DESCRIPTION
Tourette syndrome is characterized by involuntary movements and noises/words. These are known as motor and vocal tics. With difficulty, someone with TS may be able to suppress tics for a time.
The following characteristics define Tourette syndrome:
Two types of tics
At least one type of vocal tic
Not caused by another medical condition
SIGNS AND SYMPTOMS
Tourette syndrome can include a wide variety of tics. Here are some of the most common types.
Simple motor tics:
- Eye blinking
- Facial grimacing
- Head jerking
- Shoulder shrugging
- Arm thrusting
Complex motor tics:
- Hopping
- Touching
- Tapping
- Twirling
- Eye rolling
Simple vocal tics:
- Throat clearing
- Coughing
- Spitting
- Grunting
- Sniffing
Complex vocal tics:
- Uttering words or phrases like “shut up”
- Uttering unacceptable obscene words (coprolalia)
- Repeating others’ words (echolalia)
Several other psychiatric and behavioral disorders are associated with TS.
These include:
- Attention deficit hyperactivity disorder (ADHD)
- Obsessive compulsive disorder (OCD)
- Learning disabilities
- Anxiety
- Emotional swings
TREATMENT AND THERAPIES
Deciding whether or not to treat Tourette syndrome depends on several factors. A child may not require treatment if:
- Symptoms are not interfering with the child’s normal daily functioning
- Symptoms wax and wane quickly
- Symptoms are improving with age
For those with more severe symptoms, treatment needs to be comprehensive. It will likely involve education, behavioral intervention, and medication. It is useful to understand these treatment options and discuss them with a physician.
Education
Learning what to expect from TS can help children and their families feel less worried. It can be helpful and relieving to learn that:
- Tics tend to improve later in life
- Symptoms often wax and wane
- Tics can increase with stress and fatigue
The Tourette Syndrome Association is a helpful educational resource.
Behavioral Intervention
There are several options for behavioral intervention:
- Comprehensive Behavioral Intervention for Tics (CBIT). CBIT includes habit reversal therapy (or HRT). It also includes training that can prevent stress from triggering tics.
- Psychotherapy. Psychotherapy can help treat conditions associated with Tourette syndrome, such as ADHD and OCD.
Medication
Not every child with Tourette syndrome will need medication for tics. There is no medicine cure for TS.
Sometimes, the associated disorders are more impairing than the tics themselves. In these cases, the associated disorders may be treated instead. Treating them may even improve tic severity.
There is no one medication helpful to all children with TS. However, below are some of the types of medication used for tic suppression.
- Alpha Adrenergic Agonists. These medications are marketed to control high blood pressure. However, they are effective for tics. For most children, both the benefits and the side effects are modest.
- Antipsychotics. These are the most effective class of medication to treat tics. They work by decreasing dopamine functioning. Side effects can include weight gain, diabetes, and increased breast tissue. If they are used for a long period of time, these medicines can cause tardive dyskinesia, which are abnormal and involuntary body movements.
- Other medications. A variety of other medications can help:
-
- Anti-anxiety or anti-seizure medicines
- Medicines for other movement disorders
- Nicotine
- Cannabidiol (CBD)
Deep Brain Stimulation
In rare cases, patients are severely disabled by TS. These individuals may not improve using standard approaches. In these cases, surgery can be an option. One such surgery is deep brain stimulation, or DBS. DBS has been used to treat other movement disorders. It is used more frequently in adults. In children, it is still investigational. It needs to be investigated further. It should be used only at centers with expertise in the procedure.
Resources
Tourette Association of America
Founded in 1972, the Tourette Association of America (formerly known as the Tourette Syndrome Association) is the only national organization serving the community, and works to raise awareness, advance research, and provide ongoing support to patients and families impacted by Tourette syndrome and Tic disorders. To this end, the TAA directs a network of 31 Chapters, 83 support groups and recognizes 18 Centers of Excellence across the country. The TAA is a nonprofit 501(c)(3) organization.
Publications
JCN: Updates on Tics and Tourette’s Syndrome
Podcast from SAGE Neuroscience and Neurology/Journal of Child Neurology (JCN). Dr. Alison Christy talks to Dr. Jaclyn Martindale, assistant professor and director of the Pediatric Movement Disorders Clinic and Comprehensive Tourette Syndrome and Tic Disorder Clinic at Atrium Health Wake Forest Baptist.
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