Tourette Syndrome (TS)

Understanding TS

Tourette syndrome (TS) is a condition of the nervous system and causes people to have tics (sudden twitches, movements, or sounds done repeatedly). People who have tics cannot stop their body from doing these things. TS is a little like having hiccups. Even though one might not want to hiccup, the body does it anyway. Sometimes people can stop themselves from doing a certain tic for a while, but it is hard. Eventually the person has to do the tic.

Symptoms of TS

Tics can be motor (involving movement) or vocal (involving sound) and are classified as either simple or complex. They may range from very mild to severe, although most cases are mild. Simple tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. They are more common than complex tics. Complex tics involve several muscle groups. Examples of motor tics include eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Complex motor tics might include a combination of these movements and also movements such as touching objects, hopping, jumping, bending, or twisting. Some of the most dramatic and disabling tics result in self-harm such as punching oneself in the face.

Examples of simple vocal tics include repetitive throat clearing, sniffing, barking, or grunting sounds. Complex vocal tics may include repeating one’s own words or phrases, repeating others’ words or phrases, or more rarely, using vulgar, obscene, or swear words.

Diagnosing TS

Diagnosis of Tourette syndrome (TS) is done by presence of both motor and vocal tics that occur several times a day, every day or intermittently for at least 1 year; onset of tics before age 18; and tics not caused by medications, other substances, or medical conditions. There are no blood, laboratory, or imaging tests done to diagnose TS. Many individuals with TS also have behavioral problems such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), anxiety, learning disabilities behavioral or conduct issues, sleep problems and problems with social skills.

Treatment of TS

Tic symptoms are often mild, do not cause impairment, and often no treatment is needed. For those individuals whose symptoms interfere with daily functioning, there is effective treatment, including medication, behavioral treatments (for example, awareness training and completing response training to reduce tics) and psychotherapy (to help cope with TS and accompanying problems or conditions). Food and Drug Administration (FDA)-approved medications (taken orally) to treat tics include haloperidol (Haldol^®), pimozide (Orap^®), and aripiprazole (Abilify^®). Clinical studies have shown oral tetrabenazine (Xenazine^®) to be effective in treating tics.

References:

• Tourette Syndrome | Centers for Diseases Control and Prevention
• Tourette Syndrome: An Overview | Tourette Association of America
• Porta M, Sassi M, Cavalleria M, Fornari M, Brambilla A, Servello D. Tourette's syndrome and role of tetrabenazine: review and personal experience. Clin Drug Investig. 2008;28(7):443-59. doi:10.2165/00044011-200828070-00006. PMID: 18544005.
• Kenney C, Kuo S, Jimenez-Shahed J. Tourette's Syndrome Am Fam Physician. 2008 Mar 1;77(5):651-658.