Free Shipping on orders over $99

Tourette syndrome: A guide to understanding the condition and treatments

Behaviour, General, Mental Health | May 31, 2016 | Author: The Super Pharmacist

anti-psychotic, behaviour, mental health, antipsychotics, adhd

Tourette syndrome: A guide to understanding the condition and treatments

Tourette syndrome is a relatively rare neurological condition in which sufferers make unusual movements and sounds. These movements and sounds are called “tics,”  and may include unusual movements (motor tics) - blinking, grimacing, grunting, and shoulder shrugging.

Many people associate Tourette syndrome with one particular tic, blurting out offensive words or curses. Involuntarily saying obscene words is called coprolalia, and approximately 40% of people with Tourette syndrome have this tic.1

Most people consider tics to be involuntary; however, sufferers may be able to briefly suppress them.2 People with Tourette syndrome describe an irresistible urge before the tic that is relieved when the tic occurs.3 When the tic does emerge, it is usually stronger and more forceful if the person tried to suppress it.

Diagnosing Tourette syndrome

The diagnosis of Tourette syndrome is usually straightforward. There is no test for the condition, but the symptoms make the diagnosis. In fact, parents who are aware of Tourette syndrome suspect the diagnosis before they even have their child evaluated.

The Tourette Syndrome Classification Study Group lists the following diagnostic criteria:

  • Diagnosing Tourette syndromeMultiple tics are apparent, though not necessarily at the same time
  • Tics must occur many times a day, nearly every day, or intermittently for more than one year
  • Anatomical location, number, frequency, type, complexity, or severity of tics must change over time
  • Onset of tics before the age of 21
  • Involuntary movements and noises must not be explained by another medical condition
  • Tics must be witnessed by a reliable examiner or recorded 4

If tics last for less than one year, the condition is called transient tic disorder or transient tics of childhood, not Tourette syndrome. These transient conditions occur in as many as 1 in 4 healthy children.1,2 Tourette syndrome often occurs with other mental health conditions including ADHD, OCD, and learning disorders.5 Most children with Tourette syndrome will start showing symptoms before the age of 11. In fact, the average age at which Tourette syndrome tics become noticeable is six.5 Interestingly, about half of all children with Tourette syndrome will no longer have tics once they reach the age of 18. About 45% of those who continue to have tics beyond the age of 18 will experience a decrease in the severity of tics over time.6

Treatment for Tourette syndrome

The severity of Tourette syndrome can vary substantially. When tics are mild and do not interfere with school or social functioning, people with Tourette syndrome may be successfully treated with education and psychotherapy alone.7 When tics significantly interfere with school, work, or life, treatments may include various medications, injections, and surgery.

Educational resources

Patients and their caregivers may find comfort, support, and educational resources from ​

Treatment for Tourette syndromeTourette Association of America, 
Tourette Canada
European Tourette Syndrome and
Tourette Syndrome Association of Australia.

Indeed, parents, teachers, employers, and anyone who regularly interacts with a person with Tourette syndrome can benefit by learning about the illness.2

Psychotherapy

Various forms of psychotherapy may be used to manage Tourette syndrome. Perhaps the most notable and effective is the psychotherapeutic process called habit reversal training (HRT).8

There are two main components of HRT; tic awareness training; and competing response training.9

Tic awareness training teaches sufferers to recognise the signs that precede a tic. Competing response training encourages patients to perform a voluntary movement that prevents the involuntary tic (e.g. smiling instead of grimacing). While HRT seems simple, it is effective for mild Tourette syndrome.10

Medications

Drug treatment for Tourette syndrome is aimed at reducing the frequency of tics. Drugs used to treat Tourette syndrome include:

  • Tetrabenazine
  • Fluphenazine
  • Risperidone
  • Haloperidol
  • Pimozide
  • Clonidine
  • Guanfacine
  • Topiramate

While these medications are effective, each may cause troublesome adverse events.11,12,13,14 Therefore patients, parents, and physicians may have to balance relief of tics with potential side effects of these medications.

Injections

Treatment for Tourette syndromeIf motor or vocal tics can be localised to a specific muscle or small group of muscles, botulinum toxin (Botox) injections may be used to suppress the tic.

In essence, the patient with Tourette syndrome sends a signal from the brain to the muscle to perform the tic, but the botulinum toxin in the muscle prevents the muscle from moving.

This curious treatment has actually been shown to be effective in clinical trials.15,16

Surgery

In people with severe Tourette syndrome who cannot find relief through other treatments, surgical treatments are available. The primary surgical treatment for Tourette syndrome is called deep brain stimulation.17 In deep brain stimulation, a probe is placed directly in the brain attached to a wire that extends outside of the body. A neurologist can adjust the electrical stimulation provided to the probe to change brain activity and, consequently, behavior. So far, results in Tourette syndrome patients treated with deep brain stimulation have been encouraging; however, this treatment should be considered preliminary rather than standard care.18,19 Moreover, few surgical centers currently performed deep brain stimulation surgery for patients with Tourette syndrome.

www.superpharmacy.com.au Australia's best online pharmacy

References

1 Jankovic J, Kurlan R. Tourette syndrome: evolving concepts. Mov Disord. May 2011;26(6):1149-1156. doi:10.1002/mds.23618

2 Kurlan R. Clinical practice. Tourette's Syndrome. N Engl J Med. Dec 9 2010;363(24):2332-2338. doi:10.1056/NEJMcp1007805

3 Kwak C, Dat Vuong K, Jankovic J. Premonitory sensory phenomenon in Tourette's syndrome. Mov Disord. Dec 2003;18(12):1530-1533. doi:10.1002/mds.10618

4 Definitions and classification of tic disorders. The Tourette Syndrome Classification Study Group. Arch Neurol. Oct 1993;50(10):1013-1016.

5 Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P. An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries. Dev Med Child Neurol. Jul 2000;42(7):436-447.

6 Robertson MM. The Gilles de la Tourette syndrome: the current status. Arch Dis Child Educ Pract Ed. Oct 2012;97(5):166-175. doi:10.1136/archdischild-2011-300585

7 Kurlan RM. Treatment of Tourette syndrome. Neurotherapeutics. Jan 2014;11(1):161-165. doi:10.1007/s13311-013-0215-4

8 Dutta N, Cavanna AE. The effectiveness of habit reversal therapy in the treatment of Tourette syndrome and other chronic tic disorders: a systematic review. Funct Neurol. Jan-Mar 2013;28(1):7-12.

9 Azrin NH, Nunn RG. Habit-reversal: a method of eliminating nervous habits and tics. Behav Res Ther. Nov 1973;11(4):619-628.

10 Piacentini J, Woods DW, Scahill L, et al. Behavior therapy for children with Tourette disorder: a randomized controlled trial. JAMA. May 19 2010;303(19):1929-1937. doi:10.1001/jama.2010.607

11 Scahill L, Chappell PB, Kim YS, et al. A placebo-controlled study of guanfacine in the treatment of children with tic disorders and attention deficit hyperactivity disorder. Am J Psychiatry. Jul 2001;158(7):1067-1074. doi:10.1176/appi.ajp.158.7.1067

12 Kenney C, Jankovic J. Tetrabenazine in the treatment of hyperkinetic movement disorders. Expert Rev Neurother. Jan 2006;6(1):7-17. doi:10.1586/14737175.6.1.7

13 Yang CS, Zhang LL, Zeng LN, Huang L, Liu YT. Topiramate for Tourette's syndrome in children: a meta-analysis. Pediatr Neurol. Nov 2013;49(5):344-350. doi:10.1016/j.pediatrneurol.2013.05.002

14 Gaffney GR, Perry PJ, Lund BC, Bever-Stille KA, Arndt S, Kuperman S. Risperidone versus clonidine in the treatment of children and adolescents with Tourette's syndrome. J Am Acad Child Adolesc Psychiatry. Mar 2002;41(3):330-336. doi:10.1097/00004583-200203000-00013

15 Marras C, Andrews D, Sime E, Lang AE. Botulinum toxin for simple motor tics: a randomized, double-blind, controlled clinical trial. Neurology. Mar 13 2001;56(5):605-610.

16 Porta M, Maggioni G, Ottaviani F, Schindler A. Treatment of phonic tics in patients with Tourette's syndrome using botulinum toxin type A. Neurol Sci. Feb 2004;24(6):420-423. doi:10.1007/s10072-003-0201-4

17 Thenganatt MA, Jankovic J. Recent Advances in Understanding and Managing Tourette Syndrome. F1000Res. 2016;5. doi:10.12688/f1000research.7424.1

18 Maciunas RJ, Maddux BN, Riley DE, et al. Prospective randomized double-blind trial of bilateral thalamic deep brain stimulation in adults with Tourette syndrome. J Neurosurg. Nov 2007;107(5):1004-1014. doi:10.3171/jns-07/11/1004

19 Servello D, Porta M, Sassi M, Brambilla A, Robertson MM. Deep brain stimulation in 18 patients with severe Gilles de la Tourette syndrome refractory to treatment: the surgery and stimulation. J Neurol Neurosurg Psychiatry. Feb 2008;79(2):136-142. doi:10.1136/jnnp.2006.104067

backBack to Blog Home