Definition

Tourette syndrome (TS) is a condition characterized by involuntary repetitive movements and sounds, known as tics, that cannot be controlled. Individuals with Tourette syndrome may experience episodes of eye blinking, repeated shoulder movements, or the utterance of sounds and/or words that are not socially acceptable. These manifestations cannot be controlled by the individual and are typically preceded by an uncomfortable sensation that compels them to perform these actions.

Tics typically appear between the ages of 2 and 15, with the average onset occurring at age 6. Males are 3-4 times more likely to experience Tourette Syndrome than females.

Although there is no cure for Tourette Syndrome, several management options to control symptoms are available. Tics may diminish or become more manageable as individuals grow older.

Causes

The exact cause of Tourette Syndrome is still uncertain. Tourette Syndrome is believed to result from a combination of genetic and environmental factors. Brain chemicals, such as dopamine and serotonin, are thought to play a role in the development of Tourette Syndrome.

Risk factor

Risk factors for Tourette Syndrome include:

• Family history. Having a family member with Tourette Syndrome or other tic disorders increases the risk of developing Tourette Syndrome.
• Gender. Males have a 3-4 times higher risk of developing Tourette Syndrome compared to females.
• Pregnancy history. Smoking during pregnancy, infections, low birth weight, and complications during pregnancy can increase the risk of Tourette Syndrome.

Symptoms

Tics are sudden, brief, and uncontrollable movements or sounds. Tics are an initial symptom of Tourette Syndrome, but not all tics are indicative of Tourette syndrome. Tics can range from mild to severe. Severe tics can disrupt communication, daily functioning, and quality of life.

 Tics can be classified as:

•  Simple tics, involving repetitive movements of a small group of muscles.
• Complex tics, involving coordinated patterns of movement that affect several large muscle groups.

Tics can also be divided into vocal tics and motor tics. Motor tics generally precede vocal tics.

Common simple motor tics in Tourette Syndrome include eye blinking, head movements, shoulder shrugging, nose twitching, and tongue clicking. Common complex motor tics in Tourette Syndrome include touching and smelling objects, repeating movements, walking in patterns, jumping, or bending.

Tics in Tourette Syndrome also encompass vocal tics. Simple vocal tics in Tourette Syndrome include grunting, coughing, throat clearing, or barking. Complex vocal tics involve repeating words or phrases or using profanity.

The occurrence of tics can vary depending on type, frequency, and severity. Triggers such as stress, anxiety, fatigue, sleep disturbances, changing patterns over time, and worsening during the transition from childhood to adolescence can occur.

Before experiencing tics, individuals with tics typically feel an uncomfortable sensation that compels them to perform certain movements. This is called a premonitory urge. This sensation can be discomfort, itching, or specific tension. By performing the mentioned tics, individuals with tics feel more comfortable. With specific training, someone with Tourette Syndrome can learn to resist this discomfort and stop the tics.

Diagnosis

To establish a diagnosis, a doctor needs to conduct an examination and ensure that the child meets the criteria based on DSM-5 below:

 Having two or more motor tics (for example, eye blinking or shoulder movements) and at least one vocal tic (for example, humming, throat clearing, and saying specific words), even though they do not occur simultaneously.

• Having tics for more than one year. Tics can occur several times a day.
• The onset of tics before age 18.
• Not currently taking certain medications or having other medical conditions (such as seizures, Huntington's disease, encephalitis).

Tourette Syndrome cannot be diagnosed through laboratory tests, blood tests, or brain imaging. Tests such as MRI, CT scans, and electroencephalograms (EEGs) can only rule out other causes with symptoms similar to Tourette Syndrome.

Management

Because tic symptoms are generally mild and do not cause impairment, some individuals with Tourette Syndrome do not require specific treatment. However, there are several medications and therapies available to alleviate symptoms if there is impairment in daily life.

Other therapy options include:

• Behavioral therapy, which involves exercises to ignore tics. During these sessions, your child will be trained to ignore the urge to perform tics.
• Psychotherapy can help individuals with Tourette Syndrome live with the condition, including other conditions such as ADHD, depression, anxiety, and OCD.
• Deep brain stimulation (DBS) is indicated for tics that do not respond to other treatments. However, DBS therapy options are still in development.

If your child has tourette syndrome

Having a child with Tourette Syndrome can be a challenge. You can do the following to learn more about Tourette Syndrome:

•  Discuss your condition and your child's condition with your doctor.
• Find accurate information about Tourette Syndrome.
• Ask your doctor about other conditions that may occur concurrently with Tourette Syndrome (such as ADHD, anxiety, OCD).
• Join a parent group with children with Tourette Syndrome.
• Work with your child's school. Tourette Syndrome can affect your child's learning experience at school. Therefore, good communication between you and the school can help provide a better experience for your child.
• Children with Tourette Syndrome may experience bullying. Discuss this possibility with your child's school.
• Tics may improve with age.
• Help your child remain confident.

Complications

Children or adults with Tourette Syndrome can generally live healthy and active lives. However, in more severe cases, Tourette Syndrome can affect behavior and pose challenges in social life. Uncontrolled Tourette Syndrome can also affect your self-confidence.

 Conditions often associated with Tourette Syndrome include:

•  Attention-deficit/hyperactivity disorder (ADHD)
• Obsessive-compulsive disorder (OCD)
• Autism spectrum disorder
• Learning disorders
• Sleep disorders
• Depression
• Anxiety disorders
• Pain related to tics, such as headaches
• Disturbed emotional management

Prevention

Tourette Syndrome cannot be prevented, but you can reduce the risk of your child developing Tourette Syndrome. By avoiding smoking during pregnancy and regularly attending prenatal check-ups with your doctor, you can reduce the risk of Tourette Syndrome.

When to see a doctor?

If you observe your child engaging in unusual repetitive movements or making specific sounds, have this condition checked at the nearest healthcare facility. Not all tics are Tourette Syndrome. Many children with tics recover spontaneously within a few weeks or months. If your child exhibits anything unusual, it is important to promptly take them to the nearest healthcare facility for further examination.