Tourette Syndrome (TS) is a type of neurological disorder that is characterised by the occurrence of tics. Tics are impulsive movements/twitches in the body or vocal sounds that occur due to sudden, repetitive muscular contraction. While not technically being ‘involuntary’, tics are often referred to as an involuntary act as they are difficult to control voluntarily.
Onset may be observed between the ages of 2-15 years, or sometimes even up to the age of 21 years, and it usually continues throughout adulthood. TS is a non-degenerative condition and is not known to have any impact on the normal lifespan of a person. However, individuals with more severe tics may find that TS poses certain challenges to getting about with their day-to-day lives.
Tics are the principal symptom observed in individuals with TS and are generally classified as:
- motor tics – involving movements in one or more parts of the body (mostly upper)
- vocal tics – involving making sounds with the mouth
In most cases, an individual might feel a ‘premonitory urge’, that is a tingle or itch of sorts, before the onset of a tic. With practice and effort, some individuals are able to hold off tics temporarily when they feel these urges. However, sometimes, holding off tics could exacerbate their occurrence later on.
Tics are further categorised as
- simple tics – sudden, short, repetitive tics involving limited muscle groups
- complex tics – more distinct tics that generally follow a coordinated pattern and involve several muscle groups
Tics vary in type, intensity and frequency from one individual to another, and may sometimes even change over time. Common examples of tics observed in TS include:
. blinking / darting eyes
. twitching nose
. twitching mouth
. jerking head
. shrugging shoulders
. bending / twisting / hopping
. repetition of movements
. touching / smelling objects
. walking / stepping in a specific pattern
. making obscene gestures
. clearing throat
. repetition of one’s own or other’s words / phrases
. using obscene / vulgar words
In most cases, individuals with TS have been found to be associated with other behavioural or developmental conditions such as:
- Obsessive Compulsive Disorder (OCD)
- Attention Deficit and/or Hyperactivity Disorder (ADHD)
- Learning disabilities, such as dyslexia, difficulty in writing or doing mathematical calculations
- Anxiety and/or depression
- Sleeping disorders
- Anger management issues
In a social context, children (and sometimes even adults) with TS may find themselves to be targets of bullying due to lack of awareness or understanding of the condition, or even lack of empathy.
It is not clear as to what exactly causes TS, but research has shown there to be a genetic involvement in most cases. As such, individuals with a close family member with TS or other Tic Disorders are at a higher risk of developing TS. Also, men appear to have a three to four times higher risk at developing TS than women.
In individuals with TS, exposure to different stresses, excitement, or anxiety are often known to trigger the onset of tics.
There is no specific test for the diagnosis of TS. Observation of one or more type of tic for a period of over one year more or less suffices to confirm a diagnosis.
As there is no known cause of TS apart from the genetic aspect of it, there is no way to prevent the incidence of the condition. However, in some cases, treatments such as those discussed below may be recommended in order to help patients deal with the condition better. Also, if an individual knows what events or environments tend to trigger the onset of tics, care can be taken to avoid exposure to such situations.
While there is no cure for TS, the following may be recommended by some doctors as means to alleviate the symptoms of TS for individuals who are more severely affected by it:
- behavioural therapy – this may involve habit reversal training which works on the sources that trigger tics, or exposure with response prevention (ERP) which works on controlling urges to tic
- medicines – these are usually only prescribed for patients whose lives are significantly affected by the symptoms of TS, but may have unpleasant side effects
- psychotherapy – this is usually to help patients deal with the mental aspect of dealing with TS, as well as other complications (discussed above) that may arise
Cover illustration adapted from Dr. Singhal Homeo