TOURETTES SYNDROME

If your child has tics, it doesn’t necessarily mean they have Tourette’s syndrome.

Children often develop tics, known as transient tics, before growing out of them after several months.

To classify that the tics are brought by Tourette’s syndrome, they have to be present for at least a year and include at least one vocal tic.

Tics can be:

• Vocal (Sounds) – such as grunting, coughing or shouting out words
• Physical (Movements) – such as jerking of the head or jumping up and down

Tics can also be:

• Simple – for example, making a small movement or uttering a single sound
• Complex – for example, making a series of movements or speaking a long phrase

Most people diagnosed with Tourette’s syndrome have a combination of physical and vocal tics, which can be both simple and complex.

• Simple vocal tics
  • Grunting
  • Clearing The Throat
  • Coughing
  • Screaming
  • Sniffing
  • Squeaking
  • Blowing

• Simple physical tics
  • Blinking
  • Jerking the Head
  • Twitching the Nose
  • Teeth Grinding 
  • Rolling the Eyes
  • Twisting the Neck
  • Rotating the Shoulders

• Complex vocal tics
  • Repeating other people’s phrases (echolalia)
  • Repeating the same phrase over and over again (palilalia)
  • Swearing loudly or shouting inappropriate words and phrases (coprolalia)

Swearing is often associated with Tourette’s syndrome, but it’s actually a fairly uncommon symptom affecting a minority of people with the syndrome.

• Complex physical tics
  • Shaking the Head
  • Hitting or Kicking Objects
  • Jumping
  • Shaking
  • Touching Themselves or Others
  • Copying the Movements of Others (Echopraxia)
  • Making Obscene Gestures, Such As Giving Someone ‘The Finger’ (Copropraxia)

Premonitory sensations

Uncomfortable or unusual feelings (referred to as premonitory sensations) are of ten experience by people with Tourette’s syndrome before they have a tic.

Examples of premonitory sensations include:

• A burning feeling in the eyes that feels as if it can only be relieved by blinking
• Tension in a muscle that can only be relieved by twitching or stretching the muscle
• A dry or sore throat that can only be relieved by grunting or by clearing the throat
• An itchy joint or limb that can only be relieved by twisting the joint or limb

Pattern of tics

Tics of people with Tourette’s syndrome tend to follow a set pattern. They may be worse during periods of:

• Stress
• Anxiety
• Tiredness
• Illness
• Nervous Excitement
• Relaxation After A Busy Day 

On the other hand, the tics are often reduced when they’re doing an enjoyable activity involving a high level of concentration, such as reading an interesting book or playing competitive sports.

Diagnosis

• The first stage in diagnosing Tourette’s syndrome is to rule out other possible causes of your child’s symptoms (like allergies and vision problems).

It’s also necessary to rule out other conditions that can cause tic-like behaviours, such as:

• Autistic Spectrum Disorder – a developmental disorder which causes problems with social interaction, learning and behaviour, and may cause mannerisms or stereotypes (repetitive movements) that can be mistaken for tics
• Dystonia – a condition that causes involuntary muscle spasms

Your child may be referred to a number of experts to help rule out these conditions.

• Brain-imaging scan (CT scan and MRI scan) can also be used to check for any brain or nervous system abnormalities suggesting a neurological cause for your child’s symptoms, other than Tourette’s syndrome. However, most children with tics or Tourette’s syndrome don’t require a brain scan.
• There’s currently no single test to determine Tourette’s syndrome. A diagnosis can only be made by assessing your child’s symptoms to see whether they follow the pattern usually associated with the syndrome.

A confident diagnosis of Tourette’s syndrome can usually be made if your child:

• Has symptoms that are not being caused by other medical conditions or any medication they are taking
• Started having tics before 18 years of age
• Has had several physical tics and at least one vocal tic
• Has tics that occur many times during the day, virtually every day
• Has been having tics for at least a year

Treatment and Medications

Treatment plan

The first and most important part of treatment for Tourette’s syndrome is to ensure you, your child and, if needed, your child’s teachers, friends and other family members all have good information and knowledge about the condition. This includes:

• Being able to explain Tourette’s syndrome to others if asked about tics
• Understanding that tics are not ‘put on’
• Understanding that tics come and go and sometimes they may be better than at other times
• Knowing that having tics doesn’t generally stop you doing anything you want to do
• Knowing that treatments may help to relieve tics, but are unlikely to make them go away completely
• Being aware that most people ‘outgrow’ tics by the time they reach adulthood

Next, the treatment plan for tics could involve one or more of the following:

• Treatments that don’t involve taking medication – such as:
  • Behavioural Therapy– It’s a type of psychological treatment designed to change the pattern of your or your child’s behaviour.
  • Habit reversal– It’s a type of behavioural therapy that has proved successful in treating Tourette’s syndrome
  • Exposure and response prevention (ERP)– This involves increasing exposure to the urge to tic in order to suppress the tic response for longer.
• Medication – the three types of medication that may be prescribed are:
  • Alpha2-adrenergic Agonists– This type of medication is thought to stabilise levels of a brain chemical called norepinephrine. This is thought to decrease the risk of the basal ganglia misfiring and triggering tics.
  • Muscle Relaxants– Baclofen and clonazepam are two muscle relaxants that are sometimes used to treat Tourette’s syndrome
  • Dopamine Antagonists– This are the most effective type of medication for preventing tics. They work by blocking the effects of dopamine on the brain
• Surgery – in extremely rare, severe cases, surgical techniques may be suitable. It is only recommended for adults. The aim of surgery is to make a small ‘break’ in some of the pathways in the brain that may be responsible for tics. The region of the brain that is usually operated on is called the limbic system, although several different areas have been targeted.
• Deep Brain Stimulation- This is a relatively new technique that, like surgery, has been used to treat very severe cases of Tourette’s syndrome where other treatments have failed. DBS involves permanently implanting electrodes (small metallic discs) in the parts of the brain known to be associated with Tourette’s syndrome.