Tourette Syndrome

Tourette syndrome (TS) is an inherited neurological disorder. It is characterized by sudden, involuntary, repetitive muscle movements (motor tics) and vocalizations (vocal tics). Tourette syndrome is named after Dr. Georges Gilles de la Tourette, a French neurologist who first described nine cases in 1885.

Symptoms

According to the Tourette Syndrome Association (TSA), symptoms usually appear before the individual is 18 years old. The first symptoms may be facial tics, such as eye blinking or mouth twitches. Motor tics can also be symptoms of the disorder. These consist of heading jerking, shoulder shrugging and facial grimaces. Other symptoms may be uttering strange and unacceptable sounds, words or phrases. Many people associate swearing with Tourette. TSA says that only occurs in a small minority, less than 15 percent of those afflicted. The National Institute of Neurological Disorders and Strokes (NINDS) says in severe cases, the individual may practice lip and cheek biting and head banging.

People with TS can sometimes suppress their tics for a short time, but TSA describes the effort as similar to that of holding back a sneeze. Eventually tension mounts to the point where the tic escapes. Tics worsen in stressful situations (Read about "Stress"); however, they improve when the person is relaxed or absorbed in an activity. In most cases, tics decrease markedly during sleep.

TSA lists additional behavioral problems that may also be present:

• obsessive compulsive behavior (Read about "Obsessive-Compulsive Disorder")
• attention deficit disorder (Read about "Attention Deficit Hyperactivity Disorder")
• learning disabilities
• problems with impulse control

The natural course of TS varies from patient to patient. Although TS symptoms range from very mild to quite severe, TSA says the majority of cases fall in the mild category.

Causes

Although the cause of TS is unknown, TSA says current research suggests an abnormality in a gene or genes, which affect the brain's metabolism of neurotransmitters such as dopamine or serotonin. (Read about "The Brain")

Neurotransmitters are chemicals in the brain that carry signals from one nerve cell to another. TSA says genetic studies (Read about "Genetics") indicate TS is inherited as a dominant gene(s) that may produce varying symptoms in different family members. The agency reports a person with TS has about a 50 percent chance of passing the disorder to their children and the majority of offspring affected are sons.

Diagnosis

Tourette syndrome is a clinical diagnosis. This means blood tests or other laboratory tests do not definitively diagnose the disorder. (Read about "Laboratory Testing") NINDS says Tourette syndrome is usually diagnosed by observing the symptoms and evaluating family history. (Read about "Family Health History") For a diagnosis of TS to be made, tics have to be present for more than a year.

Treatment

The goal of therapy in patients with TS is to relax motor and vocal tics and alleviate associated behavioral problems. Many patients with mild symptoms may not require treatment. However, there are medications to help control symptoms that interfere with academic, occupational or social functioning. TSA says other types of therapy may also be helpful. These include:

• psychotherapy
• relaxation techniques
• biofeedback (Read about biofeedback in "CAM Therapies")

Prognosis

There is no cure for TS. However, TSA says the condition often improves with age and tics may disappear altogether in some individuals as they mature. Research aimed at understanding how the disorder is transmitted and locating the gene marker for TS is underway. In the meantime, those with TS can expect to live a normal life span and although the disorder can be chronic, it is not a degenerative condition. TS does not impair intelligence and most people with TS are able to hold jobs and lead full lives.