Tourette syndrome is a multifaceted neurological disorder characterized by tics. Tics are involuntary repetitive movements or sounds that cannot be controlled. Tics are like hiccups. Even if we don’t want to hiccup, the body does it anyway. Sometimes people can control tics, but it is hard to do so.
Types of tics
Tics are sudden movements or sounds that occur repeatedly. Movements of body parts are called motor tics, whereas the production of sounds is called vocal tics.
1. Motor tics
- Movements like blinking eyes, shrugging shoulders, and nose twitching are simple motor tics.
- Complex motor tics activate multiple groups of muscles which appear like purposeful movements. These could be chewing, hopping, touching, and jumping.
2. Vocal tics
- Simple vocal tics include throat clearing, sniffing, coughing, gulping, or animal noises.
- Complex vocal tics include the production of words or sentences involuntarily. Repetition of other actions or words is known as the Echo phenomenon and is often seen in people with complex vocal tics. Making these obscene gestures or swearing is known as the copro phenomenon. Though often publicised, it is seen in less than 30 per cent of patients.
Tics typically, wax and wane and become prominent during periods of emotional excitement or fatigue.
Symptoms of Tourette syndrome
The most common symptom of Tourette syndrome is tics. There are multiple motor tics and at least one vocal tic in Tourette syndrome. This usually appears before 18 years of age, kids between 5 and 10 years are the most vulnerable. These tics occur many times a day, nearly every day, for more than one year. They may decrease during adolescence or adulthood in most cases. In Tourette syndrome, it may become worse during adulthood.
Diagnosing Tourette syndrome
There is no lab or imaging modality to diagnose Tourette syndrome and the diagnosis is made clinically. The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) criteria are used to diagnose Tourette syndrome. Secondary causes of the tic disorder could be the result of the consumption of drugs (amphetamine, cocaine, etc), any neurodevelopmental disorders (Down syndrome, Autistic spectrum disorders), brain lesions (trauma, encephalitis), or toxins (carbon monoxide).
Tourette syndrome can coexist with the following 4 conditions:
- Attention deficit hyperactivity disorder (ADHD) occurs in 60 per cent of patients with Tourette syndrome. Symptoms include distractibility, inattentiveness, and hyperactivity.
- Obsessive-compulsive disorder (OCD) occurs in 20 per cent of patients with Tourette syndrome. They are characterized by recurrent obsessions and compulsions like checking, counting, washing, and forced touching.
- Mood disorders like depression are seen in 10 per cent of patients.
- Other psychiatric disorders linked to Tourette syndrome are self-injurious behaviour and anxiety.
Read the risk factors of Tourette syndrome
- Those with a family history of Tourette syndrome, are at greater risk of developing it.
- Males are about three to four times more likely to develop it.
Here are the treatment options available:
- Medications like dopamine antagonists (Pimozide, haloperidol), stimulants (methylphenidate, dextroamphetamine) to increase attention and concentration, and antidepressants.
- Behavioural therapy like cognitive behavioural therapy helps in identifying urges and learning to voluntarily move in a way incompatible with the tic.
- Psychotherapy can help cope with ADHD and depression.
- Deep brain stimulation can be used in severe cases.