16 year old Bianca had been living with the worst case of Tourette’s until Professor Peter Silburn, an Australian neurologist, with his team gave her another life through a winning Deep Brain Stimulation (DBS) operation. She now lives a contented life with great depletion in tics and other characteristics of the syndrome.
Tourette syndrome (TS), a neurodevelopmental disorder, is the namesake of Georges Gilles de la Tourette, a French Physician, as he described the symptoms of the syndrome in 9 patients in 1884. Tourette’s is characterized by physical and verbal tics. Tics most commonly emerge between the age of 6 and 18 years. As the Tourette’s sufferer reaches early adulthood, the tics either become less severe or fade away completely but sometimes as the person reaches adulthood Tourette’s become even worse. The syndrome was before regarded rare. Now studies suggest that 1 of every 162 children in United States have Tourette’s. People belonging to any ethnic and racial group can have TS and boys are more likely to have it than girls. Most of the Tourette’s patients are associated with another mental, behavioral or developmental disorder. The disorders are stated in the picture below:
Other Disorders Associated With Tics:
Involuntary, irresistible and repetitive body movements or sounds called “tics” are the basic signs of Tourette syndrome as TS is one of the tic disorders. In the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, the four tic disorders are described by The American Psychiatric Association (APA) based on the type and duration of tics.
1.Transient tic disorder:
Transient tic disorder is also known as benign tic disorder of childhood. It consists of multiple motor and/or vocal tics which must occur for at least 4 weeks but not more than 12 months.
2. Chronic tic disorder:
Chronic tic disorder is also referred as chronic motor or vocal tic disorder as it consists of either single or multiple motor or phonic tics, but not both. The tics must be present for more than a year.
3. Tourette syndrome:
Tourette’ syndrome or Tourette’s or simply TS consists of motor and phonic (vocal) tics both. The tics must occur for more than a year.
4. Tic disorder not otherwise specified is diagnosed when tics are present, but do not meet the full criteria of a specific disorder.
Tics are of two types: motor and vocal (phonic), which are further categorized as simple and complex.
1. Simple motor tics:
Tics involving only one muscle group or body part are called simple motor tics. The examples include: Eye blinking, head jerking, shoulder shrugging, etc.
2. Complex motor tics:
Complex motor tics involve more than one muscle group to perform a series of movements. Facial grimacing, kicking, jumping, obscene gesturing, etc. are the examples of complex motor tics.
3. Simple vocal tics:
Making simple sounds like grunting, throat clearing, barking, hissing, etc. are simple vocal tics.
4. Complex vocal tics:
Stating meaningful words or sentence involuntarily are complex vocal tics. For instance: yelling, cursing, phrases with obscenities, etc.
Doctors still haven’t learnt about the exact cause of Tourette’s syndrome but both genetic and environmental factors probably play a role.
Tourette’s is believed to be hereditary, thus, people with family members having Tourette’s are more likely to get it. But a few cases have shown that people, having not a single gene that causes Tourette’s in their families, have had tics. In the recent years, research, aiming to identify the variations in genes that enhances TS developmental risks, has been taking place. To identify clearly which genes contribute to TS, more and more contribution from the people with TS will be really worthy.
Not always genetic factors lead to Tourette’s. The environmental factors play a role too which means that the factors in the environment may influence brain to the development of tics. Use of alcohol and cannabis and inadequate weight gain during pregnancy increase the risks for the child to develop Tourette’s.
Researchers also claim that TS can be caused due to trouble in brain network. An area in the brain called Basal Ganglia plays a vital role in the development of Tourette’s as it controls the body movements thus abnormality in that area, can affect the levels of brain neurotransmitters as these are the messengers in the brain that send signal between nerve cells.
Tourette’s cannot be diagnosed by a specific test. No blood or laboratory tests diagnose TS. Doctors detect TS by verifying that the patient has had tics (both motor and vocal) for at least a year and those tics keep altering severity, type and location. The patients experience tics multiple times in a day or sporadically. Presence of other neurological conditions can also assist doctors to diagnose Tourette’s. Doctors also make sure that the patient is not having tics due to intake of any drug, medications or other substances. Sometimes MRI, CT, EEG or other blood tests may be required to distinguish between TS and other conditions that are often mistaken as TS. Some patients diagnose TS long time after the symptoms onset due to either complete unawareness about the syndrome or they mistake TS with other conditions.
Treatment of Tourette’s varies patient to patient depending on the type and severity of tics. Treatment might not be required if the tics aren’t much severe. In most cases, tics either get milder or completely fade away as the patient grows into adulthood. But not every patient is fortunate enough to experience it. For some patients, treatment is indispensable.
Medication is not preferred to be given before any other intervention. If despite of all the other non-medical interventions, tics still get in the way of day to day life then medicines are prescribed by doctors.
Haldol (haloperidol), an antipsychotic drug, is used to control tics as it decreases the excitement in the brain. Tetrabenazine treats uncontrolled muscle movements called Huntington's chorea. Pimozde(Orap) and Fluphenzazine are also used to treat tics. Guanfacine, a non-stimulant, is used to treat ADHD. Strattera (atomoxetine) is the first nonstimulant approved by FDA for the treatment of ADHD. Ritalin, a central nervous system stimulant, also helps in treating ADHD. Desipramine, an antidepressant drug, is used to promote recovery of depressed patients. Xanax helps in treating anxiety. Risperidone is called atypical antipsychotics. It belongs to a class of drugs. It is also prescribed to the patients as it treats certain mental/mood disorders.
Tetrabenazine to control tics may result in severe depression. Haldol can cause headache and dizziness. Strattera (atomoxetine) troubles sleeping and decreases appetite resulting in weight loss. Guanfacine causes low blood pressure and dizziness. Desipramine causes nausea, vomiting, constipation, diarrhea etc. Other side-effects of the mentioned medications can be weight gain and involuntary repetitive movements.
Sometimes Doctors suggest seeing therapists so that the patients can cope up with anxiety and stress in a better way. It helps them learn relaxation techniques.
Habit-Reversal therapy (HRT) is a therapy for tic disorders. TS patients with Onychophagia, trichotillomania and tics have been benefitted with HRT. It helps to notice the feeling preceding to tics and control it and respond to it by performing alternative behaviors. HRT has been proven to be efficient for kids and adults both as it results in great reduction in tics only after a few weeks of the therapy. Similarly, psychotherapy helps in treating ADHD and anxiety.
Deep Brain Stimulation (DBS) is one another way to treat the syndrome. It is a neurosurgical procedure in which a medical device called neurostimulator is placed inside the brain. The device treats movement disorders by sending electrical impulses to specific areas in brain through implanted electrodes.
In addition to medication and therapies, bringing alterations in lifestyle also treats TS. Make kids involved and focus their mind on activities e.g. writing, painting or playing sports. Relaxation exercises, deep breathing, visual imagery etc. helps patients to feel relieved. These activities only benefit as they aim to divert the attention and thus dealing with tics. Moreover, no side-effects are resulted. Time to time visits to doctor to check progress is also recommendable.