Tourette's

Tourette's syndrome (TS)

Tourette’s syndrome is a condition affecting the brain and nervous system (a neurological condition) that is characterised by involuntary, random sounds and movements, known as tics.

It usually begins in childhood.



Examples of simple physical tics include:
blinking of the eyes
jerking their head
twitching their nose
grinding their teeth
rolling their eyes
twisting their neck
rotating their shoulders
Simple phonic tics

Examples of simple phonic tics include:
grunting
clearing your throat
coughing
screaming
sniffing
squeaking
blowing

Examples of complex physical tics include:
shaking of the head
hitting or kicking objects
jumping
shaking
touching themselves or others
copying the movements of other people – the medical term for this is "echopraxia"
making obscene gestures, such as giving somebody "the finger" – known as copropraxia
Complex phonic tics

Examples of complex phonic tics include:
repeating other people’s phrases – known as "echolalia"
repeating the same phrase over and over again – known as "palilalia"
shouting swear words or inappropriate or words and phrases – known as "coprolalia"
While many people associate shouting swear words with Tourette’s, it’s actually a relatively uncommon symptom and only affects a minority of people with the syndrome.
Premonitory sensations

Complex physical tics

The tics do not usually pose a serious threat to a person's physical health, although physical tics, such as jerking of the head, can often be painful. However, children and adults affected by Tourette’s syndrome can experience associated problems such as social isolation, embarrassment and low self-esteem.

Most people with Tourette’s syndrome find that they experience uncomfortable or unusual physical feelings before they have a tic and this feeling is then only relieved once they carry out the tic – much like an itch that can only be relieved by scratching it.
These types of feelings are known as premonitory sensations.

Examples of premonitory sensations include:

a burning feeling in the eyes that feels as if it can only be relieved by blinking

tension in a muscle that can only be relieved by twitching or stretching the muscle

a dry and sore throat that can only be relieved by grunting or by clearing your throat

an itchy joint or limb that can only be relieved by twisting the joint or limb



Pattern of tics

If your child has Tourette’s syndrome, you will probably find that their tics follow a set pattern. Tics tend to be worse during periods of:

anxiety
stress
tiredness
illness
nervous excitement

On the other hand, the tics tend to be calmer when the child is taking part in an enjoyable activity that involves a high level of concentration, such as:

reading an interesting book
playing competitive sports
playing a computer game


You may find that your child is able to control their tics to a certain extent when they are in a place where they would be particularly noticeable, such as a classroom or lecture hall. However, maintaining control over tics can be difficult and tiring over prolonged periods of time.

Many children with Tourette’s syndrome often experience a sudden "release" of tics after trying to suppress them (for example, after returning home from school).


Treating Tourette’s syndrome

Some people with Tourette’s syndrome only experience tics occasionally and do not require treatment.

When the tics are more frequent, there are several medications that have proved reasonably effective in helping to control them.

A type of psychotherapy known as behavioural therapy can also be effective in many people with Tourette’s syndrome.




Associated conditions

Children who develop Tourette’s syndrome will usually also have one or more other developmental or behavioural conditions. The two most commonly reported conditions are described below:

Obsessive compulsive disorder (OCD) is a condition that causes persistent obsessive thoughts and compulsive behaviour. For example, feeling compelled to constantly wash your hands because you are obsessed with the fear that you will catch a serious illness if you don’t.

Attention deficit hyperactivity disorder (ADHD) is a behavioural condition that causes symptoms such as short attention span, being easily distracted and being unable to sit still because you are constantly fidgeting (hyperactivity).

In addition, children with Tourette’s syndrome may have other behavioural problems, such as flying into sudden rages or engaging in inappropriate or anti-social behaviour with other children.

In many cases, these associated conditions and behavioural problems can be more disruptive and troublesome than Tourette’s itself.

Causes

The cause of Tourette’s syndrome is unclear but it appears to be strongly associated with a part of the brain called the "basal ganglia", which plays an important role in regulating body movements.

In people with Tourette’s syndrome the basal ganglia appears to "misfire", resulting in the tics associated with the condition.

Who is affected by Tourette’s syndrome?

Tourette’s syndrome is a lot more common than most people realise, as it affects around 1 in every 100 people.

The symptoms usually begin at around the age of seven and become most pronounced during the teenage years.

Boys are more likely to be affected by Tourette’s syndrome than girls. It is unclear why this is the case.


Outlook

Two thirds of people will experience a marked improvement in their symptoms, usually around 10 years after they first began. Many of these people will no longer require medication or therapy to control their tics.

For some people the Tourette symptoms become much less troublesome and frequent, while for others they can disappear entirely.

In the remaining third of people with Tourette’s syndrome, their symptoms will persist throughout their life, but the symptoms will usually become milder as they grow older. This means their need for medication and therapy may pass over time.


When to seek medical advice

It is always recommended that you contact your GP for advice if either you or your child starts having tics.

Many children have tics for several months before growing out of them, so the appearance of tics does not automatically mean that your child has Tourette’s syndrome.

However, symptoms such as tics need further investigation and probably a referral to a doctor who specialises in conditions that affect the brain and nervous system (neurologist).