What is Tourette syndrome?
Tourette syndrome, or simply Tourette’s, is a complex nerve disorder that causes a person to make sudden, repeated movements or vocal sounds called tics. Tics come and go and most are mild, though some can be severe. They often change in location, type, frequency, and intensity, and are uncontrollable without treatment.
Tics often present for the first time in childhood with symptoms easing as you enter adulthood. There are medications and therapies that can help reduce more severe tics, making it easier to go about your daily tasks and reduce any possible risk of self-harm.
Common symptoms of Tourette’s
The main symptoms of Tourette’s are involuntary tics, which usually begin between the ages of five and 10 and peak in intensity during early adolescence. These rapid body movements or vocalizations (sounds) often become more easily controlled during late adolescence and early adulthood.
Certain factors impact when tics are expressed:
- Tics may improve during periods of calm or focused activity and even go away completely during deep sleep, though tics can occur during light sleep.
- Symptoms may worsen during periods of excitement, illness, stress, fatigue, or anxiety.
- Physical discomfort or hearing sounds that are similar to vocal tics may provoke tic symptoms.
While some people with Tourette syndrome can control tics to a certain extent, tension often builds up to where a tic must be expressed involuntarily.
Understanding different types of tics
Tics are classified based on whether they involve muscles (motor tics) or sounds (vocal tics). They are then further classified into simple or complex tics.
- Simple tics are sudden, quick, repetitive movements in just a few muscles. Simple tics occur more frequently than complex tics and may happen just before a complex tic.
- Complex tics involve several muscle groups that perform distinct, coordinated movement patterns.
Simple motor tics tend to be brief, abrupt, and restricted to a small number of muscles. They are often the first type of tic to emerge and may include:
- Eye blinking
- Eye darting
- Facial grimacing or nose scrunching
- Head or shoulder twitching
- Jaw or mouth movements
- Nose twitching
- Shoulder shrugging
Simple vocal tics are less common than simple motor tics and tend to appear sometime after simple motor tics develop. These sounds may include:
- Barking
- Coughing
- Grunting
- Shouting
- Sniffing
- Throat clearing
These tics typically emerge sometime later in childhood after simple motor tic symptoms have already appeared. They involve coordinated movements of different muscle groups that can last longer and appear more intentional than simple motor tics. They may include:
- Bending
- Gesturing
- Hopping
- Jumping
- Sniffing or touching an object
- Stepping in a certain pattern
- Twisting
Complex vocal tics are the rarest of the tics associated with Tourette’s. They also emerge later than simple tics and can include:
- Repeating words or phrases
- Repeating another person’s words or phrases (echolalia)
- Using vulgar, obscene, or swear words (coprolalia)
Causes of Tourette syndrome
Scientists believe that chemical messengers (neurotransmitters) in the brain, such as dopamine, norepinephrine, and serotonin, don’t communicate properly between nerve cells in people with Tourette’s.
Experts don’t know exactly why this happens. The condition does run in some families, and researchers have found associations between Tourette syndrome and changes (mutations) in specific genes. However, Tourette’s is not always inherited and environmental factors may also play a role. The condition is also more prevalent in people assigned male at birth.
Making a diagnosis of Tourette’s
There’s no specific test for Tourette syndrome and diagnosing the disorder can be challenging because some tics overlap with symptoms of other conditions. For example, sniffling may be a symptom of allergies, and eye blinking may result from an eye or vision problem.
To pinpoint a Tourette’s diagnosis, your care team will look for the presence of both motor and vocal tics and tic symptoms that began before the age of 18. They’ll also look for tics that happen multiple times a day every day, or on and off for more than a year.
To confirm a diagnosis, they may investigate other explanations for the tics, like medications, substances, or other conditions. Blood tests and certain imaging studies can rule out other causes of symptoms that mimic Tourette syndrome.
Tourette syndrome treatment
There is no cure for Tourette syndrome, but treatments may help control tics. Mild tics may not require treatment, while more severe tics or tics that cause accidental self-harm may need to be controlled with medication.
Medications can help manage tics or reduce symptoms of other conditions that often occur with Tourette’s. Medications may include:
- Alpha-adrenergic blockers (clonidine or guanfacine): These first-line treatments for tics inhibit the release of noradrenaline. This hormone helps send messages from nerve-to-nerve and nerve-to-muscle.
- Botulinum toxin: These injections are inserted into a muscle to weaken or paralyze it temporarily. This treatment may relieve simple or vocal tics.
- Fluphenazine: This medication works to control tics by blocking or lessening the effects of dopamine in the brain to change mood, thinking, or behavior.
- Haloperidol: This medication helps to control motor and verbal tics by blocking the activity of dopamine in the brain.
- Pimozide: This medication controls severe motor or verbal tics by blocking the activity of dopamine.
- Risperidone: This medication helps rebalance levels of dopamine and serotonin. This reduces the uncontrollable urges to move or vocalize in Tourette syndrome.
- Tetrabenazine: This medication decreases the dopamine stored in the brain to reduce unwanted motor and verbal tics.
- Topiramate: This anti-seizure medication helps manage symptoms in some people with Tourette’s.
Your doctor may also prescribe medication to help manage symptoms of other behavioral or mental conditions that may occur with Tourette syndrome, such as:
A procedure called deep brain stimulation (DBS) involves the surgical placement of a medical device in the chest (similar to a pacemaker) that sends an electrical impulse through wires to specific areas of the brain that are responsible for the tics. These electrical signals can help to block the abnormal brain signals causing tics.
DBS may help reduce severe tics that are not controlled with medications or behavioral therapy. Researchers are studying DBS as a treatment for people with Tourette syndrome and people who have Tourette’s and obsessive-compulsive disorder.
People living with Tourette’s may benefit from a combination of medication and specific therapies to help control tics.
Comprehensive behavioral intervention for tics (CBIT) is a form of psychotherapy that teaches you ways to monitor tics and identify the beginnings of an urge for a tic. You then learn to do voluntary movements that compete with the tic to prevent the tic from happening. CBIT also teaches stress reduction techniques and ways to reduce tic triggers, such as stress or anxiety.
Expert care and advanced treatments for Tourette’s
As the leading movement disorders center across Pennsylvania and New Jersey, Penn Medicine has decades of experience caring for adults with Tourette syndrome. Our involvement in research and clinical trials puts us at the leading edge of Tourette's treatment, enabling us to offer a wide range of the latest, most effective therapies. Our care teams work closely with you to understand your specific symptoms and needs and create a treatment plan that brings you the most relief while helping you perform daily tasks with confidence.
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