- Tourette disorder
- Tourette's syndrome
- Gilles de la Tourette's syndrome
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- What is Tourette syndrome?
- What are the signs and symptoms of Tourette syndrome?
- What causes Tourette syndrome?
- What other disorders are associated with Tourette syndrome?
- Is Tourette syndrome a rare disease?
- Is Tourette syndrome inherited?
- How might Tourette syndrome be treated?
- What is the prognosis for individuals with Tourette syndrome?
- Where can I learn more about Tourette syndrome?
Tourette syndrome is a complex neurological disorder that is characterized by repetitive, sudden, 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. A variety of genetic and environmental factors likely play a role in causing Tourette syndrome. A small number of people with Tourette syndrome have been found to have mutations involving the SLITRK1 gene. The syndrome is believed to 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. It is estimated that about 1% of the population has Tourette syndrome. 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. 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.
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 eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing, sniffing/snorting, grunting, or barking sounds.
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. 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.
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.
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.
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.
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 Living With section.
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.
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.
Behavioral treatment such as awareness training and competing response training can also be used to reduce tics. 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.
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. Tourette syndrome does not impair intelligence. Although tic symptoms tend to decrease with age, it is possible that neurobehavioral disorders such as ADHD, OCD, depression, generalized anxiety, panic attacks, and mood swings can persist and cause impairment in adult life.
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
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 Tourette Syndrome Information Page: http://www.ninds.nih.gov/disorders/tourette/tourette.htm
Scientists Discover First Gene for Tourette Syndrome:
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.
- Tourette syndrome. Genetics Home Reference (GHR). May 2013; https://ghr.nlm.nih.gov/condition/tourette-syndrome.
- Tourette Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke (NINDS). April 16, 2014; http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm.
- Mary Robertson. The prevalence and epidemiology of Gilles de la Tourette syndrome Part 1: The epidemiological and prevalence studies. Journal of Psychosomatic Research. March 11, 2008;
- Campellone JV, Zieve D. Gilles de la Tourette syndrome. MedlinePlus. February 20, 2014; http://www.nlm.nih.gov/medlineplus/ency/article/000733.htm.
- What is Tourette Syndrome?. Tourette Association of America. 2010; http://www.tsa-usa.org/Medical/whatists.html. Accessed 3/6/2016.
- Paul Girolami. National Institute of Neurological Disorders and Stroke (NINDS). Scientists Discover First Gene for Tourette Syndrome. January 31, 2007; http://www.ninds.nih.gov/news_and_events/news_articles/news_article_Tourette_gene_121505.htm.
- Frequently Asked Questions. Genetic and Rare Diseases Information Center. https://rarediseases.info.nih.gov/about-gard/pages/31/frequently-asked-questions. Accessed 3/6/2016.
- Tourette Syndrome: Treatment. Mayo Clinic. November 21, 2015; http://www.mayoclinic.org/diseases-conditions/tourette-syndrome/diagnosis-treatment/treatment/txc-20163628.