What is Tourette’s syndrome? The symptoms and treatment methods

Tourette’s syndrome is a neurological disease that begins in childhood, occurs involuntarily, and is expressed as tics consisting of constantly repetitive movements or sounds. Tourette syndrome was first described by the French doctor Gerard Gilles de La Tourette in 1985. It is also known as incontinence, sudden shouting, and tic disease among the people.

People with Tourette’s syndrome have a normal level of intelligence. The life expectancy of the patients is not affected by Tourette’s syndrome. Tourette syndrome is a chronic disease that lasts for many years.

During the disease, the symptoms may be suppressed and re-increased over time. Tics are impulses that cannot be controlled, such as sneezing. Apart from involuntary tics such as blinking and shrugging, symptoms such as making different sounds, saying bad words, and swearing can be seen.

Tourette’s syndrome is quite disturbing for the person. As a result of his involuntary actions, his self-confidence decreases, and his social life is negatively affected. In patients with Tourette’s syndrome, it is quite common to force oneself to suppress the symptoms. The person may suppress their tics for a while, so as not to be misunderstood by their environment. However, in these patients, such a strain causes exacerbation of the tics. Tics may appear suddenly with more severe symptoms.

Who gets Tourette syndrome?


Tourette’s syndrome is mostly seen in children. The first symptoms are observed especially in children aged 4-6 years. When Tourette’s syndrome occurs between the ages of 10 and 12, the disease progresses more seriously. In clinical findings, the severity of Tourette’s syndrome decreases in three-quarters of patients after puberty. In adults, severe Tourette syndrome is very rare.

Tourette’s syndrome, which is a “neurobiological”, hereditary disease, is more common in men than women. The incidence of Tourette’s syndrome has been determined as 2-5 per 10,000 people, depending on age.

What is Tourette's syndrome? The symptoms and treatment methods

How is the diagnosis of Tourette’s syndrome made?


The diagnosis of Tourette’s syndrome cannot be made using imaging methods such as brain tomography (CT), magnetic resonance (MR), and positron emission tomography (PET) because the disease has no pathological findings. In Tourette’s syndrome, where laboratory results or measurement tests cannot be used, the diagnosis is made by the specialist physician based on the anamnesis and clinical observations. The presence of certain criteria is important in diagnosing the disease.

  • Tourette syndrome symptoms must appear before the age of 18.  
  • Simple and complex tics should be seen together in patients.
  • The tics must have been present for more than a year.

What is the cause of Tourette’s syndrome?


The exact cause of Tourette’s syndrome is not yet known. It is thought to be caused by a neurochemical disorder in the part of the brain called the basal ganglia where motor movements are regulated.

Studies have shown that the disease is hereditary. The child of an individual with Tourette’s syndrome has 50% of the disease. Tourette’s syndrome is seen in 5-15% of first-degree relatives of patients.

In DNA research, it has been discovered that not a single gene, but many genes are effective in the occurrence of the disease. In addition to genetic factors, it has been observed that situations that cause stress also trigger tics. Exam anxiety, fatigue, excitement, panic increase the severity and number of tics. The pressure exerted on the child by the family because of his tics may also increase the patient’s tics.

Risk factors


Risk factors for Tourette’s syndrome include:

  • Family history. Having a family history of Tourette’s syndrome or other tic disorders may increase the risk of developing Tourette’s syndrome.
  • Sex. Men are about three to four times more likely to develop Tourette’s syndrome than women.

Complications


People with Tourette’s syndrome generally lead healthy and active lives. However, Tourette syndrome often involves behavioral and social difficulties that can damage your self-image.

Conditions often associated with Tourette’s syndrome include:

  • Attention deficit/hyperactivity disorder (ADHD)
  • Obsessive-compulsive disorder (OCD)
  • Autism spectrum disorder
  • learning difficulties
  • Sleeping disorders
  • Depression
  • Anxiety disorders
  • Pain due to tics, especially headaches
  • Anger management issues

Is every tic Tourette’s syndrome?


Not every tic is Tourette’s syndrome. In order for a person with tics to be diagnosed with Tourette’s syndrome, the tics must have continued for more than one year and the tics must be complex.

What are the symptoms of Tourette’s syndrome?


Symptoms vary according to the age of the person and the severity of the disease and are followed as mild or severe. The most important symptoms of Tourette’s syndrome are tics.

Tics are divided into the motor and vocal tics:

MOTOR TICS: THESE ARE MUSCLE TICS THAT ARE CAUSED BY THE SIMULTANEOUS WORK OF ONE OR MORE MUSCLES.

VOCAL TICS: TICS, ALSO KNOWN AS PHONIC TICS, ARE CHARACTERIZED BY SOUNDS THAT OCCUR IN THE MOUTH, NOSE, AND THROAT AREAS.

According to their structure, tics are divided into two as simple and complex (mixed):

SIMPLE TICS: THESE ARE TICS THAT COME ON SUDDENLY FOR MONTHS. THEY OCCUR WITH A VERY SHORT PERIOD OF MOVEMENT OF THE MUSCLES.

Simple motor tics:

  • Wink and roll.
  • Nod head.
  • Eyebrow lift.
  • Shrug.
  • Turning the head and neck
  • Blowing air.
  • Handling and smelling objects
  • Don’t stick the tongue out.
     

Simple vocal tics:

  • Throat clearing.
  • Cough.
  • Sniffle.
  • Stretch.

In complex tics, more than one muscle group works at the same time.

Complex motor tics:

  • Grimace.
  • Foot strike.
  • Walking in a circle.
  • Punching
  • Grinding teeth.
  • Bending, crouching, jumping and kicking.

Complex vocal tics:

  • Stuttering
  • Ekolalalia (repetition of syllables, sounds, words, or movements made by others)
  • Copropraxia (making obscene signs)
  • Palilali (multiple repetitions of the same phrase or word)
  • Palypraxia (repetition of the same movements many times)
  • barking, shouting and screaming,

In Tourette’s syndrome, different symptoms can be seen apart from tics.

Symptoms such as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and depression are frequently encountered in Tourette syndrome, such as difficulty concentrating, constantly switching from one activity to another, needing to move constantly, not seeming to listen.

Compulsive disorders are also seen in Tourette syndrome. The patient repeats the movements that he has made into menstruation in a certain order. For example, checking repeatedly whether the stove is not extinguished, the desire to ensure that the places of the items are always in the same direction and in the same place…

Learning difficulties such as dyslexia, reading, writing and perception difficulties, visual/body integration problems are seen in Tourette’s syndrome. Sleep disorders such as walking or talking in the patient’s sleep, trouble falling asleep, and waking up frequently are seen in Tourette’s syndrome.

Inability to control impulses, anger and aggression may also occur in advanced patients.

What are the treatment methods in Tourette syndrome?


Mild tics, which are vague, may go away on their own over time and do not require treatment. However, if mild-moderate and moderate-severe tics affect the person’s emotions and social life negatively, they should be treated.

The type of treatment is planned according to the patient’s age, clinical findings, the severity of the disease, and the discomfort given to the patient. Behavioral and drug therapy are used in the treatment of Tourette’s syndrome.

Interventional therapies, psychological support, and various training are applied in the treatment of low-severity tics that do not affect the daily and social life of the person much. In the treatment of stress-induced tics, it is aimed to reduce tics by using relaxation techniques. Having different hobbies and meditating also reduce the severity of Tourette’s syndrome.

In patients for whom behavioral therapy is insufficient, drug therapy is administered. The most preferred drugs in drug treatment are clonidine, guanfacine, clonazepam or other anxiety drugs (especially if there is accompanying anxiety) and antipsychotics.

Deep brain stimulation (DBS), which has been used in the treatment of Parkinson’s and obsessive-compulsive disorder in recent years, is also used in the treatment of Tourette’s syndrome. A plug-in electrode is used to change the activity of the brain current. DBS is not applied to every patient with Tourette’s syndrome. Before the surgical procedure, the patient should be examined by a neurologist, psychiatrist, and neurosurgeon and its suitability should be decided.

Early recognition of the symptoms of Tourette syndrome in children is even more important than the treatment of the disease. Because the symptoms are seen may cause ridicule and exclusion in the child with Tourette’s syndrome. Any unusual behavior that attracts the attention of family, teachers, or a random person should be taken into account. It should not be forgotten that especially the family should follow these suspicious behaviors and get help from a specialist physician.

Therapy

  • Behavioral therapy. Cognitive Behavioral Interventions for Tics, including habit reversal training, can help you track tics, identify arousing impulses, and learn to act voluntarily in a way that is inconsistent with the tic.
  • Psychotherapy. In addition to helping you cope with Tourette’s syndrome, psychotherapy can also help with accompanying problems such as ADHD, obsessions, depression or anxiety.
  • Deep brain stimulation (DBS). For severe tics that do not respond to other treatment, DBS may be helpful. DBS involves implanting a battery-operated medical device into the brain to provide electrical stimulation to targeted areas that control movement. However, this treatment is still in the early research stages and more research is needed to determine if it is a safe and effective treatment for Tourette’s syndrome.
Tics and Tourette syndrome

Page content is for informational purposes only. The content of the page does not include items containing information on therapeutic health care. Consult your doctor for diagnosis and treatment.

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