Tourette’s syndrome is a nervous system disorder, which causes the people suffering from it to make sudden sounds or movements known as tics, which are not in their control.1 Patients can continuously blink or clear their throat in this syndrome. Some patients will blurt out words which they had not intended to say in the first place.
Treatment helps in controlling these tics; however, not all patients need treatment, only when the symptoms start affecting their life. Many patients have a milder form of this disease. It commonly starts during childhood, and boys tend to suffer from this disorder more than the girls. Symptoms usually get better upon growing up and in some patients, symptoms can completely subside.
Causes of Tourette’s Syndrome
Tourette’s syndrome has been connected to different regions of the brain, which also includes an area known as the basal ganglia, which is responsible for controlling body movements.1 Any changes in this region affect the nerve cells and the chemicals which carry messages between them. According to the research, any problem in this brain network can play a role in Tourette’s.
The exact cause why these problems occur in the brain is not known; however, genes are thought to play a role. It is felt that there is more than one cause behind Tourette’s. Individuals with a family history of Tourette’s are at an increased risk for getting it themselves, but symptoms may differ among the members of the same family.
Signs & Symptoms of Tourette’s Syndrome
Tics are the primary symptom of Tourette’s. Some patients have very mild tics that are not that noticeable. Some may have very obvious tics, which happen continuously. Tics get worsened if the patient is stressed, excited, tired or sick. In severe cases, these tics can be a cause for embarrassment and also affect a patient’s social and work life.
Tics are of two types:
Motor tics comprise of movement and include:
- Jerking of the arm or head.
- Twitching of the mouth.
- Making a face
- Shrugging of shoulders.
Vocal Tics include:
- Clearing the throat.
- Barking or yelping.
- Repeating what other people say.
Tics also are classified as simple or complex. A simple tic will affect only one or a few parts of the body, such as blinking of the eyes or making a face. A complex tic involves more than one part of the body or saying words, such as jumping and swearing.
Before the patient experiences a motor tic, he/she may feel a sensation, which is like tension or tingling. The movement causes the sensation to subside. Patient may be able to hold or control the tics for some time, but cannot control or stop them from occurring. About half of the patients suffering from Tourette’s also have symptoms of ADHD or attention deficit hyperactivity disorder. The doctors are not sure of the reason why. Patient may have trouble in concentrating, sitting still or in completing tasks.
- Tourette’s also causes problems with anxiety, learning disabilities like dyslexia and obsessive-compulsive disorder, which is a disorder where the patient gets compulsive thoughts and behaviors which he/she cannot control, e.g. washing hands over and over again.2
Investigations for Tourette’s Syndrome
A neurologist should be consulted if the patient is displaying symptoms of Tourette’s. There aren’t any specific tests to diagnose this condition; however, the doctor can ask the following questions:
- What symptoms did you experience which made you consult a doctor?
- Do you unintentionally blurt out things or make sounds? When did this start?
- Do you move your body in a way, which you are not able to control? For how long this has been going on?
- Is there any activity, which alleviates or worsens your symptoms?
- Do any of your family members suffer from similar symptoms?
- Do you have trouble concentrating or feel anxious?
Certain investigations of the brain can be done to exclude other medical conditions, which are similar to Tourette’s and these include imaging tests such as:
- CT (Computed Tomography) scan, which uses a powerful x-ray to take detailed images of the brain.
- MRI (Magnetic Resonance Imaging) uses radio waves and powerful magnets to take pictures of internal structures and organs.
Treatment for Tourette’s Syndrome
In most cases, the tics are mild and do not need treatment. If the tics are affecting a patient’s quality of life, then the doctor can prescribe medicine to help with them. It can take some time to come to the right dosage, which not only controls the tics, but also has fewer side effects.
Some of the medications which are given for Tourette’s syndrome include:
- Antipsychotics, such as haloperidol, pimozide and fluphenazine work on dopamine, which is a brain chemical, to control tics.
- Antihypertensive medications, such as clonidine, guanfacine, also help in treating tics.
- Antidepressants, such as paroxetine, fluoxetine and sertraline help in relieving depression and its associated symptom, such as sadness, anxiety, stress and some obsessive-compulsive symptoms.`
- Methylphenidate and dextroamphetamine are the medicines used to treat ADHD and help the patient stay focused and in paying attention.
Talk therapy should also be undertaken along with the medicines. It helps in dealing with social issues associated with tics and other symptoms. A counselor or psychologist will help in all these things by counseling the patient.
Behavior therapy also helps and comprises of habit-reversal training, where the patient is taught on how to recognize when a tic is coming and then how to move in such a way which can stop it.
Lifestyle Modifications for Tourette’s Syndrome
The hardest thing about having Tourette’s is that the patient has to deal with a lot of frustration or embarrassment, as tics are something which the patient cannot control. Certain measures can be taken by the patient along with taking medications, which will help in making the patient feel better, such as:
- Getting support from your family members, friends or joining a support group helps in dealing with the challenges of the Tourette’s.
- Patient should try to stay as much active as possible by playing different sports; by undertaking various hobbies, such as painting; or volunteering in other activities. All these things will help the patient relax and keep his/her mind off their symptoms.
- Other relaxing techniques, such as reading, meditating, listening to music, doing yoga, help in combating the stress which can cause or worsen the tics.
- Patient should educate themselves about this condition as much as possible so that the patient knows what to do during the symptoms.
- If a child is suffering from this condition, then he/she may find it very difficult to cope and adjust to daily life. The child should be taught different ways to handle comments or teasing from other kids. Also, parents should talk to their kids’ respective schools by educating them about this syndrome and look into the support which the school can offer, such as smaller classes or extra tutoring.