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Description

Tourette Syndrome (TS) is an inherited neurological disorder characterized by repeated involuntary movements and uncontrollable vocal sounds called tics.

Symptoms range from very mild to quite severe, but the majority of cases fall into the mild category. The first symptoms of TS are usually facial tics - commonly eye blinking. Other motor tics may appear later, such as head jerking, neck stretching, foot stamping, or body twisting and bending. It is not uncommon for a person with TS to continuously clear his or her throat, cough, sniff, grunt, yelp, bark, or shout. A person with TS may touch other people excessively or repeat actions obsessively and unnecessarily. A few patients with TS demonstrate self-harming behaviours such as lip and cheek biting and head banging. People with TS can sometimes suppress tics for a short time, but eventually tension mounts to the point where the tic escapes. Tics worsen in stressful situations and improve when the person relaxes or is absorbed in an activity.

Tourette syndrome often is accompanied by other behavioural or emotional problems. For example, attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder are very common. Learning difficulties, sleep abnormalities, depression and anxiety, impulse control and conduct problems also occur regularly.

The most dramatic symptoms are easy to notice, but the disorder often is hard to recognize. People with mild to moderate tics may be too embarrassed to discuss their problems. Parents and teachers usually pay more attention to behaviour, learning and attention problems. Sometimes tics are mistaken for other medical problems. For example, people might consult an allergist for sniffling or an eye doctor for unusual eye movements.

TS is diagnosed by observing the symptoms and evaluating family history when:

The person has multiple motor tics and one or more vocal tics
Tics occur most days for at least one year
The person was not free of tics for more than three months during the past year
Symptoms began before age 18
The tics are not caused by another illness, a substance or a medication.
The doctor also will ask questions about the impact of the tics on daily life, and about the other problems that commonly occur with Tourette's, such as obsessions, compulsions, attention and learning problems, anxiety and changes in mood.

The symptoms of TS generally appear before the individual is 18 years old. Males are more often affected than females.


Treatment

The majority of people with TS require no medication, but medication is available to help when symptoms interfere with functioning but are only able to help reduce specific symptoms. Neuroleptic and antihypertensive drugs can have long- and short-term side effects, and use of stimulants is controversial. Relaxation techniques and biofeedback may be useful in alleviating stress.


Prognosis

There is no cure for TS; however, the condition in many individuals improves as they mature. Individuals with TS can expect to live a normal life span. Although TS is generally lifelong and chronic, it is not degenerative. In a few cases, complete remission occurs after adolescence.

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