Tourette syndrome

From Freepedia

Tourette syndrome
ICD-10 code: F95.2
ICD-9 code: 307.23

Tourette syndrome — also called Tourette's syndrome, Tourette Spectrum (TS), Tourette's disorder, or Gilles de la Tourette syndrome is a neurological or neurochemical disorder characterized by tics: involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way. Symptoms include multiple motor and one or more vocal tics present at some time during the disorder although not necessarily simultaneously; the occurrence of tics many times a day (usually in bouts) nearly every day or intermittently throughout a span of more than one year; the periodic change in the number, frequency, type and location of the tics, and in the waxing and waning of their severity; symptoms disappearing for weeks or months at a time; and onset before the age of 18. Vocal tics may fall into various categories, including echolalia (the urge to repeat words spoken by someone else after being heard by the person with the disorder), palilalia (the urge to repeat one's own previously spoken words), lexilalia (the urge to repeat words after reading them) and, most controversially, coprolalia (the spontaneous utterance of socially objectionable words, such as obscenities and racial or ethnic slurs). There are many other vocal tics besides those categorized by word repetition - in fact, a TS tic can be almost any possible short vocal sound, with the most common tics resembling throat clearing, short coughs, grunts, or moans. Motor tics can be of endless variety and may include hand-clapping, banging the knuckles together, and contorted facial grimacing.

The eponym was bestowed by Jean-Martin Charcot after and on behalf of his resident, Georges Edouard Albert Brutus Gilles de la Tourette, (1859 - 1904), French physician and neurologist.

The term "involuntary" used to describe TS tics is a source of confusion since it is known that most people with TS do have some control over the symptoms. Before tic onset, individuals with TS experience what is called a "premonitory urge," similar to the feeling that precedes yawning. What is recognized is that the control which can be exerted from seconds to hours at a time may merely postpone and exacerbate outbursts of symptoms. Tics are experienced as irresistible as a yawn and must eventually be expressed. People with TS often seek a secluded spot to release their symptoms after delaying them in school or at work. Typically, tics increase as a result of tension or stress (but are not caused by stress) and decrease with relaxation or concentration on an absorbing task. In fact, neurologist and writer Oliver Sacks has described a man with severe TS who is both a pilot and a surgeon.

Other commonly associated disorders are obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD).

The entertainment industry has often depicted those with TS as being social misfits whose only tic is coprolalia, which has led to the general public's misunderstanding of TS sufferers as "people who can't help yelling swear words a lot". However, this is merely a clinomorphism, as coprolalia is a relatively rare symptom compared to other types of tics.

Contents

Diagnosis

According to the DSM-IV, TS is indicated when a person exhibits both multiple motor and one or more vocal tics (although these do not need to be concurrent) over the period of 1 year, with no more than 3 consecutive tic-free months. This disturbance must cause distress or impairment in the individual's normal functioning. The onset must have been before the age of 18, and cannot be attributed to the use of a substance or another medical condition.

It is estimated that as many as 1 in 200 experience some form of TS. Males are affected 3 to 4 times more often than females. Some cases decrease in severity or cease entirely upon reaching adulthood.

As it is a spectrum disorder, the severity of the condition can range vastly. Those with mild cases are often highly functioning, so much so that others would not know of their condition. More severe cases can inhibit or prevent the individual from engaging in common activities such as holding a job, having a fulfilling social life, or maintaining his/her basic needs.

Treatment

The majority of people with TS require no medication, but medication is available to help when symptoms interfere with functioning. TS medications are only able to help reduce specific symptoms. Neuroleptic and antihypertensive drugs can have long- and short-term adverse effects, and use of stimulants is controversial. SSRIs, a class of antidepressants, may be prescribed when a TS patient is triggered by symptoms of OCD.

Researchers are also investigating the use of nicotine patches as a treatment. Researchers are seeking a substitute that can target brain disorders in the same way, without the risks. (BBC News)

In February 2004, surgeons in the US successfully carried out a brain surgery in which tiny electrodes, powered by batteries inserted in the chest, were placed beside the thalamus in each cerebral hemisphere. Within half a minute of activating the electrodes, the patient could walk normally and displayed a complete lack of symptoms. This surgery is not a cure; it is regarded as an experimental and dangerous procedure, and is unlikely to become widespread.

In any case, the condition in many individuals improves as they mature. Individuals with TS can expect to live a normal life span. Although TS is generally lifelong and chronic, it is not degenerative. In a few cases, complete remission occurs after adolescence, and in many cases this occurs after the age of 40.

A third to half a lifetime of living with TS generally gives one survival skills to manage the disorder. The great majority of tourettics have learned to cover-up the more socially inappopriate tics.

Cognitive Behavioural Therapy (CBT) can be used to try to disrupt the automatic chain of events underlying the tics. Relaxation techniques and biofeedback may also be useful in relieving the stress that may aggravate tics.

Genetics

Recent research by Doctor Matthew State at Yale University suggests that Tourette Syndrome may be caused by an inversion defect on chromosome 13 of gene SLITRK1. This means that Tourette Syndrome can be inherited or caused by mutation.

Other genetic studies indicate tic disorders, including TS, are inherited as a dominant gene(s) that may produce varying symptoms in different family members. A person with TS has about a 50% chance of passing the gene(s) to one of his/her children. However, the gene(s) may express as TS, as a milder tic disorder, or as obsessive compulsive symptoms with no tics at all. It is known that a higher than usual incidence of milder tic disorders and obsessive compulsive behaviours are more common in the families of TS patients. The sex of the child also influences the expression of the gene(s). The chance that the child of a person with TS will have the disorder is at least three times higher for a son than for a daughter. Yet only a minority of the children who inherit the gene(s) will have symptoms severe enough to ever require medical attention. In some cases, TS may not be inherited; these cases are identified as "sporadic" TS because a genetic link cannot be found.

Alternative medicine

Alternative medicine tends to hold the view that TS is caused by yeast infections and mercury poisoning (see gluten-free, casein-free diet).

Famous People with Tourette's

In fiction

In music

  • The grunge band Nirvana recorded a song on the In Utero album titled "Tourette's"—a song with neither audible nor written lyrics, but only shouting, as if mimicking the Tourette Syndrome.
  • A member of the romanian rap group Parazitii named his album "Sindromul Tourette" - Tourette Syndrome.
  • The song "Symphony of Tourette" by the Manic Street Preachers.

References

External links

Retrieved from "http://en.freepedia.org/Tourette_syndrome.html"


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