What is Tourette Syndrome and who it affects
Tourette syndrome is a pathological condition characterised mainly by the presence of motor and/or phonatory tics
For the diagnosis of Tourette syndrome, at least the following must be present in the patient’s history
- 2 motor tics
- 1 phonatory tic
It begins in childhood or adolescence, generally before the age of 18 and with a duration for tics of at least one year.
It predominantly affects males, with a male to female ratio of 3-4/1 and has an estimated prevalence of 0.52%.
What are the first symptoms of this disorder
The first symptoms that may appear in childhood, for example, in the primary school period, 6-8 years of age, are generally motor tics affecting the head region
- jerking movements of the head
- facial grimacing;
- eye movements.
This pathology may last until late adolescence, but in many individuals it persists into adulthood.
Sometimes transient simple tics with a duration of less than a year may be present in many children, disappearing as they appear.
What are tics and how can they be distinguished?
A tic is a phenomenon
- motor: manifested in squinting, head-rotating movements or grimacing;
- phonatory: clearing one’s throat, coughing, emission of vowels up to the involuntary articulation of sentences.
They are sudden, rapid, involuntary and unpredictable phenomena; tics are simple, when they involve a single body district, or complex, when they occur with an articulated sequence of movements of the head, shoulders, upper limbs, rather than the phonatory apparatus.
In this case, it is not just a matter of simple sounds, but the formulation of entire sentences with or without meaning, even with insults or unbecoming words (in which case it is called coprolalia).
Some of these phenomena can be dangerous for the subject, who may feel the need to hit himself, involuntarily causing himself injuries.
For this reason, they can hinder a course of work or study and lead a subject out of shame or fear of social judgement to avoid social interactions.
How long does a tic last?
Tics can last from a few seconds to several minutes and in severe cases interfere with the functioning of the subject who has to stop what he or she is doing in order to carry out the tic.
Sometimes, they are preceded by a sensation that the patient describes as annoying and that can only be alleviated by performing the tic.
This classification is important to distinguish them from compulsions, repetitive behaviours that the subject enacts to counteract an obsession.
An example might be a subject who may fear that if he or she does not touch an object a certain number of times, something bad will happen to him or her.
Tics can fluctuate in type, frequency and severity, sometimes for unknown reasons and sometimes in response to specific internal and external factors, including stress, anxiety, excitement, fatigue and illness.
Other organic causes, e.g. intoxication or degenerative processes of the central nervous system, must be excluded in order to make the diagnosis.
What causes Tourette syndrome
At this time, the cause of Tourette syndrome is unknown, but numerous scientific studies consider genetic factors to be fundamental.
Environmental and neurodevelopmental factors may also intervene and influence the development of the condition.
Following its course among young people, it has been observed that only 10% of those under 18 have moderate to severe tics, while the remaining cases are mild or very sporadic.
Up to 30% of Tourette Syndrome sufferers may have an obsessive-compulsive disorder concomitant with or as a manifestation following the remission of tics, as well as attention deficit hyperactivity disorder (ADHD) (up to 52% of patients).
Tourette Syndrome, how can it be cured?
Currently, it is possible to apply integrated interventions that are adapted to the patient’s needs and degree of severity, which allow the symptomatology present in the course of the disorder to be managed.
If the patient presents mild symptoms that do not interfere with his or her functioning, periodic observation to exclude a possible evolution may be the most useful approach.
If, on the other hand, symptoms interfere with functioning or in very young subjects, behavioural psychotherapy is applied.
Habit Reversal in Tourette syndrome
Habit Reversal is one of the most studied behavioural interventions for people with tics, which consists of 2 main parts
- tic awareness training, in which the patient identifies each tic aloud;
- competitive response training, in which the patient learns to implement a new behaviour that cannot occur at the same time as the tic.
If, for example, the patient has a tic that involves head rubbing, a new behaviour might be to put the hands on the knees or cross the arms so that the head rubbing cannot occur.
What are the different medical therapies
Medical therapies can also be used when none of the therapies described above have been satisfactory.
Pharmacological treatments do not completely eliminate tics, but they reduce their frequency and intensity and considerably improve the subject’s quality of life.
There may also be further scope for the use of tools such as transcranial magnetic stimulation.
In the case of forms that are resistant to the treatments described above, it is possible to resort to additional tools for which efficacy has been demonstrated, e.g. botulinum toxin or psychosurgery (deep brain stimulation).
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