Overview of Tourette Syndrome Essay

Nikki Allen
Tourette Syndrome (TS) is a neurological disorder characterized by involuntary motor tics and, sometimes, vocal tics (Walkup, 2013). The syndrome is named after the French medical scholar, Gilles de la Tourette. In 1885, Gilles de la Tourette published an article in the medical journal, Archives de Neurologie, which described “a bizarre neurological condition that he referred to as ‘maladie des tics’ (Kevin St. P. McNaught, 2010).” In more recent times, researchers have theorized that the disorder has origins in the basal ganglia; specifically in the caudate nucleus area. In Tourette syndrome, the neurotransmitter, dopamine is produced in excess in the nerve cells, causing the caudate nucleus to be inundated with the extra dopamine. This excess causes a reduction in the messages regarding motor control sent from the brain to the other parts of the body creating spurts of involuntary movement. Researchers surmise that the tics are the brain’s method of compensating for and correcting the chemical imbalance the body is experiencing.Overview of Tourette Syndrome Essay Other researchers have attributed the uncontrolled motor movements to an underdevelopment of serotonin and norepinephrine (Brill, 2002). Tourette syndrome is believed to be hereditary. It has also been suggested that environmental conditions and infections may play a role in the development of Tourette syndrome, but more research is needed to either prove or disprove that theory (Kevin St. P. McNaught, 2010).

For an individual to be diagnosed with Tourette syndrome, the following criteria must be met, according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5):

have two or more motor tics (for example, blinking or shrugging the shoulders) and at least one vocal tic (for example, humming, clearing the throat, or yelling out a word or phrase), although they might not always happen at the same time.Overview of Tourette Syndrome Essay
have had tics for at least a year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on.
have tics that begin before he or she is 18 years of age.
have symptoms that are not due to taking medicine or other drugs or due to having another medical condition (for example, seizures, Huntington disease, or postviral encephalitis) (CDC, 2014).Overview of Tourette Syndrome Essay
Typically, individuals will begin to show signs of Tourette syndrome in early childhood. As the individual ages, other more complex motor tics, and sometimes vocal tics, appear (Samuel H. Zinner, 2014). Tics can be classified as simple or complex. Simple motor tics involve movement of only one body part. Examples include neck twisting, eye blinking, leg jerking, and finger flexing. Complex motor tics involve more than one muscle group. Examples include leaping, twirling, touching other people or things, and biting oneself. Simple vocal tics involve moving air through the nose or mouth to create a noise. Examples include tongue clicking, whistling, throat clearing, and sniffing. Complex vocal tics involve multiple noises or words. Examples include repeating the same phrase as someone else, repeating the last sound or word multiple times, and the less common vocal tic of swearing or using obscenities (Brill, 2002).Overview of Tourette Syndrome Essay

“A Centers for Disease Control and Prevention (CDC) study has found that 1 of every 360 children 6 through 17 years of age and living in the United States have been diagnosed with TS based on parent report; this represents about 138,000 children. Other studies using different methods have estimated the rate of TS at 1 per 162 children (CDC, Data & Statistics, 2014).” All ethnic groups can be affected by the disorder. Males tend to be affected five times more often than females. Diagnosis occurs more frequently in the 12-17 year old range. Caucasians have twice as many occurrences than Hispanic Americans or African Americans (CDC, Data & Statistics, 2014). 90% of individuals with Tourette syndrome have other comorbid conditions, such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), Oppositional Defiant Disorder (ODD), anxiety, mood or sleep disorders, and learning disabilities (Samuel H. Zinner, 2014).Overview of Tourette Syndrome Essay

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Two approaches are commonly used once the diagnosis of Tourette syndrome has been made: the behavioral approach and the medication approach. In the behavioral approach, the therapists concentrate on Habit Reversal Training (HRT) or Comprehensive Behavioral Intervention for Tics (CBIT). HRT has the most success in adults because its success depends on the person’s awareness of their tics in general, as well as, the sensation just prior to the tic occurring. In HRT, the individual can initiate a competing response to either lessen the appearance of the tic or inhibit the tic from occurring altogether (Martin L. Kutscher, 2014). For example, if the person has a wrist flexion tic, they can perform and sustain a wrist extension until the tic urge passes (Samuel H. Zinner, 2014). Adults have had the most success with HRT because they are more aware of their bodies due to their maturity level. Therapists do not typically try to use this technique with young children. CBIT is considered a more comprehensive behavioral approach because it combines education, relaxation techniques, and an individualized approach of recognizing lifestyle factors that exasperate the frequency of tics. This approach has had success in both adults and children. The major drawback to the behavioral approach is the fact that the benefits are not immediate and that it takes commitment from and maturity of the patient to see the most benefits. (Martin L. Kutscher, 2014).Overview of Tourette Syndrome Essay

In the medication approach, doctors prescribe medications to treat only the symptoms, since there is no medication that will cure Tourette syndrome nor eliminate tics entirely. Catapres and Tenex are most often prescribed when starting a drug therapy program. These drugs can also be helpful with managing ADHD, anxiety, and insomnia. Other medications, such as Risperdal, Orap, Haldol, and Klonopin, can be prescribed for more severe tics. Most medication trials have been performed on adults and the use of these drugs in children are considered off-label, but some younger individuals have had success with drug therapy. Some drawbacks to the medication approach are: unpleasant side effects, difficulty with compliance in regards to patients actually taking their medication, and lack of response from the medication itself in controlling tics (Samuel H. Zinner, 2014).Overview of Tourette Syndrome Essay

Occupational therapists can contribute to the treatment of Tourette syndrome. The occupational therapist can treat the patient using HBT and CBIT techniques. Education of Tourette syndrome for the patient and caregiver should be addressed prior to any OT intervention. An occupational therapist can help a patient to identify and emphasize their strengths rather than focus on the shame and social stigma that often accompanies movement disorders or vocal tics (Samuel H. Zinner, 2014). Other areas an OT can work on with the patient are: deep breathing and relaxation techniques, guided imagery, and progressive muscle relaxation. Implementing a home exercise program (HEP) and encouraging the patient to practice yoga or tai chi have been shown to also be beneficial (Brill, 2002).Overview of Tourette Syndrome Essay

Tourette Syndrome (TS) was first formally identified by a French Physician called Georges Albert Edouard Gilles de la Tourette (1857-1904) in 1884. He wrote an article describing nine individuals who displayed involuntary movements (tics), involuntary sounds, compulsive rituals and compulsive behaviours, all with childhood onset. The condition was subsequently named Gilles de la Tourette Syndrome or what is nowadays better known as just Tourette Syndrome (TS).

For many years after this TS was considered to be extremely rare. There is now growing evidence that it may be quite common and often goes un-diagnosed and there are probably many more incorrect diagnoses of TS.

These days TS is known amongst the medical professions as being a spectrum disorder of neurological origin with varying symptoms depending upon the person.Overview of Tourette Syndrome Essay

Characteristics of Tourette Syndrome

Tourette Syndrome is characterised by several indicators including muscular tics, vocal or phonic tics, disinhibited thoughts, emotional differences including difficulties in emotional regulation, obsessive compulsions and rituals. The characteristics and frequency of indicators can change throughout a “Touretter’s” life time. The onset of Tourette Syndrome is usually in childhood between the ages of 5 and 10 (average 7) years old (Packer, 1994). People with TS have little or no control over the indicators and often describe their TS as having a mind of its own or as a “monster within”. Tics, thoughts and compulsions have a habit of occurring when they are least wanted, and by purposely trying to repress them can make the urge become stronger and stronger until a release becomes inevitable.Overview of Tourette Syndrome Essay

Tics can be divided into two types:

Muscular tics – Rapid and repetitive movements of one muscle group, such as eye blinking, shoulder shrugging, squinting, or facial grimacing, hyperventilating, head nodding, stomach contracting.

Vocal tics – Repetitive sounds that can include throat clearing, sniffing, grunting, squeaking, coughing and words or phrases.

This division is based on the objective appearance of the tics, although some Tourettists would argue that there is no internal difference between muscular and vocal tics and the part of the brain that orders the tics does not differentiate (Bloss, 2006). Tics often last a short while, and then disappear and become replaced by a different tic. This is a phenomenon called “waxing and waning” by the medical professions.Overview of Tourette Syndrome Essay

As Tourette Syndrome develops so does the nature of the tics. They become more complex. Simple muscular tics of the head and neck often become complex muscular tics consisting of several muscle groups in one sequence.

Phonic tics often develop from meaningless utterances to full words and phrases.

Complex and developed tics can take on several forms (Packer, 94).Overview of Tourette Syndrome Essay

Echolalia is the vocal imitation of sounds made by people or objects. Many Tourettists find the urge to repeat these sounds irresistible, and often have to practice until the sounds are perfect. Pete, (Big Brother UK, 2006) has demonstrated a remarkable ability to imitate sounds such as bird songs, cat meows and drum beats.Overview of Tourette Syndrome Essay

One of the more disturbing indicators of Tourette Syndrome are vocal and muscular tics (coprolalia/copropraxia) in the form of expletives, socially taboo words and obscene and inappropriate gestures. The person with TS cannot control these urges and can often become scorned upon by other people. Coprolalia/copropraxia are only present in less than 30% of Touretters (Packer,94), however because of media stereotypes these are the symptoms the general public often and only associate with Tourette Syndrome.

Objective: This is a practical review of Tourette syndrome, including phenomenology, natural history, and state-of-the-art assessment and treatment. Method: Computerized literature searches were conducted under the keywords Tourette syndrome,tics, and children-adolescents. Results: Studies have documented the natural history of Tourette syndrome and its frequent co-occurrence with attention problems, obsessive-compulsive disorder (OCD), and a range of other mood and anxiety disorders, which are often of primary concern to patients and their families. Proper diagnosis and education are often very helpful for patients, parents, siblings, teachers, and peers. When necessary, available anti-tic treatments have proven efficacious.Overview of Tourette Syndrome Essay First-line options include the alpha adrenergic agents and the atypical neuroleptics, as well as behavioral interventions such as habit reversal. Conclusions: The study of tics and Tourette symdrome has led to the development of several pathophysiological models and helped in the development of management options. However, fully explanatory models are still needed that would allow for accurate prognostication in the course of illness and the development of improved treatments.Overview of Tourette Syndrome Essay

Tourette Syndrome is a neurological disorder characterized by tics; involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way. Diagnostic criteria include: both multiple motor and one or more vocal tics present at some time, although not necessarily simultaneously, the occurrence of tics many times a day (usually in bouts) nearly everyday or intermittently throughout the span of more than one year; period changes in the number, frequently, type and location of the tics, and in the waxing and waning of their severity. Symptoms can sometimes disappear for weeks and or months at a time; and the onset is before the age of 18.       According to the Tourette syndrome Association there…show more content…
Exams should not be timed and should take place in a private room if vocal tics are a problem and the students should be given permission to leave the room when tics become overwhelming. Accommodations for writing problems, many children with TS also have visual-motor integration problems. They may come across with difficulties when having to copy information from the board, completing long assignments, neatness of written work, and when given a specific time to finish an assignment. Sometimes it appears as though the student is lazy or avoiding work, but in reality the effort to record the work on paper may be overwhelming. Accommodations for language problems, it is helpful for the children to have pictures and graphs when given written directions. The assignments should have instructions and the teacher should give the child the opportunity to read the directions out loud and make sure he/she understands it.Overview of Tourette Syndrome Essay