What is Tourette Syndrome?

Tourette Syndrome (TS) is a neurological or "neurochemical" disorder characterized by tics -- involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way.

The cause has not been established, although current research presents considerable evidence that the disorder stems from the abnormal metabolism of at least one brain chemical (neurotransmitter) called dopamine. Very likely other neurotransmitters, such as serotonin, are also involved.

In 1825 the first case of TS was reported in medical literature by Dr. Itard. It was a description of the Marquise de Dampierre, a noblewoman whose symptoms included involuntary tics of many parts of her body and various vocalizations including echolalia [repetition or echoing of verbal utterances] and coprolalia [involuntary swearing or the involuntary utterance of obscene words or socially inappropriate & derogatory remarks]. She lived to the age of 86 and was again described in 1883 by Dr. Georges Gilles de la Tourette, the French neurologist for whom the disorder was named. Samuel Johnson, the lexicographer and André Malraux, the French author, are among the famous people who are thought to have had TS.

Symptoms

The most common first symptom is a facial tic, such as rapidly blinking eyes or twitches of the mouth. However, involuntary sounds, such as throat clearing and sniffing, or tics of the limbs may be the initial signs. For some, the disorder begins abruptly with multiple symptoms of movements and sounds.

The symptoms include:

  • Both multiple motor and one or more vocal tics present at some time during the illness although not necessarily in the same way;
  • The occurrence of tics many times a day (usually in bouts) nearly every day or intermittently throughout a span of more than one year;
  • The periodic change in the number, frequency, type and location of the tics, disappear for weeks or months at a time; and
  • Onset before the age of 18.

The term "involuntary" used to describe TS tics is a source of confusion since it is known that most people with TS do have some control over the symptoms. What is recognized is that the control which can be exerted from seconds to hours at a time, may merely postpone more severe outbursts of symptoms. Tics are experienced as irresistible as the urge to sneeze and must eventually be expressed. People with TS often seek a secluded spot to release their symptoms after delaying them in school or at work. Typically, tics increase as a result of tension or stress (but are not caused by stress) and decrease with relaxation or concentration on an absorbing task.

Individuals not only struggle with the condition itself, they must bear the double burden of the stigma attached.

Frequency/Ratio of TS

Since many people with TS have yet to be diagnosed, there are no absolute figures. Recent epidemiological studies suggest that the figure may be one in one hundred when those with chronic and transient tics are included in the count.

Tic Categories

Two categories of TS tics and some common examples are:

Simple:

  • Motor - Eye blinking, head jerking, shoulder shrugging and facial grimacing;
  • Vocal - Throat clearing, yelping and other noises, sniffing and tongue clicking.

Complex:

  • Motor - Jumping, touching other people or things, smelling, twirling about and, although very rare, self-injurious actions including hitting or biting oneself;
  • Vocal - Uttering ordinary words or phrases out of context, echolalia (repeating a sound, word or phrase just heard) and in rare cases, coprolalia (vocalizing socially unacceptable words). The range of tics or tic-like symptoms that can be seen in TS is enormous. The complexity of some symptoms often confuses family members, friends, teachers and employers who may find it hard to believe that the actions or vocal utterances are "involuntary".

Cure/Remission of TS

At this point in time, there is no cure for TS. Remission can occur at any time. Present data suggests that the tic symptoms tend to stabilize and become less severe in adult life. Those diagnosed with TS can anticipate a normal life span.
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