Tourette Syndrome is a neurological disorder characterized by repetitive, involuntary movements and vocalizations called “tics.” The average age of onset is between three and nine years, and the disorder affects about three to four times more males than females. Symptoms may last an entire lifetime, but are usually worse during the early teens and improve during the late teens and early 20s continuing into adulthood.
Tourette Syndrome Symptoms
Tourette syndrome symptoms are described as “tics,” but tics can be broken down into several categories, including simple, complex, motor, and vocal:
- Simple motor tics: Brief, repetitive movements that involve a limited number of muscle groups, such as exaggerated eye blinking or other eye movements, facial grimacing, shoulder shrugging, or head or shoulder jerking.
- Simple vocal tics: Brief, repetitive vocalizations, such as throat clearing, sniffing, grunting, or barking.
- Complex motor tics: Distinct, coordinated patterns of movements involving several muscle groups, such as facial grimacing combined with a head twist and a shoulder shrug, sniffing or touching objects, hopping, jumping, bending, or twisting.
- Complex vocal tics: Brief, repetitive vocalizations that include words or phrases.
In more severe cases, complex vocal tics may include involuntary cussing (coprolalia) or repeating the words or phrases of others (echolalia), and complex motor tics may involve self-harm, such as head banging.
To receive a diagnosis of Tourette syndrome, a patient must meet the following criteria:
- Have both motor and vocal tics for at least one year, although not necessarily at the same time.
- Exhibit tics every day during that year several times a day.
- Have tics before the age of 18 years.
- Exhibit symptoms that are not caused by medications or other substances or another medical condition.
- See a change in symptoms over time in location, frequency, type, complexity, or severity.
Tourette Syndrome Treatments
Currently, there is no cure for Tourette syndrome, but medication and therapy may be helpful in reducing the frequency and severity of the tics:
- Medications: One or more medications may be prescribed to alleviate the tics or help with other disorders that commonly accompany Tourette syndrome, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, or depression. Medications include:
- Neuroleptics (anti-psychotics), specifically those designed to reduce dopamine levels, hence reducing nervous tension. Neuroleptics include fluphenazine (Prolixin), haloperidol (Haldol), risperidone (Risperdal), and pimozide (Orap).
- Stimulants to increase attention and concentration in patients with Tourette syndrome who have ADHD symptoms. However, stimulants may be contraindicated in the treatment of Tourette syndrome because they carry the risk of worsening the tics.
- Central adrenergic inhibitors, such as clonidine (Catapres or Kapvay) and guanfacine (Intuniv), which are typically prescribed for high blood pressure, may help alleviate behavioral symptoms and improve impulse control.
- Antidepressants, especially selective serotonin reuptake inhibitors, such as fluoxetine (Prozac) may help alleviate sadness and anxiety and any comorbid OCD.
- Antiseizure medications, such as topiramate (Topamax), which is commonly used to treat epilepsy, may help reduced uncontrolled movements in some people with Tourette syndrome.
- Behavioral therapy: Cognitive Behavioral Interventions for Tics (CBIT) and Habit-Reversal Training (HRT) can help a patient monitor tics, identify premonitory urges (early warning signs of an oncoming tic), and modify behavior in a way that is incompatible with the tic.
- Psychotherapy: Various talk therapies can help a person cope more effectively with Tourette syndrome and address other accompanying issues, such as ADHD, OCD, anxiety, or depression.
- Deep brain stimulation (DBS): DBS involves implanting a battery-powered electronic device that delivers electrical stimulation to targeted areas of the brain.DBS may be helpful if medication and other therapies prove ineffective.