Tourette's syndrome (TS) is a disorder that causes people to make sounds and words (vocal tics) and have body movements (motor tics) that are beyond their control. Tics occur suddenly, may last from several seconds to minutes and have no meaning for the person. Tics need to be present for at least one year before the diagnosis of Tourette's syndrome can be confirmed.
Most people with Tourette's syndrome have their own unique type and pattern of tics. Tics may come and go over weeks and months. They may also change from one type to another. Many people with Tourette's syndrome have episodes of tics that interfere with their daily activities.
The first tics of Tourette's syndrome usually begin when children are between the ages of seven and ten years. But tics can begin as early as two years of age and as late as 18. Tics that begin after the age of 18 are not considered symptoms of Tourette's syndrome. Tourette's syndrome may or may not continue into adulthood.
About a third of children with Tourette's syndrome have no tics by the time they reach early adulthood. Another third have fewer and milder tics by the time they become adults. Another third continue to have severe tics into adulthood.
People with Tourette's syndrome may have other problems as well, including:
- Learning difficulties. A school-aged child with a tic that interferes with writing may have difficulty completing written assignments. Vocal tics may interfere with a child's ability to concentrate.
- Behavioral problems. Children may have aggressive, hostile, irritable and immature behavior. They may also have attention deficit hyperactive disorder.
- Children with Tourette's syndrome are also more prone to hurt themselves on purpose. Behavioral problems may be related to the emotional stress they feel because of the tics.
- Sleep problems. Patients may have trouble falling asleep, may be restless during sleep and may talk during sleep. They may also sleepwalk or have nightmares.
The effect Tourette's syndrome has on a child's life varies. Having tics does not affect a child's intelligence, but the condition may interfere with learning. The severity of the tics is not a good indicator of how well a child tics will do in school or social situations. The child's intelligence, ability to adjust to change and support from other people affect how well the child will cope.
The uncontrollable motor and vocal tics that are symptoms of Tourette's syndrome can be either simple or complex.
Simple motor tics involve only one muscle group. Complex ones can be a combination of many simple motor tics or a series of movements that involve more than one muscle group.
Some tics are more embarrassing than others. For example, a slight twitch of the eyes, jerk of the neck or a cough or throat-clearing causes less embarrassment than saying obscene words (coprolalia) or making obscene gestures (copropraxia).
Sometimes tics can be suppressed (much like people can hold back a sneeze) for a short while. However, most often the person eventually needs to let go and allow the tic to occur. Tics can be absent at certain times (such as during a particular class at school or a visit to a doctor) or they may last longer and be more severe (such as after trying to suppress them or when under stress). Tics may come and go over months, change from one tic to another tic or disappear for no apparent reason.
The course of Tourette's syndrome usually has a predictable pattern.
As children grow older, they may become aware of the tics. The child may explain them in different ways. Some ways may be comforting. ("I have a silly little cough.") Other ways can be upsetting. ("I am going crazy" or "Something or someone is inside me making me act goofy.") The child may try to cover up the tics by making other sounds or movements.
By age 10 or 11 years, a child with tics may be able to tell when one is starting. The child may feel muscle tightness, a skin irritation (such as a tickle) or a skin temperature change. At this age, a child's tics may start to become severe. During the teen years, tics usually are severe. Tics usually decrease during the 20s, and they may get worse again during the 30s or 40s.
Some adults with Tourette's syndrome are able to ignore the tics, and many adults consider themselves cured of Tourette's syndrome. However, some adults (particularly those with attention deficit hyperactive disorder or obsessive compulsive disorder may continue to have tics (and other behaviors) that interfere with their lives.
Most people with Tourette's syndrome are believed to have a gene that makes them more likely to develop the condition. However, that gene has not been identified. Other factors, such as a person's emotional and physical health or external stress, may also contribute to the development of Tourette's syndrome.
Diagnosis of Tourette's syndrome is based on the patient's medical history and the presence of tics. Diagnosis often requires keeping records of the child's symptoms and school performance over a period of time. For a diagnosis of Tourette's syndrome, the following must be present:
- Tics beginning before the age of 18. Tics that begin after that are not considered to be caused by Tourette's syndrome.
- Both body movements (motor tics) and sounds or words (vocal tics) are present (though not always at the same time) and have lasted for at least one year.
- Tics occur many times a day (usually in bouts) nearly every day.
Tics are not caused by another condition, such as seizures or medications (stimulants).
Although some children are bothered little by tics, other children are greatly affected. To evaluate the effect tics have on a child's life, the doctor will often ask parents questions about areas of the child's life. The child may also need psychological testing as well as testing for learning problems.
It can be difficult to diagnose Tourette's syndrome because tics (or symptoms that look like tics) can be caused by other related disorders. Tests that may be done to check for other conditions include an electroencephalogram (EEG) or computed tomography (CT) scan of the head to see if a person may have seizures or other brain problems. Blood tests may also be done to check for other conditions, including overuse of certain medications (such as amphetamines) or rare medical conditions, such as not being able to break down copper in the body (Wilson's disease).
There is no known cure for Tourette's syndrome. However, behavioral management techniques done at home, professional counseling, relaxation therapy, biofeedback, hypnosis and some medications are effective methods for treating the condition.
Brain surgery is currently being studied as a treatment for tics.