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Tourette syndrome

*

* Not a rare disease

Other Names for this Disease

  • Gilles de la Tourette's syndrome
  • Tourette disorder
  • Tourette's syndrome
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.

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I am writing an English research paper on Tourette syndrome. Can Tourette syndrome be cured? What are the treatment options? Please provide any available information.

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What is Tourette syndrome?

Tourette syndrome is a disorder of the nervous system that causes a person to make repeated and uncontrolled (involuntary) movements and sounds (vocalizations) called tics. Tourette syndrome is named for Georges Gilles de la Tourette, who first described this disorder in 1885. There is strong evidence that Tourette syndrome is passed down through families, although the gene has not yet been found. The syndrome may be linked to problems in certain areas of the brain, and the chemical substances (dopamine, serotonin, and norepinephrine) that help nerve cells talk to one another. Tourette syndrome can be either severe or mild. It is estimated that about 1% of the population has Tourette syndrome.[1] Many people with very mild tics may not be aware of them and never seek medical help.   Tourette syndrome is four times as likely to occur in boys as in girls.[2]  Although Tourette syndrome can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood.[3]

Last updated: 7/14/2011

What are the signs and symptoms of Tourette syndrome?

The early symptoms of Tourette syndrome are almost always noticed first in childhood, with the average onset between the ages of 7 and 10 years.[3] Although the symptoms of Tourette syndrome vary from person to person and range from very mild to severe, the majority of cases fall into the mild category.[4]

The repetitive, stereotyped, involuntary movements and vocalizations called tics are classified as either simple or complex. Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. Some of the more common simple tics include eye blinking and other vision irregularities, facial grimacing, shoulder shrugging, and head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds.[3]

Complex tics are distinct, coordinated patterns of movements involving several muscle groups. Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug. Other complex motor tics may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting. Simple vocal tics may include throat-clearing, sniffing/snorting, grunting, or barking. More complex vocal tics include words or phrases. Perhaps the most dramatic and disabling tics include motor movements that result in self-harm such as punching oneself in the face or vocal tics including coprolalia (uttering swear words) or echolalia (repeating the words or phrases of others). Some tics are preceded by an urge or sensation in the affected muscle group, commonly called a premonitory urge. Some individuals with Tourette syndrome will describe a need to complete a tic in a certain way or a certain number of times in order to relieve the urge or decrease the sensation.[3]

Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics, for example tight collars may trigger neck tics, or hearing another person sniff or throat-clear may trigger similar sounds. Tics do not go away during sleep but are often significantly diminished.[3]

Last updated: 4/21/2011

What causes Tourette syndrome?

Although the cause of Tourette syndrome is unknown, current research points to abnormalities in certain brain regions (including the basal ganglia, frontal lobes, and cortex), the circuits that interconnect these regions, and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells.[3][5] Given the often complex presentation of Tourette syndrome, the cause of the disorder is likely to be equally complex.[3] In many cases, there is a family history of tics, Tourette Syndrome, ADHD, OCD.[4]

In 2005, scientists discovered the first gene mutation that may cause some cases of Tourette syndrome. This gene, named SLITRK1, is normally involved with the growth of nerve cells and how they connect with other neurons.  The mutated gene is located in regions of the brain (basal ganglia, cortex, and frontal lobes) previously identified as being associated with Tourette syndrome.[6] 
Last updated: 4/21/2011

Is Tourette syndrome inherited?

Evidence from twin and family studies suggests that Tourette syndrome is an inherited disorder. Although early family studies suggested an autosomal dominant mode of inheritance (an autosomal dominant disorder is one in which only one copy of the defective gene, inherited from one parent, is necessary to produce the disorder), more recent studies suggest that the pattern of inheritance is much more complex.  Although there may be a few genes with substantial effects, it is also possible that many genes with smaller effects and environmental factors may play a role in the development of Tourette syndrome. Genetic studies also suggest that some forms of ADHD and OCD are genetically related to Tourette syndrome, but there is less evidence for a genetic relationship between Tourette syndrome and other neurobehavioral problems that commonly co-occur with Tourette syndrome.[3]

Due to the complex nature of Tourette syndrome inheritance, affected families and those at risk may benefit from consulting with a genetics professional. Information about how to locate a genetics professional is provided in the Services section.  
Last updated: 4/21/2011

How might Tourette syndrome be treated?

Many individuals with Tourette syndrome have mild symptoms and do not require medication.[2][3] However, effective medications are available for those whose symptoms interfere with functioning. Neuroleptics are the most consistently useful medications for tic suppression; a number are available but some are more effective than others (for example, haloperidol and pimozide). Unfortunately, there is no one medication that is helpful to all people with Tourette syndrome, nor does any medication completely eliminate symptoms. In addition, all medications have side effects.[3] Additional medications with demonstrated efficacy include alpha-adrenergic agonists such as clonidine and guanfacine. These medications are used primarily for hypertension but are also used in the treatment of tics.[3]

Effective medications are also available to treat some of the associated neurobehavioral disorders that can occur in patients with Tourette syndrome. Recent research shows that stimulant medications such as methylphenidate and dextroamphetamine can lessen ADHD symptoms in people with Tourette syndrome without causing tics to become more severe.  However, the product labeling for stimulants currently contraindicates the use of these drugs in children with tics/Tourette syndrome and those with a family history of tics.[3] 

For obsessive-compulsive symptoms that significantly disrupt daily functioning, the serotonin reuptake inhibitors (clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline) have been proven effective in some individuals. [3]

Psychotherapy may be helpful as well. It can help with accompanying problems, such as ADHD, obsessions, depression and anxiety. Therapy can also help people cope with Tourette syndrome. For debilitating tics that don't respond to other treatment, deep brain stimulation (DBS) may help. DBS consists of implanting a battery-operated medical device (neurostimulator) in the brain to deliver electrical stimulation to targeted areas that control movement. Further research is needed to determine whether DBS is beneficial for people with Tourette syndrome.[7]
Last updated: 4/22/2011

Can Tourette syndrome be cured?

Although there is no cure for Tourette syndrome, the condition in many individuals improves in the late teens and early 20s. As a result, some may actually become symptom-free or no longer need medication for tic suppression.[3]
Last updated: 2/24/2010

What is the prognosis for individuals with Tourette syndrome?

Many individuals with Tourette syndrome notice improvement of their symptoms in their late teens and early 20s. As a result, some may actually become symptom-free or no longer need medication for tic suppression. Although the disorder is generally lifelong and chronic, it is not a degenerative condition. Individuals with Tourette syndrome have a normal life expectancy. TS does not impair intelligence. Although tic symptoms tend to decrease with age, it is possible that neurobehavioral disorders such as depression, panic attacks, mood swings, and antisocial behaviors can persist and cause impairment in adult life.[3]

Last updated: 2/24/2010

What other disorders are associated with Tourette syndrome?

Many individuals with Tourette syndrome experience additional neurobehavioral problems including inattention; hyperactivity and impulsivity (attention deficit hyperactivity disorder—ADHD) and related problems with reading, writing, and arithmetic; and obsessive-compulsive symptoms such as intrusive thoughts/worries and repetitive behaviors. For example, worries about dirt and germs may be associated with repetitive hand-washing, and concerns about bad things happening may be associated with ritualistic behaviors such as counting, repeating, or ordering and arranging.  People with Tourette syndrome have also reported problems with depression or anxiety disorders, as well as other difficulties with living, that may or may not be directly related to Tourette syndrome.[3][4] 


Last updated: 2/24/2010

Where can I learn more about Tourette syndrome?

You can contact the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health (NIH), for information on Tourette syndrome.

NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Toll-free:  800-352-9424
Phone: 301-496-5751
TTY: 301-468-5981
E-mail form: http://www.ninds.nih.gov/contact_us.htm
Web site:   http://www.ninds.nih.gov/
Tourette Syndrome Fact Sheet: http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm
NINDS Tourtte Syndrome Information Page: http://www.ninds.nih.gov/disorders/tourette/tourette.htm
Scientists Discover First Gene for Tourette Syndrome: 
http://www.ninds.nih.gov/news_and_events/news_articles/news_article_Tourette_gene_121505.htm

More information on Tourette syndrome can be found at the following links from MedlinePlus, the National Library of Medicine Web site designed to help you research your health questions.
http://www.nlm.nih.gov/medlineplus/ency/article/000733.htm
http://www.nlm.nih.gov/medlineplus/tourettesyndrome.html

Last updated: 2/24/2010

References
Other Names for this Disease
  • Gilles de la Tourette's syndrome
  • Tourette disorder
  • Tourette's syndrome
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.