Tourette syndrome
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Tourette syndrome — also called Tourette's syndrome, Tourette Spectrum (TS), Tourette's disorder, or Gilles de la Tourette syndrome (after its discoverer, Georges Gilles de la Tourette) — is a neurological or neurochemical disorder characterized by tics — involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way. Symptoms include multiple motor and one or more vocal tics present at some time during the disorder although not necessarily simultaneously; the occurrence of tics many times a day (usually in bouts) nearly every day or intermittently throughout a span of more than one year; the periodic change in the number, frequency, type and location of the tics, and in the waxing and waning of their severity; symptoms disappearing for weeks or months at a time; and onset before the age of 18. Vocal tics may fall into various categories, including echolalia (the urge to repeat words spoken by someone else after being heard by the person with the disorder), palilalia (the urge to repeat one's own previously spoken words), lexilalia (the urge to repeat words after reading them) and, most controversially, coprolalia (the spontaneous utterance of socially objectionable words, such as obscenities and racial or ethnic slurs). There are many other vocal tics besides those categorized by word repetition - in fact, a TS tic can be almost any possible short vocal sound, with the most common tics resembling throat clearing, short coughs, grunts, or moans. Motor tics can be of endless variety and may include hand-clapping, banging the knuckles together, and contorted facial grimacing.
The term "involuntary" used to describe TS tics is a source of confusion since it is known that most people with TS do have some control over the symptoms. Before tic onset, individuals with TS experience what is called a "premonitory urge," similar to the feeling that precedes yawning. What is recognized is that the control which can be exerted from seconds to hours at a time may merely postpone and exacerbate outbursts of symptoms. Tics are experienced as irresistible as a yawn and must eventually be expressed. People with TS often seek a secluded spot to release their symptoms after delaying them in school or at work. Typically, tics increase as a result of tension or stress (but are not caused by stress) and decrease with relaxation or concentration on an absorbing task. In fact, neurologist and writer Oliver Sacks has described a man with severe TS who is both a pilot and a surgeon.
Other commonly associated symptoms are obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD).
The entertainment industry has often depicted those with TS as being social misfits whose only tic is coprolalia, which has led to the general public's misunderstanding of TS sufferers as "people who can't help yelling swear words a lot". However, this is merely a clinomorphism, as coprolalia is a relatively rare symptom compared to other types of tics.
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Diagnosis
According to the DSM-IV, TS is indicated when a person exhibits both multiple motor and one or more vocal tics (although these do not need to be concurrent) over the period of 1 year, with no more than 3 consecutive tic-free months. This disturbance must cause distress or impairment in the individual's normal functioning. The onset must have been before the age of 18, and cannot be attributed to the use of a substance or another medical condition.
It is estimated that as many as 1 in 200 experience some form of TS. Males are affected 3 to 4 times more often than females. Some cases decrease in severity or cease entirely upon reaching adulthood.
As it is a spectrum disorder, the severity of the condition can range vastly. Those with mild cases are often highly functioning, so much so that others would not know of their condition. More severe cases can inhibit or prevent the individual from engaging in common activities such as holding a job, having a fulfilling social life, or maintaining his/her basic needs.
Treatment
The majority of people with TS require no medication, but medication is available to help when symptoms interfere with functioning. TS medications are only able to help reduce specific symptoms. Neuroleptic and antihypertensive drugs can have long- and short-term side effects, and use of stimulants is controversial. Relaxation techniques and biofeedback may be useful in alleviating stress.
Until 2004, there wasn't a cure for TS. However, doctors in the US successfully carried out a brain surgery in February 2004, in which tiny electrodes powered by batteries inserted in the chest, were placed beside the thalamus in each cerebral hemisphere. Within half a minute of activating the electrodes, the patient could walk normally and displayed a complete lack of symptoms. However, this is a dangerous procedure and is unlikely to become widespread. In any case, the condition in many individuals improves as they mature. Individuals with TS can expect to live a normal life span. Although TS is generally lifelong and chronic, it is not degenerative. In a few cases, complete remission occurs after adolescence, and in many cases this occurs after the age of 40.
Cognitive Behavioural Therapy (CBT) can be used to try to disrupt the automatic chain of events underlying the tics.
Genetics
Genetic studies indicate tic disorders, including TS, are inherited as a dominant gene(s) that may produce varying symptoms in different family members. A person with TS has about a 50% chance of passing the gene(s) to one of his/her children. However, the gene(s) may express as TS, as a milder tic disorder, or as obsessive compulsive symptoms with no tics at all. It is known that a higher than usual incidence of milder tic disorders and obsessive compulsive behaviours are more common in the families of TS patients. The sex of the child also influences the expression of the gene(s). The chance that the child of a person with TS will have the disorder is at least three times higher for a son than for a daughter. Yet only a minority of the children who inherit the gene(s) will have symptoms severe enough to ever require medical attention. In some cases, TS may not be inherited; these cases are identified as "sporadic" TS because a genetic link cannot be found.
Alternative medicine
Alternative medicine tends to hold the view that TS is caused by yeast infections and mercury poisoning (see gluten-free, casein-free diet).
Famous People with Tourette's
- Joshua James William Skaug - author
- Mahmoud Abdul-Rauf - former NBA player
- Howard Ahmanson, Jr, American Christian fundamentalist and millionaire philanthropist
- Tim Howard - goalkeeper for Manchester United Football Club
- Jim Eisenreich - former major league baseball player
- Mike Johnston - relief pitcher for the Pittsburgh Pirates
- Michael Wolff - Jazz musician
- Dr. Samuel Johnson, lexicographer, certainly had Tourette syndrome as evidenced by the writings of James Boswell.
- Some historians think Mozart may have had Tourette syndrome, although many experts on Tourette syndrome disagree (see external link below).
- Some neurologists think Thelonius Monk may have had Tourette syndrome
In fiction
- The Tic Code (http://www.imdb.com/title/tt0165986/) is an unusually accurate discussion of the syndrome, with extensive input from Polly Draper, whose husband and son both suffer from it.
- The character of Jeronimo in The Confusion (volume two of Neal Stephenson's Baroque Cycle) is a typical clinomorphism, with severe coprolalia and extremely fast reflexes.
- Seldom Silent, Never Heard (http://www.tvtome.com/tvtome/servlet/GuidePageServlet/showid-579/epid-42316/), a sixth-season episode of Quincy, M.E., focuses extensively on Tourette's Syndrome. It originally aired on March 4, 1981.
- The main character, Lionel, in Motherless Brooklyn by Jonathan Lethem also suffers severely from coprolalia.
In music
- The grunge band Nirvana recorded a song on the In Utero album titled "tourette's [sic]"—a song with neither audible nor written lyrics, but only shouting, as if mimicking the Tourette Syndrome.
References
- Tourette Syndrome Fact Sheet (http://www.ninds.nih.gov/health_and_medical/pubs/tourette_syndrome.htm), provided by NINDS
- "Making Sense of Tourette's" (http://www.sciencemag.org/cgi/content/summary/305/5689/1390?etoc), Science Magazine volume 305, 3rd Sept 2004, p1390
- DSM-IV Diagnostic Critera for TS (http://www.psychologynet.org/tourette.html)
External links
- The Tourette Syndrome Association Inc. (http://www.tsa-usa.org/) - The US advocacy group.
- The Tourette Syndrome (UK) Association (http://www.tsa.org.uk/) - The UK advocacy group.
- Tourette Syndrome Association of Australia (http://www.tourette.org.au/) - The AU advocacy group.
- Tourette's Disorder (http://www.tourettes-disorder.com/) - A TS awareness website.
- Mr. Indiana Jones (http://www.mrindianajones.com/) - A TS sufferer's personal website containing info about TS.
- BBC article on surgery that led to cure (http://news.bbc.co.uk/2/hi/health/3589395.stm), and the followup interview with the cured patient (http://news.bbc.co.uk/2/hi/health/3591401.stm).
- Mozart and Tourette Syndrome (http://www.tourettes-disorder.com/mozart.html).de:Tourette-Syndrom