Tourette Syndrome

 

Sushil M R

Associate Professor, Vindhya College of Nursing, Satna.

*Corresponding Author E-mail: sushilbelge@gmail.com

 

ABSTRACT:

Tourette (too-RET) syndrome is a disorder that involves repetitive movements or unwanted sounds (tics) that can't be easily controlled1. For example, someone with Tourette's might blink or clear their throat over and over again. Some people may blurt out words they don't intend to say2. About 100,000 Americans have full-blown Tourette's syndrome, but more people have a milder form of the disease. It often starts in childhood, and more boys than girls get it2. The exact cause of Tourette syndrome is not known. It is a complex disorder likely caused by a combination of inherited (genetic) and environmental factors. Chemicals in the brain that transmit nerve impulses (neurotransmitters), including dopamine and serotonin, might play a role1. Tics can be simple or complex. A simple tic affects one or just a few parts of the body, like blinking the eyes or making a face. A complex one involves many parts of the body or saying words. Jumping and swearing are examples. Symptoms often get better as children grow up. For some people, they go away completely3. Although there is no cure for Tourette syndrome, treatments are available. Many people with Tourette syndrome donot need treatment when symptoms are not troublesome. Tics often lessen or become controlled after the teen years. People with Tourette syndrome often lead healthy, active lives. However, Tourette syndrome frequently involves behavioral and social challenges1.

 

KEYWORDS: Tourette syndrome, Genetic, Neurotransmitters, Tics, TS.

 

 


INTRODUCTION:

Tourette syndrome was named by French neurologist Jean-Martin Charcot for his intern, Georges Gilles de la Tourette, who published in 1885 an account of nine patients with a "convulsive tic disorder". Tourette's syndrome is a common neuro developmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) tic. Common tics are blinking, coughing, throat clearing, sniffing, and facial movements. These are typically preceded by an unwanted urge or sensation in the affected muscles known as a premonitory urge, can sometimes be suppressed temporarily, and characteristically change in location, strength, and frequency.

 

 

Tourette's is at the more severe end of a spectrum of tic disorders. The tics often go unnoticed by casual observers4.

 

What Is Tourette Syndrome?

Tourette syndrome (TS) is a neurological disorder characterized by sudden, repetitive, rapid, and unwanted movements or vocal sounds called tics. TS is one of a group of disorders of the developing nervous system called tic disorders5

 

Causes and Risk Factors:

The exact cause of Tourette syndrome is not known. It is a complex disorder likely caused by a combination of inherited (genetic) and environmental factors. Chemicals in the brain that transmit nerve impulses (neurotransmitters), including dopamine and serotonin, might play a role1.

 

 

Risk factors for Tourette syndrome include:

·       Family history: Having a family history of Tourette syndrome or other tic disorders might increase the risk of developing Tourette syndrome1.

·       Sex: Males are about three to four times more likely than females to develop Tourette syndrome.1

 

Signs and Symptoms:

Tics- sudden, brief, intermittent movements or sounds- are the hallmark sign of Tourette syndrome. They can range from mild to severe. Severe symptoms might significantly interfere with communication, daily functioning and quality of life1.

 

ONSET OF TICS AND DURATION:

Tics come and go over time, varying in type, frequency, location, and severity. The first symptoms usually occur between the ages of 5 and 10 years, generally in the head and neck area and may progress to include muscles of the trunk and arms and legs. Motor tics generally occur before the development of vocal tics and simple tics often precede complex tics. Most people with TS experience their worst tic symptoms in their early teens, but tics typically lessen and become controlled by the late teens to early 20s. For some people, TS can be a chronic condition with symptoms that last into adulthood5.

 

Types of Tics:

There are two types of tics—motor and vocal.

 

Motor Tics:

Motor tics are movements of the body. Examples of motor tics include blinking, shrugging the shoulders, or jerking an arm3

 

Vocal Tics:

Vocal tics are sounds that a person makes with his or her voice. Examples of vocal tics include humming, clearing the throat, or yelling out a word or phrase3.

 

Tics can be either simple or complex:

Simple Tics:

Simple tics involve just a few parts of the body. Examples of simple tics include squinting the eyes or sniffing3.

 

Complex Tics:

Complex tics usually involve several different parts of the body and can have a pattern. An example of a complex tic is bobbing the head while jerking an arm, and then jumping up3.

 

Disorders Associated with Ts:

Many individuals with TS experience additional co-occurring neurobehavioral problems (how the brain affects emotion, behavior, and learning) that often cause more impairment than the tics themselves5.

 

The most common co-occurring conditions include5:

·       Attention Deficit Hyperactivity Disorder (ADHD), including problems with concentration, hyperactivity, and impulsivity.

·       Obsessive Compulsive Disorder or Behaviors (OCD/OCB): repetitive, unwanted thoughts, ideas, or sensations (obsessions) that make the person feel the need to perform behaviors repeatedly or in a certain way (compulsions). Repetitive behaviors can include handwashing, checking things, and cleaning, and can significantly interfere with daily life.

·       Anxiety (fear, unease, or apprehension about a situation or event that may have an uncertain ending).

·       Learning disabilities such as problems with reading, writing, and arithmetic that are not related to intelligence.

·       Behavioral or conduct issues, including socially inappropriate behaviors, aggression, or anger.

·       Problems falling or staying asleep.

·       Social skills deficits and social functioning difficulties, such as trouble with social skills and with maintaining social relationships.

·       Sensory processing issues, such as difficulty organizing and responding to sensory information related to touch, taste, smells, sounds, or movement5.

 

Diagnosis5

Continuous or intermittent assessment for the presence of tics:

There are no blood, laboratory, or imaging tests needed for diagnosis. In rare cases, neuroimaging studies, such as magnetic resonance imaging (MRI) or computerized tomography (CT), electroencephalogram (EEG) studies, or certain blood tests may be used to rule out other conditions that might be confused with TS5.

 

Treatment:

Because tic symptoms often are mild and do not cause impairment, some people with TS require no treatment. There are effective medications and other treatments for people whose symptoms interfere with daily functioning5.

 

Medications includes5

·       Medications that block dopamine are the most consistently useful medications to suppress tics .For example, haloperidol and pimozide.

·       Alpha-adrenergic agonists such as clonidine and guanfacine. These medications are used primarily for hypertension but are also used in the treatment of tics.

·       Stimulant medications such as methylphenidate and dextroamphetamine can lessen ADHD symptoms in people with TS without causing tics to become more severe. Previously, these drugs were not recommended for children with tics or TS and those with a family history of tics. Some studies show the short-term use of these drugs can help children with TS who also have ADHD.

·       Antidepressants, specifically, serotonin reuptake inhibitors (clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline) have been proven effective in some people to control symptoms of depression, OCD, and anxiety.

 

Unfortunately, there is no one medication that is helpful to all people with TS, nor does any medication   completely eliminate symptoms.

 

Other therapies and treatments can include5:

·       Behavioral treatments such as awareness training and competing response training can be used to reduce tics. A recent NIH-funded, multi-center randomized control trial called Cognitive Behavioral Intervention for Tics (CBIT) showed that training to voluntarily move in response to a premonitory urge can reduce tic symptoms. Other behavioral therapies, such as biofeedback or supportive therapy, have not been shown to reduce tic symptoms. However, supportive therapy can help a person with TS better cope with the disorder and deal with the secondary social and emotional problems that sometimes occur.

·       Psychotherapy can help individuals cope with the disorder and deal with accompanying problems or conditions, including ADHD, depression, anxiety, and OCD.

 

CONCLUSION:

Tourette syndrome (TS) is a childhood-onset psychiatric disorder characterized by chronic motor and phonic tics.1 Symptoms typically vary in nature and frequency over time and decrease with age. There is evidence of genetic contribution; however, candidates revealed by family studies do not appear to be significant risk genes for the majority of the population, and association studies have not identified common variants above threshold significance. The natural history of Tourette syndrome in most cases includes stabilization or spontaneous remission during adolescence or young adulthood. Many patients are able to stop medication by this time. Although tics may improve with maturity, other symptoms associated with the disorder may continue and even become more problematic. Symptoms of OCD, ADHD, and learning disabilities do not typically improve even when tics go into remission. There is much optimism in the field based on the combination of research advances in the underlying pathophysiology, effective treatment, and new understanding of the genetic basis of Tourette syndrome coupled with the demystification of and growing recognition of the disorder as a developmental neurobiologic condition with behavioral and emotional dimensions6

 

REFERENCES:

1.      Tourette syndrome: https://www.mayoclinic.org/diseases-conditions/tourette-syndrome/symptoms-causes/syc-20350465

2.      Stephanie Watson.Tourette's Syndrome. Reviewed by Smitha Bhandari, MD on June 14, 2021. https://www.webmd.com/brain/tourettes-syndrome

3.      What is Tourette Syndrome? https://www.cdc.gov/ncbddd/tourette/facts.html#:~:text=Tourette%20Syndrome%20(TS)%20is%20a,keep%20blinking%20over%20and%20over

4.      Tourette syndrome. https://en.wikipedia.org/wiki/Tourette_syndrome#:~:text=Tourette%20syndrome%20was%20named%20by,of%20genetic%20and%20environmental%20factors.

5.      What is Tourette syndrome?. https://www.ninds.nih.gov/tourette-syndrome-fact-sheet

6.      Rick D. Kellerman MD. Gilles de la Tourette Syndrome. https://www.sciencedirect.com/topics/neuroscience/tourette-syndrome

 

 

 

 

Received on 27.08.2022           Modified on 16.09.2022

Accepted on 19.10.2022          © A&V Publications all right reserved

Int. J. Nur. Edu. and Research. 2022; 10(4):406-408.

DOI: 10.52711/2454-2660.2022.00092