Tourette's Syndrome

Understanding Tourette’s Syndrome

Tourette’s syndrome is characterized by ‘tics’ – involuntary, repetitive movements and vocal sounds.

Tourette's syndrome overview 

Tourette’s syndrome – named after the doctor who first described the condition – is a disorder that starts during childhood.1 People with the disorder suffer from tics, which can range from blinking and sniffing to obscene gestures and swearing.1 Tics tend to get worse when the person is anxious or excited, and to improve when they are calm, or focused on an activity such as schoolwork.1 Tics can have a major impact on a person’s quality of life, and can cause problems at school. 2-4

Facts about Tourette’s syndrome

Tourette’s syndrome is a childhood-onset disorder that is characterized by persistent ‘tics’ – sudden, rapid, recurring movements and vocal sounds.1

Tics usually emerge between 4 and 6 years of age.1

Symptoms of Tourette's syndrome

A seizure is classified as either ‘generalized’ or ‘focal’, depending on whether it affects the whole brain or just a part of the brain.5,6 The following symptoms can occur during a seizure:5,6

 

  • Motor symptoms – rhythmical jerking movements (‘clonic’); muscles becoming weak or limp (‘atonic’); muscles becoming tense or rigid (‘tonic’); brief muscle twitching (‘myoclonus’); or the body flexing and extending repeatedly (‘epileptic spasms’).
  • Non-motor symptoms – staring spells (‘absence’); changes in sensation, emotions, thinking or cognition; stomach/bowel sensations, waves of heat or cold, goosebumps, heart racing, etc. (‘autonomic functions’); or lack of movement (‘behavior arrest’).
Worldwide, up to 1% of children

have Tourette’s syndrome.2

2–4 times more common

in boys than in girls.1

Epidemiology and burden

Tics typically emerge between 4 and 6 years of age, are most severe between 10 and 12 years of age, and become less severe during adolescence.1,6

 

Tics can cause embarrassment, low self-esteem, and can lead to social isolation.2 More rarely, severe tics can result in conflict with others, and even pain and injury (e.g., from hitting oneself in the face).1,2 In addition to tics, people with Tourette’s syndrome may be unusually sensitive to touch (e.g., to clothing tags or tight socks), have behavioral problems, and suffer from disrupted sleep, which can have a major impact on their quality of life.3

 

The majority of people with Tourette’s syndrome (86%) also have a psychiatric disorder, most commonly attention deficit hyperactivity disorder  ADHD) or obsessive–compulsive disorder (OCD).Often, the psychiatric disorder is more problematic for the person than the tics.8

 

Children with Tourette’s syndrome, particularly those with severe symptoms and those with co-occurring disorders, are likely to have problems at school, and to need educational help.4

Facts about Tourette’s syndrome

Typically, tics are most severe between 10 and 12 years of age, and become less severe during adolescence.1,3

Tics can range from blinking and sniffing to obscene gestures and swearing.1

People who are concerned that their children are experiencing symptoms of Tourette’s syndrome should see their doctor for help and advice.

Diagnosis and care

People who are concerned that their children are experiencing symptoms of Tourette’s syndrome should see their doctor for help and advice. Tourette’s syndrome is diagnosed following discussions about the child’s developmental history and a clinical examination.

 

Tics can be difficult to recognize, and may be mistaken for other disorders (such as movement disorders, or the repetitive behaviors that are associated with OCD), which can complicate the diagnosis.1

 

Tic severity usually improves in adolescence, regardless of treatment, and doctors may try ‘watchful waiting’ to see if tics improve by themselves.6,9,10 For children with mild and non-disabling tics, treatment should involve education, counseling, and strengthening of self-confidence.2 Treatment of more disabling tics may involve behavioral therapies and medication.2,10

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

2. Kurlan RM. Treatment of Tourette syndrome. Neurotherapeutics. 2014;11(1):161–165.

3. Martino D, Ganos C, Pringsheim TM. Tourette syndrome and chronic tic disorders: the clinical spectrum beyond tics. Int Rev Neurobiol. 2017;134:1461–1490.

4. Claussen AH, Bitsko RH, Holbrook JR, Bloomfield J, Giordano K. Impact of Tourette syndrome on school measures in a nationally representative sample. J Dev Behav Pediatr. 2018;39(4):335–342.

5. Scharf JM, Miller LL, Gauvin CA, Alabiso J, Mathews CA, Ben-Shlomo Y. Population prevalence of Tourette syndrome: a systematic review and meta-analysis. Mov Disord. 2015;30(2):221–228.

6. Leckman JF, Zhang H, Vitale A, Lahnin F, Lynch K, Bondi C, et al. Course of tic severity in Tourette syndrome: the first two decades. Pediatrics. 1998;102(1 Pt 1):14–19.

7. Hirschtritt ME, Lee PC, Pauls DL, Dion Y, Grados MA, Illmann C, et al.; Tourette Syndrome Association International Consortium for Genetics. Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiatry. 2015;72(4):325–333.

8. Kumar A, Trescher W, Byler D. Tourette syndrome and comorbid neuropsychiatric conditions. Curr Dev Disord Rep. 2016;3(4):217–221.

9. Blotch MH, Leckman JF. Clinical course of Tourette syndrome. J Psychosom Res. 2009; 67(6):497–501.

10. Pringsheim T, Okun MS, Müller-Vahl K, Martino D, Jankovic J, Cavanna AE, et al. Practice guideline recommendations summary: treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology. 2019;92(19):896–906.

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

2. Scharf JM, Miller LL, Gauvin CA, Alabiso J, Mathews CA, Ben-Shlomo Y. Population prevalence of Tourette syndrome: a systematic review and meta analysis. Mov Disord. 2015;30(2):221–228.

3. Leckman JF, Zhang H, Vitale A, Lahnin F, Lynch K, Bondi C, et al. Course of tic severity in Tourette syndrome: the first two decades. Pediatrics. 1998;102(1 Pt 1):14–19.

4. Kurlan RM. Treatment of Tourette syndrome. Neurotherapeutics. 2014;11(1):161–165.

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