Tourette Syndrome

Gilles de la Tourette (ZHEEL de la too-RETT) syndrome (called Tourette) is a neurological disorder that causes a person to make sudden movements or sounds, which are called tics. Many scientists think Tourette syndrome is caused by a chemical imbalance in the brain.

When Daniel yelped out loud like a dog, and his classmates erupted with laughter, Ms. Jones sent him to the school office. The teacher knew Daniel was being treated for hyperactivity, but recently he had been blinking his eyes, twitching his nose, and shufHing his feet. Ms. Jones decided she could no longer tolerate his interruptions. She also was concerned about Daniel. Was he just showing off, or could he have a more serious condition? She had read about Tourette syndrome, which causes strange movements and sounds. Was that Daniel's problem?

Gilles de la Tourette syndrome is named after the French physician Georges G. A. B. Gilles de la Tourette (1857–1904), who first described the disorder in 1885. It is commonly referred to as Tourette syndrome (TS). The symptoms are tics: abrupt, rapid, and repeated movements or vocal sounds. Researchers have identified more than 80 tics associated with this syndrome, including grunts, barks, babbling, eye movements, head or neck motions, throat clearing, grimaces, shrugging, sniffing, leg and mouth motions, and motions of the torso.

Tics are categorized as either simple or complex. Simple motor tics include twitching of an eye or a jerking movement of the arm. Simple vocal tics include grunts, barks, or other noises. Complex tics involve several coordinated muscle movements, including twirling or doing deep knee bends when walking. Complex vocal tics include stuttering, babbling, uttering profanities, or echoing sounds. The more common tics in TS are:

People with more severe tics may mutilate themselves by biting their lips or banging their heads. Others may exhibit obsessive-compulsive behavior such as excessive hand washing. In addition to tics, a person with TS may show signs of hyperactivity, poor coordination, or attention deficit hyperactivity disorder (ADHD).

People with TS can sometimes control their tics for minutes, but like a suppressed sneeze, the tic inevitably returns. Tics get worse when a person is tired or anxious; they get better when a person is focused and concentrating on something. Severe tics can be more pronounced around family and close friends and less pronounced in the presence of strangers. Tics are less pronounced in the morning, worse at night, and, generally, not evident when a person is sleeping.

The disorder usually begins in childhood. Symptoms appear around age seven, and 90 percent of cases develop before age 10. Boys are four times more likely to develop TS than girls. About 1 person in 2,000 has TS.

At least 25 percent of all children display a simple tic. However, these tics go away within a year and are not a sign of TS. A person with TS may have tics for a lifetime, although the frequency and type of tic may change. About 35 percent of people with TS experience an easing of symptoms in adolescence; most others find that, even if they do not disappear, tics become less frequent and less severe in adulthood. The reverse can also be true: Some people with mild symptoms develop severe tics in their 20s or early 30s.

People with TS may suffer social embarrassment or emotional stress due to their tics. The disorder does not affect their intelligence or ability to lead a full life.

In the Middle Ages, people who displayed movement and vocal tics were thought to be possessed by demons. Gilles de la Tourette, the French physician who studied the disorder in the 1800s, thought TS had a physiological basis, which means that its cause was physical, not mental. Modern scientists think Gilles de la Tourette was right.

Scientists believe TS is caused by an abnormality in the brain's neurotransmitters, which are chemicals that carry signals from one nerve cell to another. The affected neurotransmitter is dopamine, a chemical that controls movement. Research indicates that some forms of TS are inherited, which means they are passed down from parent to child.

An accurate and prompt diagnosis is important to a person with TS, especially if the symptoms surface during childhood. People with TS are often misunderstood or ridiculed, and children may be punished for behavior that is out of their control.

Most people with TS do not need medication. Medication is reserved for people with severe or disruptive cases of TS. For those with severe tics, medication can reduce the frequency and severity of their symptoms so they can function at school, at work, and in social settings.

See also Anxiety and Anxiety Disorders: Overview • Attention Deficit Hyperactivity Disorder (ADHD) • Obsessive-Compulsive Disorder • Tic Disorders: Overview