Behaviour, General, Mental Health | May 31, 2016 | Author: The Super Pharmacist
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.
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.
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
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.
Patients and their caregivers may find comfort, support, and educational resources from
Indeed, parents, teachers, employers, and anyone who regularly interacts with a person with Tourette syndrome can benefit by learning about the illness.2
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
Drug treatment for Tourette syndrome is aimed at reducing the frequency of tics. Drugs used to treat Tourette syndrome include:
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.
If 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.
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.
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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
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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