome

Tourette Syndrome is a neuropsychiatric disorder that has a typical onset before the age of 18 and is more common in males. Tourette Syndrome is most severe before puberty (10-12 years of age) and during times of anxiety, excitement, or exhaustion.

Tourette Syndrome is a type of Tic Disorder, consisting of repetitive non-rhythmic movements that occur intermittently and unpredictably out of a background of normal motor activity. Tics vary in intensity and frequency, often mimicking some aspect of regular behaviours, such as twitching of the eyebrows, and vocalizations such as yelling and swearing.
Tics usually become noticeable around six years of age and typically begin with simple tics of the face such as blinking. Vocal tics often begin to manifest after motor tics have already occurred.

Tics are often more prevalent during times of stress or heightened excitement, although they can be temporarily suppressed. Tic suppression occurs when the individual attempts to stop a particular tic from happening. Tic suppression is only temporary, and causes the urge to intensify to a stage where the tic will need to be performed in response to the irresistible urge to move. Tic suppression can also result in tension or mental exhaustion; therefore it is only used periodically, to avoid fatigue.

Individuals who experience tics often describe a large sensory urge or discomfort before the tic occurs. This immense urge is referred to as the premonitory urge. The premonitory urge is often relieved once the individual has experienced a tic. This can be described as similar to the urge of having to sneeze and the release after having sneezed.

Tics can diminish when the individual is distracted or engaged in a task. Tics also often diminish with age, with many individuals growing out of the condition throughout adolescence and early adulthood.

Tourette syndrome is the most common Tic disorder, with Chronic Tic Disorder and Provisional Tic Disorder being less common. These disorders are distinguished by the type of tic present (motor, phonic/vocal, or combined), and the duration of the disorder.

The type of tic can include the following:
Motor tics: tics that cause brief, involuntary, spasm-like movements
Echopraxia (also known as echokinesis): consists of involuntarily repeating the movement of others. This can include mimicking facial expressions or another person’s stance.

Copropraxia: consists of making obscene or inappropriate gestures, or also inappropriate touching. This can include sticking up the middle ‘rude’ finger in an offensive manner.

Phonic tics (also known as vocal tics): tics that produce a sound from the mouth or throat.

Echolalia: consists of repetitive speech or phrases that have been made by another person. This can include repeating whole sentences or just single words spoken to or around the individual.
Palilalia: consists of repeating speech or phrases spoken by themselves. This can include repeating whole sentences or just single words that they have just spoken.

Coprolalia: consists of the involuntary outburst of obscene or inappropriate words and derogatory remarks. This can include the use of obscenities and profanities that are spoken compulsively in a louder tone than normal speech.
There are also simple and complex tics, which are determined by the duration of the tic and the number of muscle groups used to perform the tic.
Simple: Consists of tics that are brief and normally only require one muscle group to perform the tic. Simple motor tics can include blinking, head bobbing, and nose twitching. While simple phonic tics can include shouting or clearing the throat.

Complex: Consists of tics that are normally longer in duration and require multiple muscle groups or combinations of movements to perform the tic. Often complex tics are a combination of simple tics being performed at the same time. Complex motor tics can consist of repeating observed movements, hopping and bending or twisting, while complex phonic tics can consist of stuttering, and using vulgar, obscene, or swear words.

Tourette Syndrome Causes
There is no known cause of Tourette Syndrome, with doctors unsure of what causes tics or why there can be an onset at different developmental stages of the individual. It is a complex disorder, with a combination of genetic and environmental factors believed to be involved, with the majority of Tourette’s being inherited.

Having a family history of Tourette syndrome or other tic disorders can increase the risk of developing the condition. A person living with Tourette Syndrome has about a 50% chance of passing on the condition to their children. Those who inherit Tourette’s may not show any symptoms or experience symptoms severe enough to require medical assistance.
It is believed that chronic tic disorder is the result of chemical abnormalities of the brain. Chemical abnormalities are when neurotransmitters (chemicals in the brain that transmit nerve impulses) may be misfiring or not communicating correctly. This can cause the same chemical message to be repeatedly sent, resulting in a tic.

Tourette Syndrome Diagnosis
There are three types of tic disorders, with Tourette Syndrome being the most commonly diagnosed. Diagnosis of a tic disorder depends on the duration of the condition and whether both or just one of the tics are motor or phonic tics.

To be diagnosed with Tourette Syndrome, both motor and phonic tics need to be present for more than a year. To be diagnosed with Provisional Tic Disorder, both motor and phonic tics are only required to be present for at least four weeks but less than a year. To be diagnosed with Chronic Tic Disorder, single or multiple motor or phonic tics (not both), need to be present for more than a year.
Diagnosis is done through observation of the individual's signs and symptoms as well as the family history of the condition.

Diagnosis of Tourette syndrome can often be overlooked due to the signs being similar to other conditions, including attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and Autism spectrum disorder (ASD). These conditions can be the cause of tics and often need to be ruled out using blood tests and imaging studies such as MRI.

Tourette Syndrome Treatment
Tourette Syndrome treatment may not be necessary unless the presenting tics cause severe interference with social development. Education regarding the diagnosis is often sufficient, teaching individuals what to expect from the condition and how to live their life to the fullest. Education should not only be directed at the individual but also their family and teachers so they can create a suitable environment to help raise those living with the condition. Education is done through therapy with trained professionals, teaching those affected how to handle Tourette Syndrome.

The following are a few options that may be suggested:
Cognitive Behavioural Therapy (CBT): helps to identify triggering events or feelings that may cause a tic to occur. Stressful or heightened excitement can trigger the urge to tic, but, by teaching the individual to become aware of these situations, they can be avoided. If it is necessary to go in stressful situations, they can be taught coping mechanisms, such as removing themselves to a quiet area to perform the necessary tic. CBT can also help to reduce anxiety and depression which is often associated with Tourette syndrome.

Habit Reversal training: involves teaching that once the urge to tic appears, opposing habits can minimise or suppress the tic. This can include learning movements incompatible with tics, e.g. engaging opposing muscles. Engaging opposing muscles such as smiling when the urge to perform a tic around the mouth can trick the brain into believing the tic has been performed.
Tourette Syndrome is a condition that has a higher prevalence in boys aged 2-14 years old, with many often outgrowing the condition in their late teens. Individuals who still experience Tourette Syndrome in adulthood are still able to be productive members of society holding secure jobs with excellent career prospects.

There has been reported that several famous individuals have lived with Tourette's Syndrome and managed to live successful lives in their profession of choice including David Beckham (international soccer star), Dan Aykroyd (Blue Brothers actor), and Wolfgang Amadeus Mozart (composer of the classical era).

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