Tourette Syndrome

Tourette syndrome is a neurological disorder that causes people to make unintended sounds, words and body movements, called tics. Both motor and vocal tics are generally repetitive, rapid and frequent. Tics occur suddenly, may last from several seconds to minutes, and have no meaning for the person. Tics need to be present for at least one year before the diagnosis of Tourette syndrome can be confirmed.

Patients with Tourette's can sometimes suppress tics for a short while; however, most often, the person will eventually need to allow the tic to occur. Tics can be absent at certain times, such as during a particular class at school or a visit to a doctor, or at other times may last longer and be more severe, such as after trying to suppress them or when under stress. Tics may come and go over months, change from one tic to another, or disappear for no apparent reason.

Most people with Tourette syndrome have their own unique type and pattern of tics. Many people with Tourette syndrome have episodes of tics that interfere with their daily activities.

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Symptoms

The first signs of Tourette syndrome usually occur in children between the ages of 7 and 10, but they can begin as early as 2 years or as late as 18. Tics that begin after age 18 are not considered symptoms of Tourette syndrome.

About one-third of children with Tourette syndrome have no tics by the time they reach early adulthood, one-third have fewer and milder tics by the time they become adults, and one-third continue to have severe tics into adulthood.

Some symptoms of Tourette syndrome include:

  • Eye blinking
  • Nose twitching
  • Grimacing
  • Head jerking
  • Shoulder shrugging
  • Arm flapping
  • Touching things or people
  • Kicking
  • Stomping
  • Hopping
  • Humming
  • Grunting
  • Throat clearing
  • Barking
  • Shouting a word or phrase
  • Repeating other people’s words (echolalia)
  • Combinations of movements and sounds

While some people with Tourette syndrome may call out obscene or inappropriate words or phrases (coprolalia) or perform obscene gestures (copropraxia), these are rather uncommon behaviors despite their frequent association with the disorder.

The uncontrollable motor and vocal tics can be classified as simple or complex: Simple motor tics involve only one muscle group. Complex ones can be a combination of many simple motor tics or a series of movements that involve more than one muscle group.

In addition to the motor and vocal tics, people with Tourette syndrome may exhibit other symptoms, including:

  • Learning difficulties
  • Concentration problems
  • Behavioral issues, such as aggressive, hostile, irritable and immature behavior
  • Attention deficit hyperactivity disorder (ADHD)
  • Obsessive-compulsive disorder (OCD)
  • Self-harming on purpose
  • Anxiety or emotional stress
  • Sleep problems, including trouble falling asleep, restlessness during sleep, talking during sleep, sleepwalking or nightmares

The effect Tourette syndrome has on a child’s life varies. Having tics does not affect a child’s intelligence, but the condition may interfere with learning. Some tics may lead to discomfort in social situations.


Causes and Risk Factors

Most people with Tourette syndrome are believed to have a gene that makes them more likely to develop the condition, which is more common in boys. Another theory is that disruption of certain chemicals in the brain responsible for sending nerve impulses may be a factor. A person’s emotional and physical health or external stress may also contribute to the development of Tourette syndrome.

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Diagnosis

Diagnosis of Tourette syndrome is based on the patient's medical history and the presence of tics. Diagnosis often requires keeping records of the child's symptoms and school performance over a period of time.

For a diagnosis of Tourette syndrome, the following must be present:

  • Tics beginning before age 18
  • Body movements (motor tics) and sounds or words (vocal tics) are both present (though not always at the same time) and have lasted for at least one year
  • Tics occur many times a day, usually in bouts, nearly every day
  • The person has no more than a three-month period of time without tics

Tourette syndrome can be difficult to diagnose because symptoms that look like tics can be caused by other related disorders. Tests to check for other conditions include an electroencephalogram (EEG) or computed tomography (CT) scan of the head to see if a person may have seizures or other brain problems. Doctors also may order blood tests to check for other conditions, including overuse of certain medications, such as amphetamines, or rare medical conditions.

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Treatments

There is no known cure for Tourette syndrome. The treatment goal is to help control tics so that the patient will not be hindered in everyday life. Treatment plans should be coordinated by experienced teams of professionals, such as those in Cedars-Sinai's Department of Neurology.

Behavioral management techniques practiced at home, professional counseling, relaxation therapy, biofeedback, hypnosis and some medications can be effective in treating the symptoms of Tourette syndrome.

Brain surgery and deep brain stimulation (DBS) currently are being studied as possible treatments for tics.

Tics generally lessen as a child ages. Most people with Tourette syndrome will live productive personal and professional lives.

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