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.

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).

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.

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.