Tourette’s syndrome: Symptoms, causes, and treatment

Tourette’s syndrome is a disorder that involves various physical tics and at least one vocal tic. A few people with Tourette’s unintentionally utter inappropriate or obscene words.

A tic is an unusual movement or sound that a person has little or no control over. It may include eye blinking, coughing, throat clearing, sniffing, facial movements, head movements, or limb movements, or making unusual sounds.

The tics are more common in people with obsessive-compulsive disorder (OCD), an autistic spectrum disorder (ASD), or attention deficit hyperactivity disorder (ADHD).

According to the Tourette Association of America, 1 in every 160 children in the United States may have Tourette’s syndrome. It is thought to affect 200,000 Americans, and it affects males more than females.

The condition has been linked to damage or abnormalities in the basal ganglia of the brain.

Fast facts on Tourette’s syndrome:

Here are some key points about Tourette’s syndrome. More detail is in the main article.

A person with Tourette’s syndrome will have physical and vocal tics lasting more than a year.

It is a neurological disorder with symptoms that are made worse by stress.

Treatment includes medication and behavioral therapy.

Tourette’s does not have serious complications, but it may be accompanied by other conditions, such as ADHD, and these can cause learning difficulties.

What is it?

Symptoms of Tourette's include frequent blinking, shaking the head, or clearing the throat.
Symptoms of Tourette’s include frequent blinking, shaking the head, or clearing the throat.

Tourette’s is one of a range of tic disorders that can involve transient or chronic tics. The tic can emerge at any age, but it most commonly appears between the ages of 6 and 18 years.

During adolescence and early adulthood, the tics will normally become less severe, but In 10 to 15 percent of cases, Tourette’s can become worse as the person moves into adulthood.

For most people, the frequency and intensity of both minor and major tics tend to fluctuate. Tics may become more frequent and more intense when a person is facing physical, emotional, or mental stress.

Most people with Tourette’s have normal intelligence and life expectancy.

Symptoms

The hallmark sign of Tourette’s syndrome is a tic. This can range from barely noticeable to severe enough to make daily life challenging.

A facial tic, such as eye blinking, may be the first sign, but each person is different.

A tic may be:

Physical: Motor movements include blinking or jerking the head or another part of the body.

Phonic: The person may utter sounds, such as grunts or squeaks, and words or phrases.

There are two main classifications:

Simple tic: This may involve moving just one muscle, or uttering a single sound. Movements are sudden, short lived, and often repetitive.

Complex tic: The physical movements are more complex, and the phonic tics may include long phrases. Complex tics involve several muscle groups.

People with Tourette’s have a combination of phonic and physical tics, which may be simple or complex.

Examples of simple physical tics may include:

eye blinking

eye darting

grinding the teeth

head jerking

neck twisting

nose twitching

rolling the eyes

rotating the shoulders

shoulder shrugging

sticking the tongue out

Examples of simple phonic tics may include:

barking sounds

blowing

clearing the throat

coughing

grunting

hiccupping

sniffing

squeaking

yelling and screaming

Examples of complex physical tics may include:

copropraxia, or making obscene gestures

echopraxia, or miming the movements of other people

flapping

head shaking

hitting things

jumping or hopping

kicking things

shaking

smelling objects

touching oneself or others

Examples of complex phonic tics include:

varying one’s voice intonation

echolalia, or repeating what other people say

paliphrasia, or saying the same phrase over and over again

coprolalia, which means uttering or shouting obscene words or phrases

Most people will experience unusual or uncomfortable sensations before the onset of a tic.

Types of advanced warning include:

a burning feeling in the eyes that is only alleviated by blinking

increasing tension in the muscles that can only be alleviated by stretching or twitching

a dry throat that is only alleviated by grunting or clearing the throat

itching in a limb or joint, where the only relief is achieved by twisting it

Situations that may cause tics to worsen include:

anxiety or stress

fatigue, or tiredness

illness, especially a streptococcal infection

excitement

a recent head injury

Medical News Today (MNT) asked the Tourette Association of America’s Medical Advisory Board what advice they would give to parents who think their child may have Tourette’s.

They told us:

“Tourette Syndrome is characterized by motor and vocal tics longer than 12 months. If this is the case, then start with a visit to the child’s primary care physician for an evaluation. Talk to him or her to see if the tics are causing pain or discomfort, bothering him or her, or affecting schoolwork or desired activities.

The Association provide resources and support for people with Tourette’s and for patents of children with the condition, including tools for parents and educators and information on how to find advocacy and support groups.

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Causes and risk factors

The exact cause of Tourette’s syndrome is unknown, but it appears to stem from a problem in the basal ganglia, the part of the brain that is responsible for involuntary movements, emotion, and learning.

Experts believe that abnormalities in the basal ganglia may cause an imbalance in levels of brain neurotransmitters, which transfer messages from one cell to another. Abnormal neurotransmitter levels may disrupt normal brain function, resulting in tics.

Parkinson’s disease, Huntington’s disease, and other neurologic conditions affect the basal ganglia.

Tourette’s syndrome is believed to have a genetic link and to be hereditary. A person who has a close family member with a tic is more likely to have one, too.

It also appears to be more common in infants who are born preterm.

Another theory is that a childhood illness may trigger tics. Infection with group A streptococcal bacteria has been linked with symptoms of Tourette’s. It may be that the bacteria cause the immune system to produce antibodies that interact with brain tissue, and this brings about changes in the brain.

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