Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition in an 86-year-old French noble woman. The early symptoms are noticed first in childhood, with the average onset between the ages of 3 and 9 years.
It occurs in people from all ethnic groups; males are affected about three to four times more often than females. It is estimated that 200,000 Americans have the most severe form of TS, and as many as one in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics.
Tics are classified as either simple or complex.
Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. Some of the more common simple tics include eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds.
Complex tics are distinct, coordinated patterns of movements involving several muscle groups. It includes facial grimacing combined with a head twist and a shoulder shrug, sniffing or touching objects, hopping, jumping, bending, or twisting.
Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics, for example tight collars may trigger neck ties, or hearing another person sniff or throat-clear may trigger similar sounds. Tics do not go away during sleep but are often significantly diminished.
How is TS treated?
Tourette syndrome requires no medication for tic suppression. However, effective medications are available for those whose symptoms interfere with functioning.
Neuroleptics (drugs that may be used to treat psychotic and non-psychotic disorders) (for example, haloperidol and pimozide).
The most common side effects of neuroleptics include sedation, weight gain, and cognitive dulling.
Neurological side effects such as tremor, dystonic reactions (twisting movements or postures), parkinsonian-like symptoms, and other dyskinetic (involuntary) movements are less common and are readily managed with dose reduction.
Medications with demonstrated efficacy include alpha-adrenergic agonists such as clonidine and guanfacine.
Recent research shows that stimulant medications such as methylphenidate and dextroamphetamine can lessen ADHD symptoms in people with TS without causing tics to become more severe
Behavioral treatments such as awareness training and competing response training can also be used to reduce tics.
A recent NIH-funded, multi-center randomized control trial called Cognitive Behavioral Intervention for Tics, or CBIT, showed that training to voluntarily move in response to a premonitory urge can reduce tic symptoms.
Other behavioral therapies, such as biofeedback or supportive therapy, have not been shown to reduce tic symptoms. However, supportive therapy can help a person with TS better cope with the disorder and deal with the secondary social and emotional problems that sometimes occur.