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Tourette Syndrome (TS)

Tourette Syndrome (TS) is a neurological or “neurochemical” disorder characterized by tics – involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way.

 

The majority of people with TS are not significantly disabled by their tics or behavioural symptoms and therefore do not require medication. However, there are medications to help control symptoms when they interfere with functioning.

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. Very likely other neurotransmitters, such as serotonin, are also involved.

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.

Symptoms of Tourette Syndrome

  1. Both multiple motor and one or more vocal tics present at some time during the illness although not necessarily in the same way;
  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;
  3. The periodic change in the number, frequency, type and location of the tics, disappear for weeks or months at a time; and
  4. Onset before the age of 18.

Common Examples of SIMPLE Tics

  • Motor tics: Eye-blinking, head jerking, shoulder shrugging, facial grimacing
  • Vocal tics: Throat clearing, yelping and other noises, sniffing and tongue clicking.

Common Examples of COMPLEX Tics

  • Motor tics: Jumping, touching other people or things, smelling, twirling about
  • Vocal tics: Uttering ordinary words or phrases out of context, echolalia (repeating a sound, word or phrase just heard)

Less Common Tics:

  • Complex: Coprolalia (vocalizing socially unacceptable words).
  • Complex: Self injurious actions, including hitting or biting oneself

The term “involuntary” used to describe TS tics is a source of confusion since it is known that most people with TS do have some control over the symptoms. What is recognized is that the control which can be exerted from seconds to hours at a time, may merely postpone more severe outbursts of symptoms. Tics are experienced as irresistible as the urge to sneeze and must eventually 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 (but are not caused by stress) and decrease with relaxation or concentration on an absorbing task.

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

The frequency of co-occurrence is still controversial, but some people with TS may have additional difficulties resulting from:

  • Obsessions - which consist of repetitive, unwanted or bothersome intrusive thoughts
  • Compulsive behaviours - repetitive, often ritualistic actions in which the person feels that something must be done over and over, often in a very specific manner
  • Attention Deficit Disorder (ADD or ADHD) (with or without hyperactivity)
  • Learning Disabilities - such as dyslexia, reading, writing and perceptual difficulties, problems with visual/motor integration
  • Behavioural problems - which may result from obsessive-compulsive traits, attention problems, poor self-esteem due to TS symptoms, and poor school performance
  • Sleep disorders - which may include walking or talking in one’s sleep, delayed sleep onset and frequent awakenings
  • Difficulties with impulse control - in which routine interactions may rapidly escalate into major confrontations resulting in inappropriate behaviours, ranging from mild unruliness to explosive, defiant rage and aggression altogether out of proportion to the underlying incident.

The majority of people with TS are not significantly disabled by their tics or behavioural symptoms and therefore do not require medication. However, there are medications to help control symptoms when they interfere with functioning.

Other types of therapy may also be helpful. Sometimes psychotherapy can assist a person with TS and help his/her family cope with the psycho-social problems associated with TS. Some behavioural therapies can teach the substitution of one tic with another that is more acceptable. The use of relaxation techniques and/or biofeedback may help during prolonged periods of high stress.

 

Useful links/resources for TOURETTE SYNDROME:
Child and Parent Resource Institute- www.cpri.ca - or call 1-519-858-2774
Life’s A Twitch, Dr. Duncan McKinlay - www.lifesatwitch.com
Publication: “Understanding Tourette Syndrome: A Handbook for Families” available at www.tourette.ca
Tourette Syndrome Foundation of Canada - www.tourette.ca, visit site for local chapter contact.
Tourette Syndrome Plus - www.tourettesyndrome.net