What Exactly is Tourette Syndrome

SYMPTOMS:
Understanding more of Tourette syndrome may lead you to notice some of its most common symptoms firsthand, especially the ones we can observe outright. Many resources have presented quite a bit of information about the symptoms of Tourette syndrome. But one needs to understand that the symptoms of the disorder may be exhibited in a manner ranging from mild to severe. And according to the most recent description of Tourette syndrome, which is a neurological disorder characterized by motor and vocal tics, the symptoms of Tourette are categorized according to this description--- motor and vocal tics respectively. Each category of tics is presented furthermore into simple and complex.


It has been mentioned in this paper early on that tics are sudden, repetitive movements. It is important to understand that these tics are not manifested by the individual purposely. The symptoms are involuntary movements and are preceded by a certain kind of sensation that goes away once the symptoms are executed. Every individual do not experience the same kind of relief most of the time. For other people with the disorder, performing the movement provides enough relief. But others find doing the movement faster and in repetition that may lead to a feeling of greater ease. In some cases though, these urges may only provide relief when pain is already felt on the involved muscle or muscle group. Depending on the age of the individual, some tics can be suppressed in a given time. For children diagnosed with the disorder, oftentimes they are unable to recognize the occurrence of tics hence they are unable to suppress them. Dr. Samuel Zinner (2004) even mentioned in his publication that the suppression is even worse than the tic itself because this can cause a rebound phenomenon and I quote “Tic suppression usually results in a rebound phenomenon at a later—safer, as it were—time and place (such as when the child returns home from school) during which the severity of the urges that had been suppressed compels more frequent and intense tics.”


During times of excessive anxiety or stress, these tics may worsen with considerable varying degrees of intensity and frequency but disappears when the individual is under concentration and are absent during sleep. The most frequent, severe or intensified symptoms of the disorder can be experienced before the mid- teen years and said to improve in most cases during late teens and early adulthood. According to the Tourette Syndrome Fact Sheet (2006), an estimated 10% of those affected have progressive and disabling symptoms that last into adulthood.


For more detailed enumeration of the symptoms, the table below presents the simple and complex symptoms for both the motor and vocal tics.

MOTOR AND VOCAL TICS

Simple Motor Tics: Facial grimacing, Shoulder shrugging, Head jerking, Eye blinking, Nose twitching, Limb jerking, Abdominal tensing, Wrist snapping, Jaw thrusting

Complex Motor Tics: Head shaking, Touching the Nose, Kicking, Touching other People, Echopraxia (copying of movements done by others), Smelling objects over and over, Stomping, Jumping, Copropraxia (obscene gestures), Various face and neck contortions, Jabbing, Self-injurious Behaviors

Simple Vocal Tics: Screaming, Sniffing, Grunting, Throat clearing, Barking, Coughing, Squeaking, Blowing, Sucking sounds, chirping, whistling, Snorting, Yelling, Laughing

Complex Vocal Tics: Palilalia (repetition of one’s own sounds, words or phrases), Echolalia (repetition of the words of others), Coprolalia (uttering of undesirable or obscene words or phrases and/or swearing), Stuttering and various changes in the pitch and volume of one’s own speech

It is imperative for your information that the listing above is not inclusive of all known motor and vocal tics. The symptoms listed are the ones oftentimes been recorded in most of the studies already done.

CO-MORBID DISORDERS:

Based on the early passages of this paper indicating that Tourette syndrome is a common denominator resulting from a combination of tics, attention deficit hyperactivity disorder, obsessive-compulsive disorder, and other behavioral problems (Jancovic, 2001), researches point out that there are other disorders associated with the one’s already mentioned that are occurring together with Tourette syndrome. According to the Medical Network (2006) in an article written by Maria Andres, researchers have found that from the American’s general population of individuals diagnosed with Tourette syndrome, many individuals, while having the disorder, also displayed symptoms associated with the other disorders mentioned above. And a number of percentage account to individuals with self- injurious behaviors.

CAUSES:

Researchers point out to common causes of Tourette syndrome. For one thing, they say that it is caused by an imbalance of the brain’s production of a very important neurotransmitter called dopamine which was already mentioned earlier in the chapter. Another reason pointed out to an abnormality in the functioning of certain brain structures responsible for the make up of Tourette syndrome which was also mentioned in the early passages. But the most researched cause of the disorder has been reported to be brought about by the whole paradigm of genetics. Genetics has said to play an important role in the disorder. The disorder is inherited in an autosomal dominant manner which means that an individual has a 50% chance of passing the gene to his or her children (NAMI, 2006). But this does not mean that everyone will show symptoms. It is believed that 70% of the females and 99% of the males with the gene responsible for Tourette syndrome will exhibit the symptoms. This also accounts for the reason why males are more affected than females. And it is presented that approximately one in ten children who inherited the gene from their parent will exhibit symptoms severe enough to require medical treatment (Tourette Syndrome Fact Sheet, 2006). Other causes of the disorder account to 10- 15% of the remaining Tourette syndrome cases. And these are extreme stress, psychological trauma, drug abuse, PANDAS (pediatric autoimmune neuropsychiatric disorder with streptococcal infection), some psychiatric conditions and other medical conditions.

PROGNOSIS:

The prognosis for Tourette syndrome is regarded as generally good. Since most of the cases exhibit mild form of tics, most of them do not even require medical attention. This means that approximately 30% of the people diagnosed with the disorder will have a decline in the severity and frequency of tics, another 30-40% will have a disappearance of the symptoms by late adolescents and the 30-40% remaining cases will experience the moderate to severe form through adulthood (Medical Network, 2006). The condition is not degenerative and will not, in any way, affect the intelligence of the person. The important aspect is that the neurobehavioral disorders existing within the course of the illness may continue and cause impairment in adulthood.

DIAGNOSIS:
Diagnosis of Tourette syndrome is perhaps one of the most challenging aspects of this disorder. A few factors account to this one. First is the disorder itself. The spectrum of its symptoms makes it hard to distinguish the disorder from other disorders with similar symptoms. Another complication is that some symptoms appear to be within normal behavior. The second factor would be the individual. In some cases, diagnosis is hard for some individuals who can literally suppress their tics in public or during the diagnosis with a medical doctor. Third is the environment. Some people may regard that the symptoms are psychotic outbursts therefore disregarding the idea of something more connected with Tourette syndrome. Truly diagnosis is practically one of the hardest parts. It is also said that some individuals may have visited quite a number of doctors before the eventual diagnosis of the disorder. Considering all these complications, experts explored the use of a guide to aid them in the diagnosis of the disorder. Criteria used underwent careful scrutiny and eventually led to the use of the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV). This manual is used for a selection of disorders including Tourette syndrome. It states that both motor and vocal tics should be present at the course of the illness but not necessarily concurrently, the tics should occur nearly everyday for a period of more than one year without remission of tics for more than three consecutive months, the age of onset of symptoms should be less than eighteen years, and the condition must not be due to medication and/ or another medical condition. On the other hand, these criteria are helpful together with observation and interview of the individual and family members.

TREATMENT/ MANAGEMENT:

It is widely reported that Tourette syndrome has no known cure. The key point is to control the symptoms of the individual with it. The treatment primarily focuses on what symptoms are currently present so as to initiate pharmacological therapy or therapy by using medications. Aside from controlling the symptoms, it is consequential to also focus the treatment and/ or management into alleviating the symptoms especially those that are most debilitating to the individual or those that basically impede with daily function. Aside from medications, many researches have documented the use of treatments like behavioral modifications and other alternative strategies such as group counseling or counseling in general which are all helpful in the treatment and/or management of Tourette syndrome. Dr. John Walkup (2007) mentioned that some individuals cannot tolerate the medications’ side effects so they are exploring other alternatives.