Tourette Syndrome

• Tics are brief involuntary purposeless movements and/or sounds. Tics can either be either ‘simple’ involving one muscle or ‘complex’ involving a group of muscles.
  
• Examples include:
  • Simple motor tics - eye blinking, facial grimaces, head and neck jerks, and shoulder shrugs
  • Complex motor tics – jumping, touching objects/ clothes
  • Simple vocal tics - grunting, coughing, sniffing and throat clearing sounds;
  • Complex vocal tics - animal like noises, swearing, etc.
    
    
• Some children experience premonitory feelings or sensations that are relieved by the execution of the tics.
  
• Tics can affect up to 20 % of children
  
• Tics are often transient and can be self-resolving within a few weeks or months.
  
• In a small group of children with tics, their symptoms can persist for more than a year. These children are diagnosed with Chronic Tic Disorder or Tourette Syndrome (TS).
• Chronic Tic Disorder is a condition in which a child experiences single or multiple occurrences of either motor or vocal tic for more than one year.
• TS is a Chronic Tic Disorder, in which a child experiences both motor and vocal tics. TS often begins between 2 and 18 years, and lasts throughout life.
• Children with TS can also have other conditions such as Anxiety, Obsessive Compulsive Disorder (OCD), and Attention Deficit Hyperactivity Disorder (ADHD).
  
  

Causes and Risk Factors

If a young person, their family, friends and school do not know about tics or TS, it can cause further psychological complications such as anxiety, social isolation, teasing/ bullying and even depression.

Diagnosis

• Tourette Syndrome is diagnosed based on history taking and observation. There are no diagnostic tests for this condition. However, there are some standards for diagnosing TS, agreed internationally. A child or young person must:
  • Have multiple motor and one or more vocal tics that happen regularly although not necessarily at the same time
  • Have tics occurring many times a day or intermittently for a period of more than one year.
  • Be less than 18 years old.
  • Not have any other conditions that could cause the tics.
    
    
• It is often difficult to diagnose TS, as tics may present as allergic rhinitis or chronic cough.
  
• TS symptoms have long been misconstrued as a sign of behavioural difficulties or ‘bad habits’, which they are not.
  
• Having a confirmed diagnosis will allow the young person and those around him to learn about and understand the disorder. With the enhanced understanding and support, patients are usually better able to cope.
  
  

Treatments

• There is no treatment that will completely cure or eliminate tics. Most people outgrow them in the end, and in the meantime, learning to live with them, understanding them and being able to explain them to others are probably the most important strategies for being less bothered by tics.
• Once the young person, their family, friends, and school understand about TS and tics, patients can usually cope better.
• One of the ways to manage tics include identifying potential triggers such as stress and sleep deprivation.
• However, some tics can be distressing, annoying or even painful. For such tics, we can consider trying two main approaches:
  
  

• Children with TS can also have other conditions such as Anxiety, Obsessive Compulsive Disorder (OCD), and Attention Deficit Hyperactivity Disorder (ADHD). Treating these conditions can often result in improvement of tics.
  
• Learning relaxation techniques and coping skills to handle stress can be helpful. e.g. breathing exercises and yoga.
  
• Behavioural therapy can help by teaching patient how to recognise when they are about to have a tic, and what movements they can do to manage it. These techniques are usually taught by a psychologist or psychiatrist.
  
  

Treatment for the Brain:

• Medications are usually not needed unless the tics interfere with activities of daily living (e.g. talking to other people, eating, bathing)
• Some medications can help modify the chemical transmission in the brain, which can then help reduce symptoms.
• Treatment for associated conditions, such as OCD and ADHD. These conditions may be more disruptive than the tics and require different treatments based on the symptoms.
• TS can be a life-long condition. But we know that many people have fewer or less noticeable tics as they grow older. Tics are usually worst between the ages of 7 and 12 years old. Following late adolescence, a lot of children may stop having tics or only get them occasionally. However some adults may need life-long treatment.
• School and Education:
  Many people with TS do not need special help in education. However some may need extra support for ADHD or OCD.
  As tics often tend to become worse during times of stress, parents of children with TS/tics may want to inform the school or the teachers on the child’s condition.
  Many young people with TS can have a successful and fulfilling time in school.
• Work:
  People with TS do all sorts of job.
  Having TS should not stop young people from doing anything that they want to do. We know of people with TS who went on to become doctors, footballers, or accountants.
  In rare cases, severe tics can make some physical task difficult.