An Unpleasant Decade: Tourette Syndrome

Tourette Syndrome (TS) is a mysterious syndrome with no known etiology, although

causes aresuspected with this disorder. One suspected cause of TS is believed to
be a childhood onset hereditary familiar neurological disorder possibly due to a
genetic mutation.

This results in a neuropsychiatric brain developmental disorder as well as

unregulated neurotransmitters in the brain of a TS patient- dopamine in particular,
which is elevated beyond normal measures. The syndrome has been identified
since the early 1800s by a French doctor. Boys are three to four times likely to have
TS than girls.

Secondary causes for TS exist, and these causes may be physiological events, such
as a head trauma, encephalitis, or a stroke. Or there may be psychogenic causes of
TS thatmay include autism, schizophrenia, and retardation. Also, excessive and
prolonged drug use from cocaine has been known to cause tics resembling TS as
well.

The identifying traits in suspected TS patient arewhat are known as tics. Tics are a
form of what is known as dyskinesia- which is the inability for one to control their
movements.

Such movements are involuntary and habitual muscular movements and

contractions combined with vocal sounds made suddenly, rapidly, and frequently.
For TS to be diagnosed, both vocal and motor displays of dyskinesia must exist
consistently for over a year before the age of eighteen.

Yet these displays of tics by TS patients are not consistent in about 20 percent of
patients. In addition, the diagnosis is made by observations of the patient’s health
care provider, as there is no diagnostic criteria available.

TS is unfortunately often misdiagnosed. Recently, a book was created that is

called, “Against Medial Advice”, which was written by James Patterson and Hal
Friedman, who is the father of Cory, the boy with TS that is discussed in the book.
Cory’s father vividly describes the hell he experienced for quite some time trying to
get the appropriate diagnosis and treatment for his son.

There is so little known about TS by health care providers, along with standard
treatment options that do not exist. Both of these factors make things difficult for
both the patient and their family often. An ever changing cocktail of powerful drugs
make tics worse for the TS patients frequently, as no pharmacological treatment
regimen works the same for every TS patient.

With diagnosing the TS patient, If only motor or vocal exists separately in a chronic
manner, this is known simply as a tic disorder, and not TS. In either one of the
disorders, the symptoms with the tics that are expressed by such patients range
from simple to complex. If the TS patient tries to suppress their involuntary tics,
they will express themselves later in the day at a greater magnitude.

Onset of TS is typically at the age of six or seven, with the symptoms of the tics
peaking around ten years of age. There are approximately 200,000 people in the
United States with TS presently.

Simple tics expressed with TS patients may include rapid eye blinking, shoulder
jerking, sniffing, grunting, and barking. In more severe cases, TS patients may
experience face grimacing, arms flapping, and excessive words that take three
forms.

The first form, which many associate with TS, is the cursing words, known as
coprolalia. The cursing is experienced in only less than 20 percent of TS patients.
Overall, the tics expressed by the TS patient become worse if the person is also
experiencing anxiety, stress, or fatigue

The other forms of the use of excessive words manifest into either palilia, which is
repetitive repeating of the same word, or echolalia, which is the repeating of the
words of others. Overall, the most common tics expressed by those with TS are
throat-clearing and eye-squinting.

Such involuntary actions by the TS patient are socially inappropriate, and the TS
patient will often inhibit their interaction with others as a result and often develop a
school phobia as well.

Other medical conditions often exist with the TS patient as well. While most TS
patients have behavioral problems, the most common medical conditions with the
TS patient are ADHD, learning disabilities, and OCD. Usually, only one of these
medical conditions is experienced by the TS patient.

About one third of TS patients experience each one of these medical conditions.

Fortunately, most TS patients are mild with their symptoms, and not severe.
Pharmacological treatment usually is needed for only a year or two when the tic
symptoms peakaround the age of ten. Those TS patients who also have ADHD have
taken stimulants to treat this medical condition, and stimulants may make the tics
worse for them. An anti-hypertensive drug called Clonidine is standard drug
treatment for the TS patient.

Other therapies that have helped TS patients have been botoxinjections at various
locations on their head and neck. Also, nicotine patches have proven to be
beneficial as well for unknown reasons.

A procedure known as deep brain stimulation (DBS)has proven to be beneficial for

the TS patient. In this procedure, small electrodes are placed on the thalamus
inside the brain, and electrical stimulation is given to this area of the brain for long
periods of time and is consistent. A battery is placed underneath the skin on the
chest of the TS patient.

This procedure has been considered a viable treatment option for Tourette
Syndromewhen other treatment options have failed to be effective for the patient.
DBS decreases the frequency and severity of tic symptoms. This treatment has
proven to be beneficial for Parkinson’s patients as well.

In addition to these treatment methods, TS patients learn through others on how to

manage their disruptive behavior. This may include cognitive behavioral therapy
and relaxation techniques.

Fortunately, the entire lifespan of this annoying syndrome lasts about ten years, and
the tics fade as the TS patient experiences their teenage years. Remission is
common after these years. Researchers continue to identify specifically a cause for
the syndrome, and the most effective treatments for TS patients.

www.tsa-usa.org

Dan Abshear