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What is Tourette syndrome?
Tourette syndrome (TS) is an inherited, neurological disorder
characterized by repeated involuntary movements and uncontrollable vocal
(phonic) sounds called tics. In a few cases, such tics can include
inappropriate words and phrases.
The disorder is named for Dr. Georges Gilles de la Tourette, the
pioneering French neurologist who first described an 86-year-old French
noblewoman with the condition in 1885.
The symptoms of TS generally appear before the individual is 18 years
old. TS can affect people of all ethnic groups; males are affected 3 to
4 times more often than females. It is estimated that 100,000 Americans
have full-blown TS, and that perhaps as many as 1 in 200 show a partial
expression of the disorder, such as chronic multiple tics or transient
childhood tics.
The natural course of TS varies from patient to patient. Although TS
symptoms range from very mild to quite severe, the majority of cases
fall in the mild category.
What are the symptoms?
The first symptoms of TS are usually facial tics--commonly eye
blinking. However, facial tics can also include nose twitching or
grimaces. With time, other motor tics may appear such as head jerking,
neck stretching, foot stamping, or body twisting and bending.
TS patients may utter strange and unacceptable sounds, words, or
phrases. It is not uncommon for a person with TS to continuously clear
his or her throat, cough, sniff, grunt, yelp, bark, or shout.
People with TS may involuntarily shout obscenities (coprolalia) or
constantly repeat the words of other people (echolalia). They may touch
other people excessively or repeat actions obsessively and
unnecessarily. A few patients with severe TS demonstrate self-harming
behaviors such as lip and cheek biting and head banging against hard
objects. However, these behaviors are extremely rare.
Tics alternately increase and decrease in severity, and periodically
change in number, frequency, type, and location. Symptoms may subside
for weeks or months at a time and later recur.
How are tics classified?
There are two categories of tics: simple and complex. Simple tics are
sudden, brief movements that involve a limited number of muscle groups.
They occur in a single or isolated fashion and are often repetitive.
Some of the more common examples of simple tics include eye blinking,
shoulder shrugging, facial grimacing, head jerking, yelping, and
sniffing. Complex tics are distinct, coordinated patterns of successive
movements involving several muscle groups. Complex tics might include
jumping, smelling objects, touching the nose, touching other people,
coprolalia, echolalia, or self-harming behaviors.
Can people with TS control their tics?
People with TS can sometimes suppress their tics for a short time,
but the effort is similar to that of holding back a sneeze. Eventually
tension mounts to the point where the tic escapes. Tics worsen in
stressful situations; however they improve when the person is relaxed or
absorbed in an activity. In most cases tics decrease markedly during
sleep.
What causes TS?
Although the basic cause of TS is unknown, current research suggests
that there is an abnormality in the gene(s) affecting the brain's
metabolism of neurotransmitters such as dopamine, serotonin, and
norepinephrine. Neurotransmitters are chemicals in the brain that carry
signals from one nerve cell to another.
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