Tourette syndrome, also known as Tourette’s syndrome, is a neurological disorder characterized by both muscle tics (repeated, involuntary movements) and verbal tics (uncontrollable vocalizations). Central to the public image of the disorder, outbursts of vulgar and inappropriate language (technically known as coprolalia—literally, “talking about feces”) actually occur in a minority of cases, possibly in as few as 15 percent. Typical tics include eye blinking, involuntary facial muscle twitching, kicking, shoulder shrugging, frequent throat clearing, and sniffing.
The disorder was first described by French physician Georges Gilles de la Tourette, in a paper published in 1885. The disorder’s cause remains unknown, but the dominant theory concerns a genetic defect resulting in abnormal functioning of at least one neurotransmitter reuptake system in the brain (see Nervous System). This theory is supported by the success of selective serotonin reuptake inhibitors (SSRIs, a category of antidepressant medications) in treating some cases of Tourette syndrome. Symptoms usually emerge in childhood or adolescence, and Tourette syndrome occurs in three to four times as many boys than girls. For a diagnosis of Tourette syndrome to be made, both verbal tics and multiple motor tics must be present, and they must occur many times a day over a span of at least one year. The most common first symptom is a minor facial tic, such as a mouth twitch or eye blink. The syndrome actually can involve a wide spectrum of symptom patterns, with no typical set of tics, but most cases are considered mild rather than severe.
Tourette syndrome and other tic disorders rarely occur alone but rather tend to be comorbid with other problems, including but not limited to depression, anxiety disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder (ADHD), and sleep disorders. Treatment is complicated, consequently, by the need to treat the symptoms of the other disorders as well. Fortunately, the majority of persons with Tourette syndrome are not sufficiently disabled by their tics to require treatment. In cases of greater severity, antidepressants and antiseizure medicines (including clonidine and haloperidol) have been widely used to reduce symptoms. Methylphenidate (Ritalin) has also been used in cases where Tourette syndrome is comorbid with ADHD, but its use in Tourette syndrome is otherwise uncommon, as its properties as a stimulant can exacerbate tics rather than reduce them.
Bibliography:
- The Tourette Syndrome Association Web site, www.tsa-usa.org, The
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