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Tourette's Syndrome

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  • Tourette's Syndrome

    Q. What is Tourette Syndrome?

    A. Tourette Syndrome (TS) is a neurological disorder characterized by tics - involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way. The symptoms include:

    1. Both multiple motor and one or more vocal tics present at some time during the illness although not necessarily simultaneously;

    2. The occurrence of tics many times a day (usually in bouts) nearly every day or intermittently throughout a span of more than one year; and

    3. Periodic changes in the number, frequency, type and location of the tics, and in the waxing and waning of their severity. Symptoms can sometimes disappear for weeks or months at a time.

    4. Onset before the age of 21.

    The term, "involuntary," used to describe TS tics is sometimes confusing since it is known that most people with TS do have some control over their symptoms. What is not recognized is that the control, which can be exercised anywhere from seconds to hours at a time, may merely postpone more severe outbursts of symptoms. Tics are experienced as irresistible and (as the urge to sneeze) eventually must be expressed. People with TS often seek a secluded spot to release their symptoms after delaying them in school or at work. Typically, tics increase as a result of tension or stress, and decrease with relaxation or concentration on an absorbing task.

    Q. How would a typical case of TS be described?
    A. The term typical cannot be applied to TS. The expression of symptoms covers a spectrum from very mild, to quite severe. However, the majority of cases are in the mild category.

    Q. What causes the symptoms?
    A. The cause has not been established, although current research presents considerable evidence that the disorder stems from the abnormal metabolism of at least one brain chemical (neurotransmitter) called dopamine. Undoubtedly, other neurotransmitters, e.g. serotonin. also are involved.

    Q. How is TS diagnosed?
    A. A diagnosis is made by observing symptoms and by evaluating the history of their onset. No blood analysis or other type of neurological testing exists to diagnose TS. However, some physicians may wish to order an EEG, MRI, CAT scan, or certain blood tests to rule out other ailments that might be confused with TS. Rating scales are available for assessment of tic severity.

    Q. What are the first symptoms?
    A. The most common first symptom is a facial tic such as rapidly blinking eyes or twitches of the mouth. However, involuntary sounds, such as throat clearing and sniffing, or tics of the limbs may be the initial signs. For some, the disorder begins abruptly with multiple symptoms of movements and sounds.

    Q. How are tics classified?
    A. Two categories of TS tics and several of the more common examples are:

    Motor - Eye blinking, head jerking, shoulder shrugging and facial grimacing.

    Vocal - Throat clearing, yelping and other noises, sniffing and tongue clicking.

    Motor - Jumping, touching other people or things, smelling, twirling about, and only rarely self-injurious actions including hitting or biting oneself.

    Vocal - Uttering words or phrases out of context and coprolalia (vocalizing socially unacceptable words).

    The range of tics or tic-like symptoms that can be seen in TS is very broad. The complexity of some symptoms is often perplexing to family members, friends, teachers and employers who may find it hard to believe that the actions or vocal utterances are involuntary.

    Q. How is TS treated?
    A. The majority of people with TS are not significantly disabled by their tics or behavioral symptoms, and therefore do not require medication. However, there are medications available to help control the symptoms when they interfere with functioning. The drugs include haloperidol (Haldol), clonidine (Catapres), pimozide (Orap), fluphenazine (Prolixin, Permitil), and clonazepam (Klonopin). Stimulants such as Ritalin, Cylert, and Dexedrine that are prescribed for ADHD may increase tics. Their use is controversial. For obsessive compulsive traits that interfere significantly with daily functioning, fluoxetine (Prozac), clomipramine (Anafranil), sertraline (Zoloft) and Daroxetine (Paxil) are prescribed.

    Dosages which achieve maximum control of symptoms vary for each patient and must be gauged carefully by a doctor. The medicine is administered in small doses with gradual increases to the point where there is maximum alleviation of symptoms with minimal side effects. Some of the undesirable reactions to medications are weight gain, muscular rigidity, fatigue, motor restlessness and social withdrawal, most of which can be reduced with specific medications. Side effects such as depression and cognitive impairment can be alleviated with dosage reduction or a change of medication.

    Other types of therapy may also be helpful. Psychotherapy can assist a person with TS and help his/her family cope, and some behavior therapies can teach the substitution of one tic for another that is more acceptable. The use of relaxation techniques and/or biofeedback can serve to alleviate stress reactions that cause tics to increase.

    Q. Is it important to treat Tourette Syndrome early?
    A. Yes, especially in those instances when the symptoms are viewed by some people as bizarre, disruptive and frightening. Sometimes TS symptoms provoke ridicule and rejection by peers, neighbors, teachers and even casual observers. Parents may be overwhelmed by the strangeness of their child's behavior. The child may be threatened, excluded from activities and prevented from enjoying normal interpersonal relationships. These difficulties may become greater during adolescence - an especially trying period for young people and even more so for a person coping with a neurological problem. To avoid psychological harm, early diagnosis and treatment are crucial. Moreover, in more serious cases, it is possible to control the symptoms with medication.

    Q. Do all people with TS have associated behaviors in addition to tics?
    A. No, but many do have one or more additional problems which may include:

    Obsessions which consist of repetitive unwanted or bothersome thoughts.

    Compulsions and Ritualistic Behaviors are when a person feels that something must be done over and over and/or in a certain way. Examples include touching an object with one hand after touching it with the other hand to "even things up" or repeatedly checking to see that the flame on the stove is turned off. Children sometimes beg their parents to repeat a sentence many times until it "sounds right."

    Attention Deficit Disorder with or without Hyperactivity (ADD or ADHD) occurs in many people with TS. Children may show signs of hyperactivity before TS symptoms appear. Indications of ADHD may include: difficulty with concentration; failing to finish what is started; not listening; being easily distracted; often acting before thinking; shifting constantly from one activity to another; needing a great deal of supervision; and general fidgeting. Adults too may exhibit signs of ADHD such as overly impulsive behavior and concentration difficulties and the need to move constantly. ADD without hyperactivity includes all of the above symptoms except for the high level of activity. As children with ADHD mature, the need to move is more likely to be expressed by restless, fidgety behavior. Difficulties with concentration and poor impulse control persist.

    Learning disabilities such as reading and writing difficulties, arithmetic and perceptual problems.

    Difficulties with impulse control which may result, in rare instances, in overly aggressive behaviors or socially inappropriate acts. Also, defiant and angry behaviors can occur.

    Sleep disorders are fairly common among people with TS. These include frequent awakenings or walking or talking in one s sleep.
    You are not aware of the consequences that would result (if you were granted what you desire) because what you seek might be to your detriment. (O soul) be conscious that your Master is more aware about your well-being than you are.

    ~Ibn Al-Jawzee

  • #2
    Yep, my son has it. Seems to be growing out of it at age 13, he had some real "interesting" and annoying tics and quirks when he was younger.
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