Clinical Information

Syndrome is a neurological disorder characterized by tics—involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way. Onset of the disorder is before age 18.

Diagnosis

Tourette Syndrome is characterized by multiform, frequently changing motor and phonic tics. The current diagnostic criteria are defined by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders IV, which uses technical language. They are:

  1. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently.

  2. 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.

  3. The onset is before age 18.

  4. 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).

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Symptoms

The varied symptoms of TS fall into three categories: motor, vocal and associated behavioral.

Motor

  • Simple motor tics: fast, darting and meaningless
    Examples: eye blinking, grimacing, arm and head jerks, stomach tensing, shoulder shrugs.

  • Complex motor tics: slower, more purposeful
    Examples: bending, biting, evening-up, gyrating, head banging, holding funny expressions, rolling eyes, tearing up paper or books

  • Copropraxia: obscene gestures

  • Echopraxia: imitating something seen

Vocal

  • Simple vocal tics: meaningless sounds and noises
    Examples: barking, coughing, grunting, monosyllabic sounds, screeching, spitting

  • Complex vocal tics: words, phrases or statements
    Examples: "oh boy," "shut up," "that's right," "watch out"

  • Rituals: repeating a phrase until it is just right

  • Speech atypicalities: unusual accents, intensities, rhythms, tones of speech

  • Coprolalia: obscene and aggressive words and statements

  • Echolalia: repeating the words of others

  • Palilaia: repeating one's own words

Associated Behavioral Disorders

  • Attention deficit hyperactivity disorder (ADHD)

  • Obsessive-compulsive disorder (OCD)

  • Impulsivity

  • Irritability

  • Self-injurious behaviors

  • Various learning disabilities

Approximately 50 percent of children with TS satisfy the diagnostic criteria for ADHD, and 30 percent meet the diagnostic criteria for OCD.

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Treatments

Many children with TS develop normally and lead rich and well-adjusted lives as adults. For them, treatment to ameliorate the tics or associated behavioral disorders is not indicated. Others, however, may benefit from a treatment program designed by a qualified professional. As with any health problem, you should always consult a physician or other medical professional when considering treatment.

Important considerations:

  • No known cure; can only treat the symptoms.

  • TS is not lethal.

  • Gene or genes responsible not yet found.

  • Stress and concentration have largest effect on symptoms.

  • Symptoms may be affected by other environmental factors, e.g., alcohol, caffeine, food, heat, medicines.

  • Some prescription drugs are effective in treatment.

  • Non-drug methods (e.g., behavior or diet modification, hypnosis) may alleviate symptoms.

  • Education and emotional support are essential for everyone with a connection to TS. Support is cheap, easy to administer and has no negative side effects. Use it as often as possible.

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Neuroscience 2002 Research

Connecticut TSA attended Neuroscience 2002, a symposium on new mechanisms and new treatments on April 20, 2002 at Yale University. James Leckman, M.D., Nelson Harris professor of Child Psychiatry at Yale University School of Medicine, spoke about "New advances in understanding the pathogenesis of Tourette Syndrome and obsessive-compulsive disorder."

Dr. Leckman graciously shared his presentation with us. You can view and download it (443 KB; allow several minutes).

To view the file online, you must have Adobe Acrobat Reader software, which is available free from Adobe. Click the link below to download the software.

 

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