The Truth About Tourette’s

Tourette’s syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition in an 86-year-old French noblewoman.

Tics are classified as either simple or complex.

Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups and might include:

• Eye blinking and other vision irregularities
• Facial grimacing,
• Shoulder shrugging, and
• Head jerking
• Shoulder jerking
• Simple vocalizations:
  • repetitive throat-clearing
  • sniffing sounds
  • grunting sounds

Complex tics are distinct, coordinated patterns of movements involving several muscle groups and might include:

• Facial grimacing combined with a head twist and a shoulder shrug
• Apparently purposeful movements:
  • sniffing objects
  • touching objects
  • hopping
  • jumping
  • bending
  • twisting

• Complex vocal tics include words or phrases

Dramatic and disabling tics include:

• motor movements that result in self-harm such as punching oneself in the face
• vocal tics including coprolalia (uttering swear words)
• echolalia (repeating the words or phrases of others)

Some tics are preceded by an urge or sensation in the affected muscle group, commonly called a premonitory urge. Some with TS will describe a need to complete a tic in a certain way or a certain number of times in order to relieve the urge or decrease the sensation.

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, or hearing another person sniff or throat-clear may trigger similar sounds. Tics do not go away during sleep but are often significantly diminished.

How is TS diagnosed?
TS is a diagnosis that physicians make after verifying that the child has had both motor and vocal tics for at least 1 year.  Common tics are not often misdiagnosed by knowledgeable clinicians.  But atypical symptoms or atypical presentation (for example, onset of symptoms in adulthood) may require specific specialty expertise for diagnosis. There are no blood or laboratory tests used for diagnosis, but neuroimaging studies, such as magnetic resonance imaging (MRI), computerized tomography (CT), and electroencephalogram (EEG) scans, or certain blood tests may be used to rule out other conditions that might be confused with TS.

It is not uncommon for parents to obtain a formal diagnosis of TS only after symptoms have been present for some time. The reasons for this are many.  For families and physicians unfamiliar with TS, mild and even moderate tic symptoms may be considered inconsequential, part of a developmental phase, or the result of another condition.  For example, parents may think that eye blinking is related to vision problems or that sniffing is related to seasonal allergies.  Many patients are self-diagnosed after they, their parents, other relatives, or friends read or hear about TS from others.

DSM  IV Definition of Tourette’s Disorder
A. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently. (A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.)

B. The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.

C. The onset is before age 18 years.

D. The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington’s disease or postviral encephalitis).

The above quoted is for educational purposes only.
These are rules of thumb and may not necessarily apply to all diagnosed Tourette’s cases

What disorders are associated with TS?
Many with TS experience additional neurobehavioral problems including inattention, hyperactivity and impulsivity (attention deficit hyperactivity disorder—ADHD). Other related problems may occur with reading, writing, and arithmetic. Sometimes obsessive-compulsive symptoms such as intrusive thoughts/worries and repetitive behaviors may occur. For example, worries about dirt and germs may be associated with repetitive hand-washing, or perhaps concerns about bad things happening may be associated with ritualistic behaviors such as counting, repeating, or ordering and arranging.  People with TS may also report difficulties with depression or anxiety disorders as well as other difficulties with living that may or may not be directly related to TS.