What is Tourette syndrome ?
Tourette syndrome (TS) is a neuropsychiatric disorder that manifests itself in so-called tics. Tics are spontaneous movements, sounds, or expressions of words which are produced without the will of the person concerned. This is comparable with sneezing or a hiccup. Tics in the Tourette syndrome can only be controlled to a limited extent.
People with Tourette’s syndrome can cause some irritation in their environment. Depending on how frequent and violent these tics are, they significantly limit the quality of life of those affected.
Tourette syndrome in children
Tourette syndrome is not a mental disorder but a neuropsychiatric disorder. The filter functions of the motor control fail. Tourette usually begins in childhood, but rarely also in youth. Younger children often make a phase with tics, which disappear by themselves after a few months.
By definition it is Tourette, if several motoric tics (movements) occur together with at least one vocal tic (loud utterances) and they last for at least one year.
The symptoms improve after puberty or even disappear completely in most patients. Others accompany the tics through the whole life. Boys are affected four times as often as girls. The reasons for this are unknown so far.
For the first time, French physician Gille de la Tourette described the disease in 1885. He is the author of the “Gilles de la Tourette Syndrome”.
Experts estimate that about one percent of people develop Tourette syndrome. However, only a small part is so severely affected with this disease that requires treatment.
Tourette’s Syndrome symptoms
A Tourette syndrome is expressed as tics. This can be involuntary movements or sound utterances. The tic term comes from French and means “twitching”. One differentiates motor and vocal tics as well as simple and complex tics.
Simple motor tics are, for example, winking, shoulder twitching or closing eyes fastly.
Complex motor tics are the touching of objects or people, body twists or limbs twitching. Obscene gestures can also occur (copropraxia). Sometimes it comes to self-harming actions – those affected hit their head against the wall, pinching themselves or stabbing themselves with a pen.
Simple vocal tics express themselves, for example, in sounds such as clearing, squealing, grunting, sniffing or snapping with the tongue.
Complex vocal tics are words or sentences that are thrown out and are not logically related to the situation. Frequently, these are obscenities or abuse (coprolalia).
The range of tics is huge and individually quite different. They change over time and new symptoms can be added. Some patients are even “inspired” by other Tourette patients – after a meeting, they take over their tics.
The tics also do not disappear during sleep and occur in all sleep stages. However, they are then weakened. As a rule, the patient has forgotten the occurrence of tics the next morning.
Changeable disease pattern
A Tourette syndrome usually begins in childhood with simple motor tics, which can gradually increase. Later, loud statements can be added. The tics often occur in series. Some sufferers only have tics from time to time- others are constantly forced to long time.
Tics can be suppressed for a certain time, but then come more violently to the outbreak. Many people can manage themselves during work or at school. Let your tics run free at home. Others have virtually no control over the symptoms.
The tics occur several times a day, usually on a daily basis. This happens either almost every day, or they disappear for some time and then gradually emerge again.
In case of emotional excitement such as pleasure, anger or anxiety, the symptoms intensify. The same applies to stress. If patients are heavily focused on one thing, the tics decrease.
Signs of tics
Sometimes the tics announce themselves by sensomotoric signs, for example tingling or tension feelings. These unpleasant sensations disappear when the tic is performed. As a rule, however, those affected also notice the Tic with his appearance.
Approximately 90 percent of all patients with Tourette syndrome develop further disturbance images. This includes:
- Attention Deficit Hyperactivity Disorder (ADHD)
- Obsessive-compulsive disorder
- Sleep disorders
- Anxiety disorders
- Social phobias
Tourette syndrome causes and risk factors
It is assumed that Tourette cases are largely genetically predisposed. Thus, the Tourette risk for children whose parents have the syndrome is ten to a hundred times higher than for children without Tourette’s syndrome in kinship.
For this to develop, additional triggers have to be added to the environment, for example pregnancy and birth complications.
Disturbed messenger metabolism
It is known that in the Tourette syndrome the messenger metabolism in the brain is disturbed. In particular the neurotransmitter dopamine plays a crucial role. Dopamine is important in the brain for relaying information.
Studies have shown that the number of dopamine receptors in the brain of patients with Tourette’s syndrome is increased. But a disturbed serotonin, norepinephrine, glutamine and opioid metabolism as well as the interactions between these substances seem to play a role.
The disturbances manifest themselves mainly in the basal ganglia. These brain areas are located in the deeper structures of both brain halves and fulfill a kind of filter function. They regulate which impulses a person translates into and does not.
Bacteria as a trigger
In rare cases, an infection with streptococci of group A is suspected of causing a Tourette syndrome to flare up. This includes scarlet fever. The antibodies that the patient develops against the bacteria can migrate into the brain and attack the basal ganglia.
How is Tourette syndrome diagnosed?
Tourette’s syndrome is often diagnosed only years after the onset of the first symptoms. As the disease causes misunderstandings and annoys people, this is problematic.
Some people with Tourette can control their tics for hours so that the doctor can not examine them themselves. Therefore, the diagnosis of Tourette syndrome is often based on the observation and description of tics. Younger children often do not even notice them.
Important questions are:
- How do the tics express themselves?
- Where, how often and how strongly do they occur?
- Does stress have an exerting influence on Tourette’s syndrome?
- Can the symptoms be suppressed?
- Are they announcing a kind of premonition?
- At what age did the tics appear for the first time?
- Are the symptoms of type, strength and frequency changing?
- Were there cases of Tourette syndrome within the family?
For the diagnosis Tourette syndrome, tics must have existed for at least one year and have manifested themselves before 18 years of age. Different forms of tic must have appeared, including several motorized and at least one vocal tic.
There are so far no laboratory tests or neurological and psychiatric examinations for Tourette syndrome. Mostly, diagnosis can be done with the help of parents or patients. Therefore, investigations primarily serve to exclude other causes of tics or tic-like symptoms.
This can be:
- Side effects of drugs (such as neuroleptics)
- Brain tumors
- Inflammation of the brain (encephalitis)
- Chorea (various malfunction of the basal ganglia, which manifest themselves in involuntary movements)
- Ballism (neurological disease, in which the patients perform abruptly spasmodic movements)
- Myoclonus (involuntary, sudden short muscle twitches of different origin)
- streptococcal infections
- An electroencephalogram (EEG) and a blood test with which streptococcal infections help in the diagnosis
How to treat Tourette’s syndrome?
A Tourette syndrome is currently not curable. Existing therapies may improve the symptoms but have no effect on the course of the disease. Nevertheless, there are a whole range of offers that make life easier with a Tourette syndrome.
At the beginning of the therapy always a psychoeducative consultation. In this context, the patients are thoroughly informed about the disease, which is already relieved by many people.
Moderate discomfort helps in many cases, a behavioral therapy, in order to get the Tics better to handle. In severe cases, medicines can help. A wide range of active ingredients are available – but they often have serious side effects.
These range from fatigue, dizziness and weight gain to a disturbed sexual function. Even with drugs, the tics do not disappear completely. Relaistic is a reduction of up to 50 percent.
It is also important to treat concomitant diseases, such as ADHD, obsessive-compulsive disorder and sleep disorders, in addition to the Tourette syndrome.
Tourette’s syndrome Prognosis
A Tourette syndrome manifests itself in childhood and adolescence – usually between the fourth and eighth year of life. As a rule, the disease starts with simple motor tics, later vocal tics are added and the symptoms become more complex.
For most of the affected people, the tics are constantly changing. In addition, poorer phases alternate with lighter ones. For the majority of patients the time between the eighth and twelfth year of life is particularly difficult.
In general, the forecast is favorable. In two-thirds of the children, the symptoms improve over time or even disappear completely.
For the remaining third, however, the forecast is less favorable. In some of them the symptoms become even more pronounced in the adult age. The loss of quality of life is especially great with them.
Living with Tourette’s syndrome
For the environment, the behaviour of people with Tourette syndrome is difficult to understand and often disturbing. Many people find it difficult to accept that those affected are largely extradited to their tics. They react in a hostile and aggressive manner, especially on insults or obscene gestures. This is of course especially true if the patients are among strangers.
Positive aspects of Tourette’s syndrome
People with Tourette’s syndrome are less controlled than others. This can also have advantages. For example, they are often very quick to react. This is a great advantage in many sports. A large part of the Tourette godfathers also suffers from an attention deficit disorder (ADS). These people are particularly creative. Thoughts flow less controlled, which can lead to the emergence of new and unusual ideas.