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Tourette Syndrome: causes, symptoms and treatments

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Tourette Syndrome: causes, symptoms and treatments
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Tourette Synrome is a neurological illness characterised by involuntary tics. These tics manifest as sudden movements and/or brief and intermittent vocalisations. Generally, the symptoms are accompanied by behaviour problems. Note than Tourette Syndrome affects 1 in every 200 people. 

Tourette Syndrome was first described in the 1880s by French neurologist Georges Gilles de la Tourette. It appears more often in boys, during their early years. It is not contagious.

What are the causes of this illness?

The exact cause of Tourette Syndrome is not known. However, there are strong genetic factors. It appears that several genes are involved, but the precise ones have not yet been identified.

It also appears that certain environmental factors contribute to triggering the onset of the illness: events that took place before, during or after birth, toxins, stress, immune reactions, etc.

What are the symptoms of Tourette Syndrome?

Tourette Syndrome manifests in highly variable ways from one person to the next. It generally emerges in childhood, with the appearance of tics that become progressively worse. In the beginning, they can go unnoticed. Teachers are often the first ones to notice unusual behaviour in children affected by Tourette Syndrome.

The tics are uncontrollable; they often come out in bursts. It has been identified that stress, fatigue, anxiety and stimulants increase the intensity or the frequency of the tics, while sleep, sexual pleasure, alcohol or activities that require concentration can reduce them. 

One person with Tourette Syndrome could take on the tics of another affected person, and thus develop new forms of tics, replacing their old ones.

Tics manifest in two forms: motor tics and vocal tics.

    • Simple motor tics are linked to involuntary muscle contractions, and are characterised by sudden, rapid and meaningless movements: blinking of the eyes, raising of the shoulders, clenching of the mouth, shaking of the head. 
    • Other tics, called “complex tics”, are more coordinated and more complex. They are often voluntary movements, which are not appropriate to the context: touching, sniffing, hitting, making obscene gestures, or imitating another person’s movements. 
    • Vocal tics can also be either simple or complex. For example, they could be noises emitted via the mouth or nose, such as sniffing, grunting, throat clearing, screaming, involuntary laughter or tongue clicking. On the other hand, complex vocal tics have a linguistic character, and could involve a repetition of words or syllables that the person themself comes up with, or that they imitate from another person. Alternatively, they could involve using foul or obscene language.

Obsessive compulsive disorder is very often linked with Tourette Syndrome, and is more common in girls. This manifests as an obsession which compels the mind to carry out an action in order to soothe the obsession.

Finally, people affected by Tourette Syndrome tend to be hyperactive, or have difficulty concentrating for long periods, or with finishing what they have started. They are easily distracted, moving endlessly from one activity to another, and they can only follow one instruction at a time. Their mood changes regularly and in unpredictable ways. 

Do treatment and management strategies exist?

There is no treatment for curing the syndrome, but available management strategies can reduce the symptoms of the illness. Children presenting with mild tics are in principal not treated.

Treatment becomes important when the degree of the problem becomes significant. In such cases, dopamine agonists (pergolide, ropinirole), GABA receptor agonists (clonazepam), or alpha2-adrenergic agonists (clonidine, guanfacine) are administered.

However, these medications have side effects, such as weight gain, stopped periods, intense fatigue and even the onset of depression. Treatment should be complemented with regular psychotherapy. Behavioural therapies (relaxation, CBT, lifestyle changes) are also recommended.

What are the consequences of Tourette Syndrome in everyday life?

In the majority of cases, people with Tourette Syndrome do not experience significant consequences in their personal, educational or professional lives. Doctors recommend using aids (such as using a tape recorder or a computer for literacy problems) in order to make everyday life easier.

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