Tourette's disorder

Definition

Tourette’s disorder is named after the doctor who first described it. It is a chronic neurological disorder which features tics (sudden, brief, repeated, stereotyped movements and vocal sounds, which are not rhythmic and serve no useful purpose).

They occur often, usually in bouts, almost every day, though they may vary in intensity and may be worsened by tension. They are unwelcome, and as hard to suppress as the urge to sneeze. Similarly to the sneeze, it can be very uncomfortable to try to suppress them and there can be a feeling of relief afterwards.

The condition usually starts before one is eighteen. Such tics can be very embarrassing and can lead to ridicule or scolding from others who don’t understand the condition. One may feel embarrassed when they happen in public, and anxious when anticipating that this may occur. They can interfere with one’s normal social and work functioning.

Tourette’s disorder may be associated with other problems, such as Attention Deficit Hyperactivity Disorder (ADHD), learning disabilities, and particularly with Obsessive Compulsive Disorder (OCD).

Cause

The exact cause is not yet known but there is a strong tendency for the condition to run in families, along with OCD.

It appears to involve abnormalities in the metabolism of the chemical dopamine in the brain, and other brain chemicals may be involved.

Who gets it?

Tourette’s disorder occurs in all societies. It is rare, though it tends to be over-diagnosed by enthusiasts with an excessively strong interest in the condition. It occurs more often in males.

Symptoms

Symptoms vary greatly in frequency and intensity through the course of a year, and may even disappear for weeks or months at a time. Generally, they are relatively mild in severity.

Typical tics can include a variety of rapid, unnecessary, muscular movements: from eye blinking or rolling, shrugs, jerking of the head, clearing of the throat, to grimaces, touching and smelling things, or hopping or flapping motions.

Vocal tics range from simple, meaningless noises or odd sounds, snorting, barking and laughing, to meaningful words or phrases blurted out.

Contrary to what one sees of Tourette’s disorder in the media, coproplalia, in which the person shouts out obscene and socially embarrassing comments, as well as sexually inappropriate gestures and touching, are uncommon.

Other examples can include echoing of the words or actions of others.

Course of the disorder

Tourette’s disorder is a chronic condition but tends to wax and wane in severity and prominence. The symptoms usually tend to get milder as one grows older, and in some cases clear up completely.

Diagnosis

It is important to recognise that mild tics, generally of only one form, are quite common in children, and usually resolve spontaneously after weeks or months.

If Tourette’s disorder is suspected because the tics are multiple in type, severe in degree and enduring, the diagnosis is made clinically, by a proper assessment by a neurologist or psychiatrist.

In preparing to visit the specialist, it is useful to keep a diary of the tics which have given rise to concern, including possible circumstances which make them worse, their frequency and severity.

Treatment

Some people experience rather little disability from the condition and are able to ignore it, not needing treatment. But treatment is needed in all significant cases which have been competently diagnosed, depending on the degree of severity and of interference with normal social and work functions.

Medication

Medication is often used to control symptoms and can be very successful as they can help to correct some of the chemical anomalies in the way the brain handles dopamine and related chemicals.

For years, the mainstay in treatment has been haloperidol, though others used include clonidine, pimozide, sulpiride and fluphenazine. Less often, a number of other drugs may prove helpful, including clonazepam, clomipramine, verapamil, nifedipine, naloxone and lithium.

Each drug may have troublesome side-effects, so good treatment involves careful selection of drug and dosage. Haloperidol can cause annoying side effects such as sleepiness, fatigue and Parkinsonian shakiness.

Medication should be carefully monitored. Patients are usually started at a low dose, and the dosage is increased gradually until the lowest effective dosage is reached.

Medication should never be discontinued without proper medical supervision as problems can arise when some of these drugs are stopped too suddenly.

Psychotherapy

Psychotherapy cannot eliminate tics but may be beneficial to help people cope with the disorder. As many develop psychological difficulties such as poor self esteem and social withdrawal as a result of the disorder itself and of negative social reactions, individual therapy may be helpful.

The disorder can place a great strain on the family. Family therapy can be beneficial in educating the family about the disorder, helping the family to accept the patient’s symptoms, alleviating possible feelings of guilt associated with the genetic nature of the disorder and helping the family understand the impact of the disorder on all family members.

The family is also encouraged to offer special support when needed but not to become overprotective.

Special education needs

It is important to inform the school when a child has Tourette’s disorder and to ensure that teachers understand the condition. Although most children with Tourette’s disorder have average IQ, some may have special education needs as a result of associated disorders.

Support groups

Support groups can offer direct support and assistance to families in crisis through providing information on Tourette’s disorder and referral to others in similar situations or to professionals.