Tourette Syndrome: What Is It, Symptoms, Causes, and Treatment?

A tic is a condition frequently seen, especially in childhood.

Tourette syndrome can be defined as a neurological disorder that causes the formation of tics in a person.

What is Tourette Syndrome?

Tourette syndrome is a condition that affects the nervous system, leading to involuntary, sudden movements (tics) and sounds in a person. Examples of such behaviors include repeated blinking and shoulder shrugging. People with Tourette syndrome may also produce unusual or inappropriate sounds without intending to.

Tics usually begin to appear between the ages of 2 and 15. The likelihood of tics occurring in boys is 3 to 4 times higher than in girls.

There is no cure to completely eliminate Tourette syndrome. The primary goal of treatment is to control the symptoms observed in the individual. If the symptoms are not severe, treatment may not be necessary for most people with Tourette syndrome. Tics typically become less frequent and more manageable as a person gets older.

What Are the Symptoms of Tourette Syndrome?

The sudden, brief, and intermittent movements known as tics are the most prominent symptom of Tourette syndrome. Tics can range from mild to severe. Severe tics may lead to communication issues in daily life and reduce a person’s quality of life.

Tics are classified into two types: simple and complex tics.

• Simple Tics: These are sudden, short, and repetitive tics that involve only specific muscle groups.
• Complex Tics: In complex tics, which are more noticeable and coordinated, multiple muscle groups are involved.

Tics can also be categorized into movement (motor) and sound (vocal) tics. Motor tics typically appear before vocal tics. However, the onset, type, and severity of tics can vary from person to person.

The most common motor tics in Tourette syndrome are:

1. Simple Motor Tics:
   • Blinking
   • Nodding
   • Shoulder shrugging
   • Rapid eye movements
   • Nose twitching
   • Mouth movements
2. Complex Motor Tics:
   • Touching and smelling objects
   • Mimicking observed movements
   • Stepping in a specific pattern
   • Making obscene gestures
   • Spinning around
   • Jumping

The most common vocal tics in Tourette syndrome are:

1. Simple Vocal Tics:
   • Grunting
   • Coughing
   • Throat clearing
   • Barking
2. Complex Vocal Tics:
   • Repeating one’s own words
   • Echoing others’ words
   • Using vulgar, obscene, or offensive language

Tics may increase in situations of stress, anxiety, fatigue, or excitement, and they can even occur during sleep. Tics can change over time. They are often more intense at the beginning of adolescence and may lessen in adulthood.

Before the onset of motor or vocal tics, individuals may experience what is known as a "premonitory urge." This is an uncomfortable sensation like itching, tension, or tingling. Performing the tic relieves this sensation. People with Tourette syndrome may exert significant effort to temporarily suppress their tics.

What Causes Tourette Syndrome?

The mechanisms causing Tourette syndrome have not yet been fully clarified. Experts believe that both genetic and environmental factors may contribute to the development of the syndrome. Chemical molecules (neurotransmitters) in the brain, such as dopamine and serotonin, which facilitate signal transmission, may also be involved in the development of Tourette syndrome.

The risk factors for Tourette syndrome are as follows:

• Family History: Individuals with a family history of Tourette syndrome or other tic disorders have an increased risk of developing Tourette syndrome.
• Gender: Tourette syndrome is more common in males.

How Is Tourette Syndrome Diagnosed?

There is no specific test for diagnosing Tourette syndrome. The diagnosis is based on the individual's history, as well as the symptoms and signs they present.

Several factors may indicate the presence of Tourette syndrome:

• Having both motor and vocal tics (they don’t need to occur simultaneously)
• The presence of tics several times a day, every day, for over a year
• Onset of tics before the age of 18
• Absence of conditions such as medication use, substance use, or medical disorders that could cause tics
• Variability in the location, frequency, type, complexity, and severity of tics

Since the symptoms of Tourette syndrome can resemble those of other conditions, misdiagnoses may occur. For example, eye blinking could be related to certain eye issues. It’s important to consider such factors when diagnosing.

Typically, the presence of both motor and vocal tics is decisive for a Tourette syndrome diagnosis. Blood tests, MRI scans, or other diagnostic tools may also be used to determine if the tics are linked to other health conditions.

What Symptoms Commonly Occur Alongside Tourette Syndrome?

In addition to Tourette syndrome, individuals may experience additional neurobehavioral problems, which can lead to more challenges than the tics themselves. While tics may decrease in adulthood, neurobehavioral issues can persist.

Common conditions that accompany Tourette syndrome include:

• Attention Deficit Hyperactivity Disorder (ADHD): Involves difficulties with concentration, hyperactivity, and impulsivity.
• Obsessive-Compulsive Disorder (OCD): Characterized by obsessions and repetitive, systematic movements developed in response to those obsessions. Examples include hand-washing, checking the stove, and cleaning.
• Anxiety: A condition marked by intense feelings of fear, worry, and distress in response to various situations.
• Learning Difficulties: Involves problems in writing, reading, and arithmetic skills independent of intelligence.
• Behavioral Problems: Includes issues such as anger, aggression, and inappropriate behaviors that make social adaptation challenging.
• Sleep Disorders: Individuals may have difficulty falling asleep or staying asleep.
• Social Skills Deficits: Difficulty forming or maintaining social relationships.

How Is Tourette Syndrome Treated?

The main goal in treating Tourette syndrome is to control the tics and prevent them from impacting daily life. Both medication and various therapies may be employed.

Medications used in treatment include:

• Drugs that Reduce or Block Dopamine: Medications with active ingredients like fluphenazine, haloperidol, risperidone, and pimozide can help control tics.
• Botulinum Injections: Injecting botulinum into the muscle involved in the tic can help relax the muscle and reduce the tic.
• ADHD Medications: Methylphenidate and dextroamphetamine help improve attention and concentration.
• Central Adrenergic Inhibitors: Drugs containing clonidine and guanfacine can help reduce behavioral symptoms like impulse control issues.
• Antidepressants: Fluoxetine may be used in individuals with Tourette syndrome who also experience anxiety or OCD.

Therapeutic approaches that may be beneficial include:

• Behavioral Therapy: Cognitive behavioral therapies can help control tics. These therapies also teach individuals to recognize premonitory urges and replace tics with other behaviors to allow the urge to pass.
• Psychotherapy: Psychotherapy can help individuals manage not only Tourette syndrome symptoms but also additional issues like OCD, anxiety, and ADHD.
• Deep Brain Stimulation (DBS): In cases where tics are severe and unresponsive to other treatments, DBS can be effective. In DBS, a battery is implanted in the brain to deliver electrical currents to certain areas, helping control involuntary movements.

Tourette syndrome typically doesn’t cause significant issues in a person’s life, and treatment may not be necessary. However, those who experience academic, social, or professional difficulties due to their tics should seek treatment, as it can improve their quality of life. It is advisable to consult a well-equipped center for the diagnosis and treatment of Tourette syndrome.