Tourette Syndrome
Definition

Gilles de la Tourette syndrome (Tourette Syndrome or TS) is a neurological disorder characterized by involuntary, repetitive, purposeless vocal sounds or muscular jerks called tics. Symptoms of TS often become evident in early childhood or adolescence and usually begin with tics involving the face, arms, limbs or trunk. A facial tic, such as an eye blink, nose twitch, or grimace, is the most common first symptom. Over time, symptoms may occur more frequently and begin to engage additional body parts such as the torso or legs. As tics occur more frequently, they often become progressively more disruptive to activities of daily living.

Symptoms

Tics can be classified into one of two categories: motor tics (movements) or vocal tics (vocalizations). Both motor and vocal tics can be simple or complex in nature. A simple tic involves a limited number of muscle groups (motor) or sounds (vocal) and is sudden, brief, and repetitive in nature. Eye blinking and eye movements, facial grimacing, shoulder shrugging, and head/shoulder jerking are common simple motor tics. Common simple vocalizations include: repetitive throat-clearing, sniffing, coughing, grunting or barking.

Complex tics are distinct patterns that involve several muscle groups (motor) or entire words or phrases (vocal). A head twist combined with a facial grimace would be considered a complex motor tic. Other complex motor tics may appear more intentional in nature, for example, sniffing or touching objects, spitting, or stomping. Complex vocal tics include whole words or phrases. While widely publicized, Coprolalia (uttering socially inappropriate words such as swearing), is estimated to be present only in 10 to 15 percent of individuals with TS. Echoing words, phrases, or movements is also reported, albeit fairly infrequently.

Many people describe an urge or sensation prior to the tic(s). This urge is referred to as the premonitory urge.

Tics may wax and wane over time but are often worse in anxious or exciting situations. Sensory stimuli, such as tight collars, hearing another person sniff or throat-clear, may also trigger or worsen tics.

Prevalence

It is estimated that the majority of individuals with TS in the Untied States, as many as 1 in 100, exhibit milder and less complex symptoms and approximately 200,000 Americans have the most severe form of TS. Males are affected three to four times more often than females, however, TS affects individuals from all ethnic groups.

Many individuals with TS report their tic symptoms as more prominent in their early teens, followed by improvement in the late teens and adulthood.

Treatment

Although there are medications available which may help reduce the severity of TS symptoms, these medications are sometimes associated with negative side effects. In treating TS, we use a type of Behavioral Therapy called Comprehensive Behavioral Intervention for Tics (CBIT). CBIT is based on Habit Reversal Therapy techniques with an emphasis on increasing an individual’s awareness as well as incorporating strategies to manage symptoms. Scientific research has shown individuals treated using CBIT achieve success rates comparable to those taking standard medications without the safety concerns and negative side effects sometimes associated with medication.