Childhood Diseases – On a Mission to Educate: Tourette Syndrome

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How would you feel if you were a young student or child where you have difficulty inhibiting certain thoughts and/or actions? Suddenly you blurt out inappropriate things or do behaviors that that you can’t control or stop. These behaviors may seem to be excessive silliness, sassiness, or inappropriate behavior. You may have uncontrollable emotional outbursts, swearing episodes, explosive outbursts, or displays of defiance. You may also act immature, have obsessive-compulsive behaviors, or rage. Many times you may exhibit a motor Tic where you might do repetitive blinking, shoulder shrugging, or facial contractions. People around you may stare or make fun of you for things that you cannot control. This is what a child or adult goes through who has Tourette Syndrome. Today I will review this very difficult and unfortunate syndrome.

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What Is Tourette Syndrome?

According to Kids Health (http://kidshealth.org/en/teens/tourette.html) Tourette Syndrome (TS) is a genetic disorder where a change in genes is passed from the parent to the child while he/she is in the womb. This genetic disorder may or may not develop into Tourette Syndrome. Unfortunately for those who do get Tourette syndrome, they will have either a motor tic involving sudden and uncontrollable movements like exaggerated blinking or a vocal tic like grunting, humming or clearing of the throat. The first signs of TS usually begins when the individual is a child or young teen. It affects people of all races and all backgrounds. According to statistics there are more boys than girls that are afflicted with TS.

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What Causes Tourette Syndrome?

The exact cause of Tourette syndrome is unknown but according to Kids Health there has been research that suggests that “it happens when there's a problem with how nerves communicate in certain areas of the brain. An upset in the balance of neurotransmitters (chemicals in the brain that carry nerve signals from cell to cell) might play a role.”

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There has been research studies done on twins and families that have suggested that TS is an inherited disorder but according to NIH (https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tourette-Syndrome-Fact-Sheet) more recent studies suggest that “the pattern of inheritance is much more complex. Although there may be a few genes with substantial effects, it is also possible that many genes with smaller effects and environmental factors may play a role in the development of TS.”

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What Are the Symptoms of Tourette Syndrome?

According to the Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/tourette-syndrome/symptoms-causes/syc-20350465) Tics are the major signs of TS. Tics are the sudden, brief, intermittent movements or sound that a sufferer of TS makes. These tics can significantly make it hard for someone to communicate, perform daily tasks or lead a quality of life existence. Per Mayo Clinic Tics are classified as:

• Simple tics: These sudden, brief and repetitive tics involve a limited number of muscle groups.

• Complex tics: These distinct, coordinated patterns of movements involve several muscle groups.

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Common Simple Motor Tics:

• Eye blinking
• Head Jerking
• Shoulder shrugging
• Eye darting
• Nose twitching
• Mouth movements

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Common Complex Motor Tics:

• Touching or smelling objects
• Repeating observed movements
• Stepping in a certain pattern
• Obscene gesturing
• Bending or twisting
• Hopping

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Common Simple Vocal Tics:

• Grunting
• Coughing
• Throat Clearing
• Barking

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Common Complex Vocal Tics:

• Repeating one’s own words or phrases
• Repeating others’ words or phrases
• Using vulgar, obscene or swear words

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Mayo Clinic also stated that Tics can also be the following:

• Vary in type, frequency & severity
• Worsen if you’re ill, stressed, anxious, tired or excited
• Occur during sleep
• Change over time
• Worsen in the early teenage years & improve during the transition into adulthood.

“Before the onset of motor or vocal tics, you'll likely experience an uncomfortable bodily sensation (premonitory urge) such as an itch, a tingle or tension. Expression of the tic brings relief. With great effort, some people with Tourette syndrome can temporarily stop or hold back a tic.”

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What Disorders Are Associated With Tourette Syndrome?

According to Medicine Net (https://www.medicinenet.com/tourette_syndrome/article.htm) many individuals with Tourette syndrome may experience additional neurobehavioral problems including:

• Inattention
• Hyperactivity
• Impulsivity
• Problems with reading, writing & arithmetic
• Obsessive-compulsive symptoms like worries about dirt & germs resulting in repetitive hand-washing or concerns about bad things happening resulting in ritualistic behaviors such as counting, repeating, or ordering/arranging things.
• Depression
• Anxiety

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How Is Tourette Syndrome Diagnosed?

Medscape (https://emedicine.medscape.com/article/1182258-overview#a1) stated that “diagnosis of Tourette syndrome is done using the specific DSM-5 criteria for Tourette’s disorder":

• Both multiple motor and 1 or more vocal tics have been present at some time during the illness, though not necessarily concurrently. (A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization)
• The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset
• The onset is before age 18 years
• The disturbance is not due to the direct physiologic effects of a substance (eg, cocaine) or a general medical condition (eg, Huntington disease or postviral encephalitis)

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What Is the Course of Tourette Syndrome?

Per National Institute of Neurological Disorders & Stroke (NIH) (https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tourette-Syndrome-Fact-Sheet) Tics can come and go over time and vary in type, frequency, location and severity. Usually the first symptom occurs in the head and neck regions and then may progress to involve muscles of the trunk and extremities. “Motor tics generally precede the development of vocal tics and simple tics often precede complex tics. Most patients experience peak tic severity before the mid-teen years with improvement for the majority of patients in the late teen years and early adulthood. Approximately 10-15 percent of those affected have a progressive or disabling course that lasts into adulthood.”

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How Is Tourette Syndrome Treated?

When the tics are not severe, most may not require any treatment. But according to Health Line (https://www.healthline.com/health/gilles-de-la-tourette-syndrome#diagnosis4) when the symptoms are severe or lead the individual to harm himself or herself, there are treatment approaches that are available: Therapy, Medications, & Neurological treatments.

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Therapy:

Per Health Line therapy can involve behavioral therapy or psychotherapy. Behavioral therapy includes “awareness training, competing response training, and cognitive behavioral intervention for tics.” Psychotherapy sessions can help the symptoms of ADHD, OCD and anxiety. Psychotherapy can involve the following:

• Hypnosis
• Relaxation techniques
• Guided meditation
• Deep breathing exercises

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Medications:

Medication is not the cure for Tourette syndrome but the following drugs may help according to Health Line:

• Haloperidol (Haldol) which can block or dampen the dopamine receptors in the brain which may help to control the tics.
• Onabotulinumtoxina (Botox) injections may help control simple motor/vocal tics.
• Methylphenidate (Ritalin) may help to reduce the symptoms of ADHD without increase tics.
• Clonidine is a blood pressure medication that can help control rage attacks and support impulse control.
• Fluoxetine (Prozac) can help control obsessive-compulsive behavior.

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Neurological Treatments:

Also per Health Line there is a Deep Brain Stimulation form of treatment for people with severe tics where a battery operated device is implanted in the brain to “stimulate parts that control movement or where electrical wires are implanted to send electrical stimuli to certain areas. They stress that you should talk to your doctor about potential risks verses benefits before deciding.

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What Are the Risk Factors For Tourette Syndrome?

Risk factors for Tourette Syndrome per Mayo Clinic include the following:

• Family history. Having a family history of Tourette syndrome or other tic disorders might increase the risk of developing Tourette syndrome.

• Sex. Males are about three to four times more likely than females to develop Tourette syndrome.

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What Is the Outlook For Tourette Syndrome?

According to NHS (https://www.nhs.uk/conditions/tourettes-syndrome/) approximately two-thirds of Tourette cases have improved symptoms about 10 years after they began. “In many of these cases, medication or therapy will no longer be needed to control the person's tics. Some people's symptoms become less frequent and troublesome, or they disappear completely.” NHS went on to say that one third of the people with Tourette’s may still have the symptoms but in many, these symptoms become milder as one ages.

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Myths About Tourette Syndrome

There are many Myths about Tourette syndrome according to Cleveland Clinic (https://my.clevelandclinic.org/health/articles/tourette-syndrome):

• Myth - People with TS can suppress tics for as long as they desire: Tics are caused by a chemical imbalance in the brain so physical and vocal tics are completely involuntary. Although tics can be suppressed for a short time, the length of suppression is not under the individual's control.

• Myth - All people with TS swear and use obscene language: Less than 20 percent of people with TS involuntarily swear & use obscene language (Coprolalia).

• Myth – Children should not be told that they have TS when they are diagnosed since it might upset them: Children who have TS already know they have a disorder. When they are given an explanation as to why their bodies are reacting a certain way, it helps them understand that they are ok and normal.

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• Myth - Having TS limits a person's abilities: TS only limits a person to the extent that the person believes he or she is limited. The major obstacle in having TS is not in dealing with the disorder but in dealing with the many behavioral symptoms that can accompany the disorder. Most people with TS lead productive lives, participate in normal activities and have rewarding careers.

• Myth - People with TS are not as intelligent as others: People with TS are as intelligent as people who do not have TS. However, about 25 percent of people with TS do have learning disabilities and require special educational assistance. When tics or associated learning disabilities interfere with a child's academic performance or social acceptance, adjustments may need to be made in the child's learning environment. All students with TS need an understanding environment that encourages them to work to their full potential but is flexible enough to accommodate their special needs.

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I hope you learned something from this article about Tourette Syndrome. There are many resources on the internet if you need more specific information. I will continue this series with another childhood disease post. I hope you will continue to join me in this quest to learn about these illnesses that children usually encounter when they are young. Thank-you for reading my article on ”Childhood Diseases – Tourette Syndrome”. If you would like to follow me, please check HERE

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These are my previous articles if you are interested in reading them:

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