Tourette’s syndrome is a life long neurological condition
(affecting the brain and nervous system) that is characterised by a combination
of involuntary noises and movements called tics. The full name is Gilles de la
Tourette’s syndrome, which originates from the 19th Century when
firsts signs of tics were identified by a French doctor named Georges de Gilles
de la Tourette. Tics can be vocal-phonic or motor, and are repetitive, fast
involuntary contractions of muscles. Examples of vocal movements can be simple
such as saying a word or grunting, or more complex such as phrasing a whole
sentence. Involuntary swearing is a socially disabling tic symptom which is
present in 10-30% of people diagnosed with Tourette’s. Physical movements can
also be simple or complex, such as jerking or making a series of movements. Names
of complex tics include echolalia, which is a vocal tic where the patient
repeats other people’s words, or coprolalia (swearing.) Furthermore a motor tic
known as copropraxia, is where involuntary production of rude gestures occurs.
The presence of comorbid behavioural symptoms often makes
diagnosis a lot harder, but a key feature of diagnosis can be at least two
motor tics and one vocal tic present since childhood. Tics relating to
Tourette’s syndrome usually develop at a young age, the average being six years
old, and rarely develop in adulthood. Although tics do develop in men and
women, men are four times more likely to develop them than women. Tics can also
be caused by other medical conditions such as Huntington’s disease and
physiological effects of substances such as stimulants. Quite often Tourette’s
syndrome occurs with other disorders for example Obsessive-compulsive
disorders, attention-deficit disorders and hyperactivity disorders, in which
60% of diagnosed patients also have these disorders.
Why do tics occur? The main explanation for the involuntary reactions is
due to genetically inherited genes; however tics tend to be intensified by
anxiety and stress. This therefore explains the peak in severity during teenage
years and on the other hand tics are eased by mental and physical
concentration. This therefore
supports the need for schools and workplaces to take into account the
implications of tics, but still provide education and jobs so that the
severities of tics for the patients are reduced. Nevertheless there is a
disabling of social capabilities with the disorder, finding it hard to face
daily activities. This is hugely unfortunate because research shows that the
syndrome is compatible with success at school and in the workplaces and it has
no effect on intellectual disability. Moreover patients can voluntarily supress
their tics for a short period of time, although this is researched to cause
inner tension and subsequent rebound in tic severity.
Finally the treatment available involves behavioural
treatments and prescription of drugs. Behavioural training involves practices
such as habit reversal training which influences tic expressions to be delayed
or abolished because patients can recognise the prior urge associated with the
involuntary movement. This method has proved to be very successful in about
half of patients treated; unfortunately access to this type of treatment is
currently limited in many countries.
Drug prescription is not given to every patient with Tourette’s
syndrome, its usually provided to patients who do not respond to behavioural
training or alternatively if the tics provide injury or pain or furthermore
social discomfort such as bullying. Haloperidol and pimozide are examples of
neuroleptics which are prescribed to patients with Tourette’s as the most
effective medication, despite the metabolic side effects. More recent
antipsychotics have been researched to provide the same benefits but without
side effects. For young patients with other conditions such as ADHD, clonidine
and guanfacine examples of a2 adrenergic agonists can be used as treatment due
to the fewer adverse effects than other drugs. On the
other hand Benzodiazepines should be avoided as long term treatment for tics
due to tolerance and addiction. The final types of treatment are Botulinum
toxic injections or surgery such as functional neurological procedure.
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