Tourette Syndrome



Gilles de la Tourette (ZHEEL de la too-RETT) syndrome is a neurological disorder that causes a person to make sudden movements or sounds, which are called tics. Many scientists think Tourette syndrome is caused by a chemical imbalance in the brain.

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Attention Deficit Hyperactivity Disorder

Neurological Disorders

Tics

Daniel's Story

When Daniel yelped out loud like a dog, and his classmates erupted with laughter, Ms. Jones sent him to the school office. The teacher knew Daniel was being treated for hyperactivity, but recently he had been blinking his eyes, twitching his nose, and shuffling his feet. Ms. Jones decided she could no longer tolerate his interruptions. She also was concerned about Daniel. Was he just showing off, or could he have a more serious condition? She had read about a condition called Tourette syndrome that involved strange movements and sounds. Was that Daniel's problem?

What Is Tourette Syndrome?

Gilles de la Tourette syndrome is named for the French physician Georges G.A.B. Gilles de la Tourette (1857-1904) who first described the disorder in 1885. It is sometimes referred to as Tourette syndrome and abbreviated TS. The symptoms are tics: abrupt, rapid, and repeated movements or vocal sounds. Researchers have identified more than 80 tics, including grunts, barks, babbling, eye movements, head or neck motions, throat clearing, grimaces, shrugging, sniffing, leg and mouth motions, and motions of the torso.

Tics are categorized as either simple or complex. Simple motor tics include twitching of an eye or a jerking movement of the arm. Simple vocal tics include grunts, barks, or other noises. Complex tics involve several coordinated muscle movements, including twirling or doing deep knee bends when walking. Complex vocal tics include stuttering, babbling, uttering profanities, or echoing sounds. Among the more common tics in Tourette syndrome:

  • Echolalia (eh-koh-LAY-lee-uh): echoing other people's words.
  • Palilalia (pal-ee-LAY-lee-uh): repeating one's own last words, sounds, or sentences.
  • Coprolalia (ko-pro-LAY-ee-uh): "babbling about feces" and refers to people with TS who use explicit and obscene language or sounds.
  • Echopraxia (eh-koh-PRAK-see-uh): imitating other people's movements.
  • Copropraxia (ko-pro-PRAK-see-uh): making obscene and socially unacceptable gestures.

People with more severe tics may mutilate themselves by biting their lips or banging their heads. Others may exhibit obsessive-compulsive behavior such as excessive hand washing. In addition to tics, a person with Tourette syndrome may show signs of hyperactivity, poor coordination, or attention deficit hyperactivity disorder (ADHD).

Literary Giant:
Samuel Johnson

Samuel Johnson (1709—1784) is a towering figure in English literature. He wrote essays, poetry and, in 1755, the monumental Dictionary of the English Language. Dr. Johnson's friends recognized that he was a brilliant writer. They also thought he was quite eccentric.

Johnson was always in motion, rocking or swerving. He twitched and grunted and blew out his breath like a whale. His friends noticed he had obsessive-compulsive behaviors. For example, when he walked outside he maneuvered so that he never walked on cracks in the paving stones, and he touched every post he passed. If he missed a post, he would go back to touch it. He also would scrape his fingernails and joints with a knife until they were raw.

When Samuel Johnson died in 1784, a physician examined his brain, looking for evidence of disease. He found none. Based on the observations and letters of his friends, most modern scholars believe Dr. Johnson had Tourette syndrome.

People with TS can sometimes control their tics for minutes but, like a suppressed sneeze, the tic returns sooner or later. Tics get worse when a person is tired or anxious; they get better when a person is focused and concentrating on something. Severe tics can be more pronounced around family and close friends and better in the presence of strangers. Tics are less pronounced in the morning, worse at night, and, generally, not evident when a person is sleeping.

The disorder usually begins in childhood. Symptoms appear around age 7, and 90 percent of cases develop before age 10. Boys are four times more likely to develop TS than girls. About 1 person in 2,000 has Tourette syndrome.

At least 25 percent of all children display a simple tic. However, these tics go away within a year and are not a sign of TS. A person with Tourette syndrome may have tics for a lifetime, though the frequency and type of tic may change. About 35 percent of people with TS experience an easing of symptoms in adolescence; most others find that, even if they do not disappear, tics become less frequent and less severe in adulthood. The reverse can also be true: Some people with mild symptoms develop severe tics in their twenties or early thirties.

Home Run Hitter:
Jim Eisenreich

Jim Eisenreich was different from other children. His body was constantly in motion, but not in the same way as other active children. His head twitched from side to side, and his shoulders jerked and shrugged. He often grunted, suddenly, for no apparent reason. His classmates laughed at his odd behavior. Doctors said Eisenreich was hyperactive and nervous and would outgrow the behavior. He did not.

Because he was embarrassed by his behavior, Eisenreich kept to himself and concentrated on something he excelled at: baseball. He was a terrific baseball player and, in 1982, he won a spot on the Minnesota Twins.

Baseball in the big leagues was competitive and stressful. Much to his embarrassment, Eisenreich began to experience tics on the field in front of thousands of fans. His neck and shoulders twitched. His face twitched. One day, deeply embarrassed, Eisenreich walked off the field.

Eisenreich retired from baseball for four years. During those years, he sought medical help and discovered the reason for the tics: He had Tourette syndrome. Medication helped ease the tics, and counseling helped Eisenreich accept himself.

Eisenreich returned to baseball and became a star hitter and out-fielder for the Philadelphia Phillies. In the second game of the 1993 World Series, he smacked a three-run home run that helped Philadelphia beat the Toronto Blue Jays. Eisenreich had returned to baseball with a new outlook on life and on a condition known as TS.

People with Tourette syndrome may suffer social embarrassment or emotional stress because of their tics. The disorder does not affect their intelligence or ability to lead a full life.

What Causes Tourette Syndrome?

In the Middle Ages, people who displayed movement and vocal tics were thought to be possessed by demons. Gilles de la Tourette, the French physician who studied the disorder in the 1800s, thought TS had a physiological basis, which means that its cause was physical, not mental. Modern scientists think Gilles de la Tourette was right.

Scientists believe TS is caused by an abnormality in the brain's neurotransmitters, which are chemicals that carry signals from one nerve cell to another. One of the affected neurotransmitters is dopamine, a chemical that controls movement. Research indicates that some forms of TS are inherited, which means they are passed down from parent to child.

How Do Doctors Treat Tourette Syndrome?

An accurate and prompt diagnosis is important to a person with Tourette syndrome, especially if the symptoms surface during childhood. People with TS often are misunderstood or ridiculed, and children may be punished for behavior that is out of their control.

Most people with Tourette syndrome do not need medication. For those with severe tics, medication can reduce the frequency and severity of their symptoms so they can function at school, at work, and in social settings.

Resources

Books

Fowler, Rick. The Unwelcome Companion: An Insider's View of Tourette Syndrome. Cashiers, NC: Silver Run Publications, 1996. A review of symptoms, causes, and treatments.

Rubio, Gwyn Hyman. Icy Sparks. New York: Viking, 1998. A novel about a 10-year-old girl who tries to conceal her tics and the unhappiness they cause her.

Organizations

U.S. National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD 20892. NINDS is a division of the National Institutes of Health. It posts a fact sheet about Tourette syndrome at its website.
http://www.ninds.gov/patients/Disorder/tourette/tourette.htm

Tourette Syndrome Association, Inc., 42-40 Bell Boulevard, Suite 205, Bayside, NY 11361. A national organization providing medical information and support.
Telephone 800-237-0717
http://tsa.mgh.harvard.edu

See also
Attention Deficit Hyperactivity Disorder
Obsessive-Compulsive Disorder

Also read article about Tourette Syndrome from Wikipedia

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