Syndrome (TS) is a neurological disorder characterized by tics --
involuntary, rapid, sudden movements or vocalizations that occur
repeatedly in the same way. The symptoms include:
multiple motor and one or more vocal tics present at some time during the
illness although not necessarily simultaneously;
occurrence of tics many times a day (usually in
bouts) nearly every day or intermittently throughout a
span of more than one year; and
changes in the number, frequency, type and
location of the tics, and waxing and waning of their severity. Symptoms
can sometimes disappear for
weeks or months at a time.
before the age of 18.
term, "involuntary," used to describe TS tics is sometimes
confusing since it is known that most people with TS do have some control
over their symptoms. What is not recognized is that the control, which can
be exercised anywhere from seconds to hours at a time, may merely
postpone more severe outbursts of symptoms. Tics are experienced as
irresistible and (as with the urge to sneeze) eventually must 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, and decrease with relaxation or when focusing on an
A. The cause has not been established, although current research
presents considerable evidence that the disorder stems from the abnormal
activity of at least one brain chemical (neurotransmitter) called
dopamine. There may be abnormal activity of the receptor for this chemical
as well. Undoubtedly, other neurotransmitters, e.g. serotonin, may
involved as well.
are the first symptoms?
A. The most common first symptom is a facial tic such as rapidly
blinking eyes or twitches of the mouth. Involuntary sounds such as throat
clearing and sniffing, or tics of the limbs may be initial signs. For a
minority, the disorder begins abruptly with multiple symptoms of movements
it important to treat Tourette Syndrome early?
A. Yes, especially in those instances when the symptoms are viewed
by some people as bizarre, disruptive and frightening. It is also
important to consider therapy when the child is concerned over her/his
acceptance to peers. Sometimes TS symptoms provoke ridicule and rejection
by peers, neighbors, teachers and even casual observers. Parents may be
overwhelmed by the strangeness of their child's behavior. The child may be
threatened, excluded from activities and prevented from enjoying normal
interpersonal relationships. These difficulties may become greater during
adolescence -- an especially trying period for young people and even more
so for a person coping with a neurological problem. To avoid psychological
harm, early diagnosis and treatment are crucial. Moreover, in more
serious cases, it is possible to control many of the symptoms with
Compulsions and Ritualistic Behaviors which occur when a person
feels that something must be done over and over and/or in a certain way.
Examples include touching an object with one hand after touching it with
the other hand to "even things up" or repeatedly checking to see
that the flame on the stove is turned off. Children sometimes beg their
parents to repeat a sentence many times until it "sounds right."
Repetitive copying and erasing of work in school can be quite disabling.
Attention Deficit Disorder with or without Hyperactivity
(ADD or ADHD) occurs in many people with TS. Children may show signs
of hyperactivity before TS symptoms appear. Indications of ADHD may
include: difficulty with concentration; failing to finish what is started;
not listening; being easily distracted; often acting before thinking;
shifting constantly from one activity to another; needing a great deal of
supervision; and general fidgeting. Adults too may exhibit signs of ADHD
such as overly impulsive behavior and concentration difficulties and the
need to move constantly. ADD without hyperactivity includes all of the
above symptoms except for the high level of activity. As children with
ADHD mature, the need to move is more likely to be expressed by restless,
fidgety behavior. Difficulties with concentration and poor impulse control
Learning Disabilities may include reading and writing difficulties,
problems with mathematics, and perceptual problems.
Difficulties with impulse control which may result, in rare
instances, in overly aggressive behaviors or socially inappropriate acts.
Also, defiant and angry behaviors can occur.
Sleep Disorders are fairly common among people with TS. These
include difficulty getting to sleep, frequent awakenings or walking
or talking in one's sleep.
A. While school children with TS as a group have the same IQ range
as the population at large, many have special educational needs. Data show
that many may have some kind of learning problem. That condition, combined
with attention deficits and the difficulty coping with frequent tics,
often call for special educational assistance. The use of tape recorders,
typewriters, or computers for reading and writing problems, un-timed exams
(in a private room if vocal tics are a problem), and permission to leave
the classroom when tics become overwhelming are often helpful. Some
children need extra help such as access to tutoring in a resource room.
When difficulties in school cannot be resolved, an educational evaluation
may be indicated. A resulting identification as "other health
impaired" under federal law will entitle the student to an Individual
Education Plan (IEP) which addresses specific educational problems in
school. Such an approach can significantly reduce the learning
difficulties that prevent the young person from performing at his/her
potential. The child who cannot be adequately educated in a public school
with special services geared to his/her individual needs may be best
served by enrollment in a special school or home schooled.
Is there Hereditary
A. Genetic studies indicate that TS is inherited as a dominant gene
(or genes) causing different symptoms in different family members. A
person with TS has about a 50% chance of passing the gene to one of
his/her children with each separate pregnancy. However, that genetic
predisposition may express itself as TS, as a milder tic disorder or as
obsessive compulsive symptoms with no tics at all. It is known that a
higher than normal incidence of milder tic disorders and obsessive
compulsive behaviors occur in the families of TS patients.
The sex of the offspring also influences the expression of the gene. The
chance that the gene-carrying child of a person with TS will have symptoms
is at least three to four times higher for a son than for a daughter. Yet
only about 10% of the children who inherit the gene will have symptoms
severe enough to ever require medical attention. In some cases TS may not
be inherited, and cases such as these are identified as sporadic TS. The
cause in these instances is unknown.
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