PARENT GUIDE
OVERVIEW
Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition in an 86-year-old French noblewoman. The early symptoms of TS are typically noticed first in childhood, with the average onset between the ages of 3 and 9 years. TS occurs in people from all ethnic groups; males are affected about three to four times more often than females.
Tourette Syndrome
By
Petty Regina
Espinosa Idalmis
Lashmann Oluseye
Onuora Vivien
SIGNS AND SYMPTOMS
Signs and Symptoms of Tics
Simple motor tics: repetitive rapid contraction of the muscle such as
· Eye blinking, head/neck jerking or head shaking
· Mouth/facial-grimacing, shoulder-shrugging
Complex motor tics appear to be more purposeful and ritualistic than simple tics. It includes:
· Grooming behaviors, smelling of objects
· Jumping, touching behaviors
· Echopraxia (imitating of observed behavior)
· Copropraxia (display of obscene gestures)
Simple vocal tics includes
· Throat clearing Coughing
· Grunting Sniffing
· Snorting Barking
Complex vocal tics includes:
• Repeating words or phrases out of context
• Coprolalia (shouting or use of obscene words or phrases)
• Palilalia (repeating his or her own words)
• Echolalia (repetition of the last heard words of others).
· Coprolalia (shouting or use of obscene words or phrases)
· Palilalia (repeating his or her own words)
· Echolalia (repetition of the last heard words of others)
Severe tic disorder is also known as Tourette disorder includes multiple motor tics, coprolalia, and echolalia. The initial tics are in the face and neck, over time it progresses to arm and hands, the body and lower extremities, and the respiratory, and alimentary system. It includes:
Tinsley Jesselin
OVERVIEW OF TOURETTE SYNDROME INCLUDING SIGNS AND SYMPTOMS, AND MANAGEMENT.
PATHOPHYSIOLOGY
Tourette syndrome (TS) is a neuropsychiatric disorder with the onset in childhood. TS affects the nervous system, causing people to make movements and sounds (also known as motor and vocal tics) that they cannot control. Although the exact underlying pathophysiological for TS is unknown, evidence supports that TS is inherited as a dominant gene, with about 50% chance of parents passing the gene on to their children (Center for Disease Control, 2018). There are many comorbid psychiatric disorders and behavioral problems likely to emerge along with TS. Epidemiological surveys indicate that up to half of all patients with TS also have attention deficit hyperactivity disorder (ADHD), and up to 40 percent of those with TS also have an obsessive-compulsive disorder (OCD), leading to a surplus of overlapping symptoms (Sadock, Sadock, & Ruiz, 2014).
According to current research, most of the impairments that affect those with Tourette’s are associated with the abnormalities in the brain’s basal ganglia region, particularly of the dopaminergic transmission in the cortico-striatothalamic (Sadock, Sadock, & Ruiz, 2014). While neurotransmitters are likely involved, the upregulation of the dopamine receptors have led some researchers to propose another hypothesis about increased sensitivity to dopamine within the striatum, prefrontal cortex, and the motor region, leading to the phenotype of tics and other behaviors associated with TS (Roberson, 2018). Therefore, it is not unusual to misinterpret the disorder’s symptoms as behavioral problems rather than the neurobiological symptoms. Research is advancing to shed further light on a possible relationship between streptococcal infections, other biological and psychosocial stressors, and the complex pathobiology of chronic tic disorders.
DIAGNOSIS
The diagnosis is usually conducted by observing the signs, symptoms or reviewing family history. The most appropriate time for diagnosis is when the patient displays both repeated vocal and motor tics. The motor tics presented need to be several, but the vocal tics may be either one or more. An individual whose diagnosis is to be conducted is supposed to have experienced the condition for at least one year.
The criteria used to diagnose Tourette syndrome include: Both motor tics and vocal tics are present, although not necessarily at the same time Tics occur several times a day, nearly every day or intermittently, for more than a year Tics begin before age 18.Most diagnosis of Tourette syndrome are however overlooked they mimic other conditions. Eye blinking which is one of the signs might be initially associated with vision problems and sniffling attributed to allergies. Both motor and vocal tics can be caused by conditions other than Tourette syndrome.
According to Rivera-Navarro, Cubo & Almazán, (2009), a diagnosis of TS is always difficult to make due to the complexity of symptoms, these symptoms the writers posit are easily confused with symptoms that also pertain to other diseases that are mainly psychological, such as hyperactivity, depression, anxiety, or behavioral disorders. Sometimes people confuse symptoms belonging to TS (e.g. coprolalia or echolalia) with normal teenage behavior, or considered the symptoms to be a result of poor education and lack of respect. However to rule out other causes of tics, a physician might recommend Blood tests and Imaging studies such as an MRI (Mayo Clinic Staff, 2018).
“Just because you don’t understand it, doesn’t mean it isn’t so.”
– unknown –
TREATMENT OPTIONS
There are various treatment options to manage the symptoms associated with Tourette syndrome (TS), particularly tics. Many individuals with Tourette syndrome do not require treatment, however, if tics interfere with daily living, there are treatments available (Centers for Disease Control and Prevention, 2020). Treatments options available for management of Tourette syndrome include medication therapy, behavioral therapy, and deep brain stimulation (Tourette Association of America, 2019).
Comprehensive behavioral interventions for tics (CBIT) involves psycho-education, habit reversal training, and behavioral interventions in attempt to modify behaviors and reduce tics (Tourette Association of America, 2019).
Medication may include Haldol, Orap, or Abilify which can be effective in managing tics and are approved by the Food and Drug Administration (FDA) for tics (Tourette Association of America, 2019). Your physician may decide to use other medications such as clonidine or guanfacine which are not approved by the FDA for tics, however, they may be effective (Tourette Association of America, 2019). Other medications may be prescribed for co-occurring conditions such as attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), or anxiety.
Deep brain stimulation (DBS) involves implantation of devices in order to target specific areas of the brain which are involved in abnormal communication in individuals with TS (Tourette Association of America, 2019).
Other treatments that may reduce tics include medical marijuana and dental devices (Tourette Association of America, 2019). Furthermore, speech therapy may be an option for individuals with co-occurring conditions. Many options are available for individuals with TS, however, individuals should consult with their physician to determine the most appropriate treatment options.
REFERENCES
Center for Disease control and prevention (2020). Information about Tourette Syndrome for families. U.S department of Health and Human services. Retrieved from https://www.cdc.gov/ncbddd/tourette/families.html
Centers for Disease Control and Prevention. (2020). Tourette syndrome treatments. Retrieved from https://www.cdc.gov/ncbddd/tourette/treatments.html
Center for Disease Control. (2018). Tourette Syndrome (TS). Retrieved from https://www.cdc.gov/ncbddd/tourette/index.html
Center for Parent Information and Resources (2015). Tourette Syndrome. Retrieved from
CDC. (2020, February 3). Retrieved from Tourette Syndrome (TS): https://www.cdc.gov/ncbddd/tourette/index.htm
Rivera-Navarro, J., Cubo, E., & Almazán, J. (2009). The Diagnosis of Tourette’s
Roberson MD, W. C. (2018). Tourette Syndrome and Other Tic Disorders Clinical Presentation: History, Physical Examination. Retrieved from https://emedicine.medscape.com/article/1182258-clinical
Mayo Clinic Staff. (2018, January 8). Mayo Clinic. Retrieved from Tourette Syndrome: https://www.mayoclinic.org/diseases-conditions/tourette-syndrome/symptoms- causes/syc-20350465
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Syndrome: Communication and Impact. Clinical Child Psychology and Psychiatry, 14(1), 13–23. https://doi.org/10.1177/1359104508100127
Tourette Association of America. (2019). Medical treatments. Retrieved from https://tourette.org/research-medical/medical-overview-treatments/
Resources
of
More
Information
on
Tourette
Syndrome
National
Tourette
Syndrome
Associatio
n
–
http://tsa
–
usa.org/
Tourette
Syndrome
“Plus”
–
http://www.tourettesyndrome.net/
Tourette
Syndrome
Fact
Sheet
from the National Institute of Neu
rological Disorders and Stroke
http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm
Parent to parent program
–
Resources
of
More
Information
on
Tourette
Syndrome
National
Tourette
Syndrome
Associatio
n
–
http://tsa
–
usa.org/
Tourette
Syndrome
“Plus”
–
http://www.tourettesyndrome.net/
Tourette
Syndrome
Fact
Sheet
from the National Institute of Neu
rological Disorders and Stroke
http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm
Parent to parent program
–
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