Gilles de la Tourette syndromeDefinition:
Gilles de la Tourette syndrome is a condition that causes a person to make repeated, quick movements or sounds that they cannot control. These movements or sounds are called tics.
The condition is commonly called Tourette syndrome.
Causes, incidence, and risk factors:
Tourette syndrome is named for Georges Gilles de la Tourette, who first described this disorder in 1885. There is strong evidence that Tourette syndrome is passed down through families.
The syndrome may be linked to problems in certain areas of the brain. It may have to do with chemical substances (dopamine, serotonin, and norepinephrine) that help nerve cells signal one another.
Tourette syndrome can be either severe or mild. Many people with very mild tics may not be aware of them and never seek medical help. Far fewer people have more severe forms of Tourette syndrome.
Tourette syndrome is four times as likely to occur in boys as in girls.
Symptoms of Tourette syndrome is often first noticed during childhood, between ages 7 and 10. Most children with Tourette syndrome also have other medical problems. These can include attention deficit hyperactivity disorder (ADHD) , obsessive compulsive disorder (OCD) , impulse control disorder, or depression.
The most common first symptom is a tic of the face. Other tics may follow. A tic is a sudden, fast, repeated movement or sound.
Symptoms of Tourette syndrome can range from tiny, minor movements (such as grunts, sniffling, or coughing) to constant movements and sounds that cannot be controlled.
Tics can include:
- Arm thrusting
- Eye blinking
- Repeated throat clearing or sniffing
- Shoulder shrugging
Tics may occur many times a day, but they tend to improve or get worse at different times. The tics may change with time. Symptoms usually get worse before the mid-teen years.
Contrary to popular belief, only a small number of patients use curse words or other inappropriate words or phrases (coprolalia).
Tourette syndrome is different from OCD. People with OCD feel as though they have to do the behaviors. Sometimes a person can have both Tourette syndrome and OCD.
Many people with Tourette syndrome can stop doing the tic for periods of time. But they find that the tic is stronger for a few minutes after they allow it to start again. Often the tic slows or stops during sleep.
Signs and tests:
There are no lab tests to diagnose Tourette syndrome. A health care provider will likely do an examination to rule out other causes of the symptoms.
To be diagnosed with Tourette syndrome, a person must:
- Have had many motor tics and one or more vocal tics, although these tics may not have occurred at the same time
- Have tics that occur many times a day, nearly every day or on and off, for a period of more than 1 year. During this period, there must not have been a tic-free period of more than 3 months in a row.
- Have started the tics before age 18
- Have no other brain problem that could be a likely cause of the symptoms
Persons who have very minor symptoms are not treated. This is because the side effects of the medicines may be worse than the symptoms of Tourette syndrome.
Different medicines are available to treat Tourette syndrome. The exact medicine that is used depends on the symptoms and any other medical problems.
Deep brain stimulation has shown promise for treating both the main symptoms of Tourette syndrome and the obsessive-compulsive behaviors, but not when these symptoms occur in the same person.
Symptoms are usually worst during the teenage years and then improve in early adulthood. In some persons symptoms go away entirely for a few years and then return. In a few persons, symptoms do not return at all.
Conditions that may occur in people who have Tourette syndrome include:
These conditions need to be diagnosed and treated.
Calling your health care provider:
Make an appointment with your health care provider if you have tics that are severe or persistent, or if they interfere with your daily life.
There is no known prevention.
Cohen S, Leckman JF, Bloch MH. Clinical assessment of Tourette syndrome and tic disorders. Neurosci Biobehav Rev. http://dx.doi.org/10.1016/j.neubiorev.2012.11.013.
Kurlan R. Clinical practice Tourette's Syndrome. N Engl J Med. 2010;363:2332-2338.
Ryan CA, Gosselin GJ, DeMaso DR. Habit and tic disorders. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 22.