Can’t Control – The Anatomy of Tourette Syndrome

We can control movement by our own free will. But not all of us can do that. Some people cannot control their movements – and even speech – voluntarily. This doesn’t necessarily mean they’re crazy. It’s beyond their control. This condition is called Tourette Syndrome.

What is Tourette Syndrome?

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.[1] TS does characteristically wax and wane, can be suppressed temporarily, and are preceded by a premonitory urge. Tourette’s is defined as part of a spectrum of tic disorders, which includes provisional, transient and persistent (chronic) tics.[2] Usually, the tics can manifest right away then slowly disappears and then appears again. Sometimes, Tourette Syndrome is called the swearing disease[3] because some people with TS involuntarily blurts out inappropriate comments and/or curse words. TS does not affect intelligence or life expectancy.

How common is Tourette Syndrome?

Tourette Syndrome is not as rare as it presents, though uncommon, with mild symptoms to some people. Males are about three to four times more likely than females to develop Tourette syndrome.[4] Between 0.4% and 3.8% of children ages 5 to 18 may have Tourette’s[2][5];the prevalence of other tic disorders in school-age children is higher, with the more common tics of eye blinking, coughing, throat clearing, sniffing, and facial movements.[2]

What causes Tourette Syndrome?

Genetics and environment may play a role in the development of TS, but the exact cause is unknown.[2] Experts don’t know the exact cause of TS, but some research points to changes in the brain and problems with how nerve cells communicate. A disturbance in the balance of neurotransmitters — chemicals in the brain that carry nerve signals from cell to cell — might play a role.[6] Tics are believed to result from dysfunction in cortical and subcortical regions, the thalamus, basal ganglia and frontal cortex. Neuroanatomic models implicate failures in circuits connecting the brain’s cortex and subcortex, and imaging techniques implicate the basal ganglia and frontal cortex.[7]

What are the symptoms of Tourette Syndrome?

The main symptoms of TS are motor tics (sudden, apparently uncontrollable movements like exaggerated blinking of the eyes) or vocal tics (apparently uncontrollable uttered sounds such as throat clearing, grunting, or sniffing).[6] When under stress, the tics usually exacerbate. It can be prolonged or changed.

Tics are classified as either simple or complex. Simple motor tics usually involve just one group of muscles. Some examples are eye blinking and grimacing. In contrast, complex motor tics usually involve more muscle groups and might look like a series of movements.[6] Simple vocal tics can be throat clearing, sniffing, or humming, whereas complex vocal tics can involve repeating other people’s words (a condition called echolalia) or involuntary swearing (called coprolalia).[6]

Motor tics involve movement. They include[8]:

Arm or head jerking
Blinking
Making a face
Mouth twitching
Shoulder shrugging

Vocal tics include[8]:

Barking or yelping
Clearing your throat
Coughing
Grunting
Repeating what someone else says
Shouting
Sniffing
Swearing

Before a motor tic happens, a person with TS may get a sensation that can feel like a tingle or tension. The movement makes the sensation go away.[8]

Symptoms usually subside as the child grows up and tics can become minimal when they become adolescents and adults.

Some people can control tic symptoms. But tension builds, and it eventually has to be released as a tic.[6] Since controlling a tic requires much effort, they usually cannot concentrate in other activities (i.e. classroom or work).

image

This is an illustration of how Tourette Syndrome is presented.[7]

How is Tourette Syndrome diagnosed?

For Tourette Syndrome to be diagnosed, the patient is referred to a neurologist. There he or shecwill be tested and asked by the neurologist about how TS presents. The following are the usual questions asked[8]:

-What did you notice that brought you here today?
-Do you often move your body in a way you can’t control? How long has that been happening?
-Do you ever say things or make sounds without meaning to? When did it start?
-Does anything make your symptoms better? What makes them worse?
-Do you feel anxious or have trouble focusing?
-Does anyone else in your family have these kinds of symptoms?

Testing includes[8]:

MRI. It uses powerful magnets and radio waves to make pictures of organs and structures inside your body.
CT scan. It’s a powerful X-ray that makes detailed images of your insides.

How is Tourette Syndrome treated?

There is no cure for TS. But there are strategies used to manage and/or control its symptoms[9]:

Habit reversal therapy – involves monitoring the pattern and frequency of the tics and identifying any sensations that trigger them. The next stage is to find an alternative, less noticeable method of relieving the sensations that cause a tic (known as premonitory sensations). This is known as a competing response.[9]

Exposure with response prevention (ERP) –involves increasing exposure to the urge to tic in order to suppress the tic response for longer. This works on the theory that you get used to the feeling of needing to tic until the urge, and any related anxiety, decreases in strength.[9]

Medications can also help if the symptoms are more frequent and severe like alpha2-adrenergic agonists, muscle relaxants and dopamine antagonists[9] to relax muscles or control nerve impulses in tics.

Antidepressants and anxiolytics can help when the patient has depression and/or anxiety.

What is the prognosis for Tourette Syndrome?

The symptoms usually improve in two-thirds of TS cases after 10 years. The tics may diminish a lot and may even disappear. Medications and therapy are not necessarily needed. However, the symptoms continue in the remaining one-third of cases and medications will be continued. Nevertheless, TS symptoms get milder as the patient ages.

image
The cycle of Tourette Syndrome.[10]

What happens if Tourette Syndrome is not diagnosed?

If not identified right away, complications may arise. The patient may lose concentration in classes or work. They may even become subjects of ridicule and discrimination and he or she will have low self-esteem, anxiety, and depression.

Can someone with Tourette Syndrome be successful?

Yes. A person with TS can become successful in many areas of life given he or she has awareness, acceptance, and/or therapy or medicine. The most important factor is, that he or she will be given support and understanding instead of discrimination.

Below are some famous people with diagnosed or suspected TS[11]:

Jim Eisenreich, professional baseball player
Mahmoud Abdul-Rauf, professional basketball player
Samuel Johnson, British writer who penned the Dictionary of the English Language and the Lives of Poets
Wolfgang Amadeus Mozart (huh? Mozart again? He also had suspected ADHD and/or autism)
Tim Howard, soccer player[12]
Howard Hughes, one of the richest men in history[12]
Dan Ackroyd, actor[12] (he also had Aspergers)
David Beckham[12]
Michael Wolff, jazz musician and actor[12]
Dash Mihok, actor[12]

image
Image courtesy of njcts.org

So, people with TS should be treated equally with us instead of laughing at them. Who knows, the one with involuntary tics may become more successful than you!

image
Image courtesy of njcts.org

This concludes the description of the conditions nder the umbrella of neurodiversity. There are more conditions aside from dyslexia, ADHD, autism, dyspraxia, dyscalculia, and Tourette Syndrome, but I will discuss them in my following blog posts.

References:
1. http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm
2. http://en.m.wikipedia.org/wiki/Tourette_syndrome
3. http://www.reviewjournal.com/life/health/tourette-syndrome-challenges-patients-doctors-alike
4. http://www.mayoclinic.org/diseases-conditions/tourette-syndrome/basics/definition/con-20043570
5. Robertson MM. “Gilles de la Tourette syndrome: the complexities of phenotype and treatment”. Br J Hosp Med (Lond). 2011 Feb;72(2):100–7. PMID 21378617 
6. http://kidshealth.org/parent/medical/brain/tourette.html
7. http://www.medz.website/2014/12/tourette-syndrome-tourette-s-disorder.html
8. http://www.webmd.com/brain/tourettes-syndrome
9. http://www.nhs.uk/conditions/Tourette-syndrome/Pages/Introduction.aspx
10. http://www.netterimages.com/images/vpv/000/000/006/6082-0550×0475.jpg
11. https://faculty.washington.edu/chudler/ts.html#fp
12. http://www.disabled-world.com/artman/publish/tourettes-famous.shtml

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2 thoughts on “Can’t Control – The Anatomy of Tourette Syndrome

  1. Pingback: Tourette Syndrome: Advantage | Aegyo Kawaii's Neurodiversity Blog (formerly When Wrong is Right)

  2. Pingback: Neurodivergent Sexuality, Part 2 | Aegyo Kawaii's Neurodiversity Blog

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