Tourette’s syndrome is a neurological disease that begins in childhood and is expressed as tics that occur involuntarily and consist of constantly repeating sudden movements or voices. Tourette syndrome was first described by the French doctor Gerard Gilles de La Tourette in 1985. It is also known as incontinence, sudden shouting, and tic disease among the people.
People with Tourette’s syndrome have a normal level of intelligence. Patients’ lifespan is not affected by Tourette’s syndrome. Tourette syndrome is a chronic disease that lasts for many years.
Throughout the illness, the symptoms may show an increasing graphic in the person over time. Tics are urges that cannot be taken under control, such as sneezing. Other than involuntary tics such as blinking and shrugging, it can be seen in symptoms such as making different sounds, speaking bad words, and swearing.
Tourette syndrome is very disturbing for the person. As a result of his involuntary actions, his self-confidence decreases, and his social life is negatively affected. Forcing oneself to suppress the symptoms is quite common in patients with Tourette’s syndrome. In order not to be misunderstood by the environment, the person may not press and do their tics for a while. But in these patients, such a strain causes the tics to flare up. Tics may occur suddenly with more severe symptoms.
Who gets Tourette syndrome?
Tourette syndrome is mostly seen in children. The first symptoms are observed, especially in children aged 4-6. When Tourette syndrome occurs between the ages of 10-12, the disease progresses more seriously. In clinical findings, it is observed that the severity of Tourette syndrome decreases in three-quarters of the patients after adolescence. Tourette syndrome, which is severe in adults, is very rare.
Tourette syndrome, a “neurobiological” hereditary disease, is more common in men than women. Tourette syndrome has an incidence rate of 2-5 per 10,000 people, depending on age.
How is Tourette syndrome diagnosed?
Since the disease has no pathological findings, Tourette syndrome cannot be diagnosed using imaging methods such as brain tomography (CT), magnetic resonance (MR), and positron emission tomography (PET). In Tourette’s syndrome, where laboratory results or measurement tests cannot be used, patients are diagnosed by a specialist physician with anamnesis and clinical observations. The presence of some criteria is important in diagnosing the disease.
- Tourette syndrome symptoms must appear before the age of 18.
- Simple and complex tics should be seen together in patients.
- The tics must have been going for over a year.
What causes Tourette syndrome?
The cause of Tourette’s syndrome is not yet fully known. It is thought to arise from a neurochemical disorder in the part of the brain called the basal ganglia where motor movements are regulated.
Studies have shown that the disease is hereditary. The child of an individual with Tourette syndrome has 50% of the disease. Tourette syndrome is encountered in 5-15% of the first-degree relatives of the patients.
In DNA research, it has been discovered that not a single gene but many genes are effective in the occurrence of the disease. In addition to genetic factors, it has been observed that situations that cause stress also trigger tics. Exam anxiety increases the severity and number of fatigue, excitement, panic, tics. The pressure exerted by the family on the child due to their tics may also cause the patient’s tics to increase.
Is every tic a Tourette syndrome?
Not all tics are Tourette syndrome. For a person with tics to be diagnosed with Tourette syndrome, the tics must have been present for more than a year and the tics must be found as complex.
What are the symptoms of Tourette syndrome?
Symptoms vary depending on the age of the person and the severity of the disease, and they are monitored mildly or severely. The most important symptoms of Tourette’s syndrome are tics.
Tics are divided into the motor and vocal tics:
MOTOR TICKS: MUSCLE TICKS THAT OCCUR WITH ONE OR MORE THAN MUSCLE WORK AT THE SAME TIME.
VOCAL TICS: TICKETS ALSO KNOWN AS FUNCTIONAL TICS CHARACTERIZED BY SOUNDS IN THE MOUTH, NOSE, AND THROAT.
Tics are divided into simple and complex (mixed) according to their structures:
Simple ticks: ticks that appear suddenly for months. THEY OCCUR WITH A VERY SHORT-TIME MOVEMENT OF MUSCLES.
Simple motor tics:
- Blinking and tilting,
- Nodding your head
- Eyebrow lift,
- Do not turn the head and neck,
- Blowing into the air,
- Handling and sniffing objects,
- Don’t stick out the tongue.
Simple vocal tics:
- Throat clearing,
In complex tics, more than one muscle group works at the same time.
Complex motor tics:
- Foot hitting,
- Don’t draw a circle by walking
- Don’t rub the teeth
- Bending over, crouching, jumping, and kicking.
Complex vocal tics:
- Echolalali (repetition of syllables, sounds, words, or movements made by others)
- Copropraxia (making suggestive signs)
- Palilali (multiple repetitions of the same sentence or word)
- Palypraxia (repetitions of the same movements many times)
- Barking, yelling and screaming,
In Tourette’s syndrome, different symptoms can be seen other than tics.
Symptoms such as attention-deficit / hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and depression, such as difficulty in concentrating attention, moving from one activity to another, needing to move constantly, and seeming not to listen are frequently encountered in Tourette’s syndrome.
Compulsive disorders are also seen in Tourette’s syndrome. The patient performs his menstrual movements over and over again in a certain order. For example, repeatedly checking whether the stove is extinguished, the desire to always keep the places in the same direction and in the same place.
Learning difficulties such as dyslexia, reading, writing, and perception difficulties, visual/physical integration problems are seen in Tourette’s syndrome. Sleep disturbances such as the patient walking or talking in his sleep, trouble falling asleep, and frequent waking up are seen in Tourette’s syndrome.
Inability to control their impulses, anger, and aggression may also occur in patients with advanced levels.
What are the treatment methods for Tourette’s syndrome?
Indeterminate mild tics may pass spontaneously over time and do not require treatment. However, if mild-moderate and moderate-severe tics negatively affect a person’s emotions and social life, they should be treated.
The treatment method is planned according to the age of the patient, clinical findings, the severity of the disease, and the discomfort given to the patient. Behavioral and drug therapy are used in the treatment of Tourette syndrome.
Interventional therapies, psychological supports, and various training are applied in the treatment of low-violence tics that do not affect the daily and social life of the person much. In the treatment of tics caused by stress, it is aimed to reduce tics by using relaxation techniques. Taking different hobbies and meditation also reduces the severity of Tourette’s syndrome.
Drug treatment is applied in patients who are insufficient in behavioral therapy. The most preferred drug therapy is clonidine, guanfacine, clonazepam, or other anxiety medications (especially if there is concomitant anxiety), and antipsychotics.
In recent years, deep brain stimulation (DBS), which is also used in the treatment of Parkinson’s, obsessive-compulsive disorder, is also used in the treatment of Tourette syndrome. An attachable electrode is used to change the activity of the brain current. DBS is not administered to every patient with Tourette’s syndrome. Before the surgical procedure, the patient should be examined by a neurologist, psychiatrist, and neurosurgeon and its suitability should be decided.
Early recognition of the symptoms of Tourette’s syndrome seen in children is even more important than the treatment of the disease. Because the symptoms are seen can cause ridicule and exclusion in the child with Tourette syndrome. Any unusual behavior that attracts the attention of the family, teachers or a random person in the environment should be taken into account. It should not be forgotten that especially the family should follow these suspicious behaviors and seek help from a specialist physician.
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