What is Tourette Syndrome?

Tourette Syndrome (TS) or Tourette disorder is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. Tics are sudden twitches, movements, or sounds that people do repeatedly. They can be of two types—motor and vocal. Of these, motor tics are movements of the body such as blinking or jerking an arm whereas vocal tics are sounds that a person makes with his or her voice such as humming. Motor tics generally precede the development of vocal tics and simple tics often precede complex tics.

Tics come and go over time, varying in type, frequency, location, and severity. The early symptoms of TS are typically noticed first in childhood, with the average onset between the ages of 3 and 9 years. The first symptoms usually occur in the head and neck area and may progress to include muscles of the trunk and extremities.

Although the cause of TS is unknown, current research points to abnormalities in certain brain regions (including the basal ganglia, frontal lobes, and cortex), the circuits that interconnect these regions, and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells. Environmental, developmental, or other factors may also contribute towards the development of the disorders. Current research suggests the role of genetics as well, thus, claiming it to be an inherited disease.

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There is no single test to confirm the presence of TS. The diagnosis requires both one motor and one vocal tic for at least 1 year. The disorder often occurs with other conditions (called co-occurring conditions) such as Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD). To rule out the presence of mimicking conditions MRI CT, or EEG become essential.

The majority of people with TS require no medication for tic suppression because tic symptoms often do not cause impairment, however, effective medications are available for those whose symptoms interfere with functioning.

Although TS can be a chronic condition with symptoms lasting a lifetime, most patients experience peak tic severity before the mid-teen years with improvement for the majority of patients in the late teen years and early adulthood. Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics, for example tight collars may trigger neck tics. They do not go away during sleep but are often significantly diminished.

Currently, there is no cure for TS. The treatment is aimed at controlling tics that interfere with everyday activities and functioning. Often, majority of people with TS require no medication for tic suppression because the symptoms do not cause impairment. Moreover, TS patients experience peak tic severity before the mid-teen years with improvement in the late teen years and early adulthood.

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Medications to help control tics or reduce symptoms of related conditions include medications that block or lessen dopamine, Botulinum (Botox) injections, ADHD medications, Central adrenergic inhibitors, Antidepressants and antiseizures medications. In addition, behavioral and psychotherapy are often advised with deep brain stimulation (DBS) to help correct behavioral issues in the patients with TS.

Currently, there is no cure for TS. The treatment is aimed at controlling tics that interfere with everyday activities and functioning. Often, majority of people with TS require no medication for tic suppression because the symptoms do not cause impairment. Moreover, TS patients experience peak tic severity before the mid-teen years with improvement in the late teen years and early adulthood.

Medications to help control tics or reduce symptoms of related conditions include medications that block or lessen dopamine, Botulinum (Botox) injections, ADHD medications, Central adrenergic inhibitors, Antidepressants and antiseizures medications. In addition, behavioral and psychotherapy are often advised with deep brain stimulation (DBS) to help correct behavioral issues in the patients with TS.

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ADHD medications such as Methylphenidate (Ritalin) and medications containing dextroamphetamine (Adderall XR, Dexedrine, others) can help increase attention and concentration. They are stimulate medications that are often prescribed to reduce the symptoms of ADHD without increasing the tics associated with TS.

Cannabis-based medications such as cannabinoid delta-9-tetrahydrocannabinol (dronabinol) is a treatment often prescribed to stop tics in adults. These medications are not recommended for children and adolescents, and pregnant or nursing women. Besides these therapies, antidepressants such as Fluoxetine (Prozac, Sarafem, others) help control symptoms of sadness, anxiety and OCD while antiseizure medications such as topiramate (Topamax) helps manage seizures associated with TS.

Cognitive Behavioral Interventions for Tics, including habit-reversal training, is often employed to monitor tics, identify premonitory urges and learn to voluntarily move in a way that's incompatible with the tic. It is not a cure for tics. However, it can help reduce the number of tics, the severity of tics, the impact of tics, or a combination of all of these. In addition, psychotherapy is also prescribed to help TS patients with accompanying problems, such as ADHD, obsessions, depression or anxiety.

For severe tics that do not respond to other treatment, Deep brain stimulation (DBS) is prescribed. DBS involves implanting a battery-operated medical device in the brain to deliver electrical stimulation to targeted areas that control movement. However, this treatment is still in the early research stages and needs more research to determine if it is a safe and effective treatment for Tourette syndrome.

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