Tourette's Syndrome: Symptoms, Causes and Treatments

He Tourette syndrome Is a neurological disorder that is characterized by the realization of repetitive, stereotyped and uncontrolled repetitive movements and / or vocalizations known as tics. It can be given in children and adults.

Although it is a poorly understood disorder, a recent study showed that tourette syndrome affects about 200,000 people And nearly 2 million individuals worldwide.

Tourette syndrome

In addition, this syndrome usually causes a series of negative consequences in the people who suffer it, affecting in its functionality, performance, Well-being and quality of life.

In this article we will review this particular neurological disorder and explain its characteristics, symptoms, diagnoses, and Possible treatments.

Characteristics of Tourette's syndrome

Tourette syndrome (TS) is a neurological disorder that causes in the person a series of abnormal movements and / or sounds called tics.

The tics are performed in an automatic and involuntary way, so that the person suffering TS is unable to control the performance of this type of Movements.

These symptoms were already described by Jean Itard In the year 1825, when witnessing them in a French girl of 7 years.

This girl who gave rise to the first description of what is now known as Tourette syndrome, presented throughout her life a series of tics Very persistent corporals, barking vocalizations and obscene vocal utterances without being able to control them.

Years later, the neurologist Georges Gilles de la Tourette Described 9 patients with motor and vocal tics. Some of them had vocal emissions Obscene and repetitive words from third parties.

It was at this time that the name of Tourette's syndrome was pronounced to describe the disorders with these characteristics.

However, there are still some difficulties in the diagnosis of this syndrome among mental health professionals today.

In fact, the Minnesota Association for Children's Mental Health reports that practically 80% of people with this disorder are"self-diagnosed"or Diagnosed by their relatives after learning about the syndrome.

That is why there may be some confusion at present about what Tourette's syndrome is and what characteristics or symptoms are due Present to configure your diagnosis.

If I have tics in any part of the face or body does it mean I have Tourette's syndrome?

The answer is no, Tourette syndrome does not consist of witnessing a single tic, since the symptoms of such disorder include:

  • Presence of many motor and vocal tics, although not necessarily simultaneous.

  • Multiple episodes of tics every day or intermittently for more than a year.

  • Changes in frequency, number, type and severity of tics.

  • Significant impairment in areas of social, professional, or other areas, especially under stressful conditions.

  • Start before 18 years of age.

Thus, it is clearly seen that the disorder of Tourette does not consist in a simple appearance of tics since it constitutes a disease Made up of a series of more complex features.

In fact, tics are relatively common symptoms, especially among children and young people, and the fact of suffering them does not dictate that they are suffering A psychopathology such as Tourette's syndrome.

What are tics?

As we have seen so far, the main symptoms and manifestations that occur in TS are those movements popularly known as tics.

However, there is some confusion in specifying what a tic is and what is not a tic.

It is for this reason that before we begin to review the symptoms and characteristics of Tourette's syndrome, I would like to make a quick review on the Characteristics of the tics, to better delimit this concept.

Tics are considered involuntary movements (motor tics), very short duration, sudden, arrhythmic, recurrent and stereotyped movements, or sounds Caused by the movement of air through the nose, mouth or throat (sonic tics).

Thus, the first assessment that we must make when talking about tics is to take into account that there may be both motor tics (when we talk Of movements) as vocal tics.

Both tics have the same characteristics, since they are involuntary, brief, sudden, automatic and occur recurrently in a way Stereotyped

In the same way, both motor tics and vocal tics can be divided into simple or complex, depending on their qualities.

Simple motor tic is the best-known tic form and is probably what many of us actually interpret as a tic.

It consists of a sudden, brief and isolated movement, such as blinking, closing the eyes, shrinking the shoulders or nose, shaking the head, closing Hands, contorting fingers, open mouth, etc.

The complex motor tic on its part consists in making patterns of movements more coordinated, sequential and slightly complex. This type of tics May not seem as automatic as the previous ones and may be interpreted as voluntary.

Examples of this type of tics are acts such as touching, jumping, performing obscene gestures (corpropraxia) and mimicking movements performed by other people ( Ecopraxies ).

These types of movements move away from what is popularly known as tic, but they constitute the same symptom, since the person who suffers them performs These actions as automatically and involuntarily as simple tics.

Vocal tics can also be differentiated between simple and complex. Simple vocal tics include a wide variety of disjointed noises and Sounds produced by the passage of air through the nose or mouth, such as clearing the throat, sucking or grunting.

In contrast, complex vocal tics are noises and sounds that have a linguistic meaning, that is, they are developed vocalizations that can Include syllables, words, or even complete sentences and sentences,

One such example is repeating words spoken by others (echolalia), repeating their own words (palialia), and vocalizing Recurring obscene words (coprolalia).

This type of tics, as it happens with complex motor tics, despite being more elaborate actions, the subject realizes them in a way Totally involuntary.

Symptoms of Tourette's Syndrome

The symptoms that present in this syndrome are the tics that we described above, both the motors as the vowels, as the simple ones and the Complex.

The most annoying and disabling tics that can occur in Tourette's syndrome are those that include motor movements that cause damage Self-inflicted as beating on the face or in different parts of the body.

Likewise, coproralia (emitting obscene or socially inappropriate words) can greatly limit the patient's daily life, produce great Difficulties to relate properly and cause problems in some cases.

The same happens with echolalia (repeating words or phrases that others say) and ecopraxia (doing the same with movements), since Can limit the development of the person and their socialization.

Thus, we see that the most important tics presented in TS are not those popularly known and named as simple motor tics, such as Close your eyes or move your shoulders.

The symptoms that occur in this disorder are much more complex, annoying and disabling, which makes Tourette syndrome in a A serious disorder that may require a particular therapeutic approach.

Likewise, most people with TS report that their tics occur in response to an involuntary sensory manifestation, such as feeling Tingling, discomfort, pressure or heat that induce them to perform the given movement.

Thus, some people with TS describe having the need to perform the tics in a certain way or a certain number of times in order to relieve The urgency or decrease the annoying feeling.

It is common for tics to worsen with excitement or anxiety and improve when the person is performing quiet and focused activities.

Similarly, certain physical experiences can trigger or worsen tics. For example, tight necks can trigger tics in the Neck or hearing a person clear your throat can trigger a tic with those characteristics.

Finally, it is possible to emphasize that although the tics that are present in the Tourette syndrome are involuntary, sometimes some people can have The ability to suppress or partially hide the performance of these acts, and thus lessen the negative impact they have on their operation.

Diagnosis

So far we have seen that Tourette syndrome is a disorder characterized by the condition of tics in a repetitive and constant way.

However, what tics and what patterns of appearance determine the fact of having a Tourette syndrome?

In order to clarify the characteristics of TS, we will now comment on its diagnostic criteria which, according to Manual of Diagnosis and Statistic of Mental Disorders (DSM) are as follows:

  1. At some point throughout the disease there have been multiple motor tics and one or more vocal tics, although not necessarily simultaneously.

  2. Tics appear several times a day (usually in waves) almost every day or intermittently over a period of time.

  3. The onset of tics must be before the age of 18 years.

  4. The onset of tics is not due to the direct physiological effects of a drug (such as a stimulant) or a medical illness (such as Huntington's disease ).

Although these are the diagnostic criteria and can be identified at the individual level, the diagnosis of TS has to be performed by a Neurologist or psychiatrist, who must perform the corresponding examinations to verify if the presented symptoms correspond with a TS.

Course of disease

The most common in Tourette's syndrome is that the intensity of tics increases and decreases over time.

It is a disorder that appears during childhood or adolescence. It can arise already in very early ages (6-7 years), and always debuts before 18 years of age.

The first tics usually appear in the neck, face or head area. Later they can evolve to other areas of the body as muscles of the Trunk and limbs.

Although it is a chronic disorder, it is not a degenerative disease and some subjects may improve their symptoms as they get older, Reaching the point of not needing pharmacological treatment.

Usually the first tics to appear are the simple motors, later the simple vowels appear and finally the tics can arise Complex (both motor and vocal).

The maximum intensity of tics usually appears during childhood or adolescence. In late stages of adolescence and adulthood, despite Persist, the disease may present at a lower intensity.

About us

Tourette's syndrome is considered an unusual disorder, however, recent studies have determined that between 1 and 3% of children School may suffer from this disease.

Likewise, a higher prevalence in males has been noted. Every 4 males affected TS only one female would be.

Treatment

Since tics are symptoms that do not cause deterioration, many patients do not usually require any treatment.

However, when the tics suffered cause a deterioration of their functioning, especially through complex tics, they must be treated with medicines.

Usually used Neuroleptics (Drugs used to treat psychotic disorders), as they partially suppress the appearance of Tics.

However, these medications do not allow the elimination of symptoms completely and usually cause a series of negative side effects: sedation, Weight gain, slowness of thought and movement, etc.

You can also use other medicines such as clonidine or guanfacine, drugs used to treat hypertension, or medicines Stimulants such as methylphenidate and dextronfetamine.

However, these drugs have not been extensively studied and to date have not demonstrated a sufficiently high efficacy Ensure success in the treatment of Tourette's syndrome.

In extreme cases surgery can be performed.

References

  1. AMERICAN PSYCHIATRIC ASSOCIATION (APA). (2002). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. [Links]

  2. Lang AE. Patient's perception of tics and other movement disorders. Neurology 1991; 41: 223-8.
  3. Kurlan R, Behr J, Medved I, Shoulson J, Pauls D, Kidd KK. Severity of Tourette's syndrome in one large kindred: implications for determination of Disease prevalence rate. Arch Neurol 1987; 44: 268-9.
  4. Mason A, Banerjee S, Eapen V, Zeitlin H, Robertson MM. The prevalence of Tourette syndrome in a mainstream school population. Dev Med Child Neurol 1998; 40: 292-6.
  5. Miranda M, Menendez P, David P, Troncoso M, Hernandez M, Chana P. Tics disease: analysis of 70 patients Rev Med Chile 1999: 127: 1480-1486.
  6. Jankovic J, Stone L. Dystonic tics in patients with Tourette's syndrome. Mov Disord 1991; 6: 248-52.


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