Tourette syndrome

  • Definition
    • Tourette syndrome is a condition that causes a person to make repeated, quick movements or sounds that they cannot control.

  • Alternative Names
    • Gilles de la Tourette syndrome; Tic disorders - Tourette syndrome

  • Causes
    • Tourette syndrome is named for Georges Gilles de la Tourette, who first described this disorder in 1885. The disorder is likely 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 4 times as likely to occur in boys as in girls.

  • Symptoms
    • 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.

      Different types of tics can include:

      • Arm thrusting
      • Eye blinking
      • Jumping
      • Kicking
      • Repeated throat clearing or sniffing
      • Shoulder shrugging

      Tics may occur many times a day. They tend to improve or get worse at different times. The tics may change with time. Symptoms often get worse before the mid-teen years.

      Contrary to popular belief, only a small number of people 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.

  • Exams 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 1 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.
  • Treatment
    • People who have mild symptoms are not treated. This is because the side effects of the medicines may be worse than the symptoms of Tourette syndrome.

      A type of talk therapy (coginitive behavioral therapy) called habit-reversal may help to suppress tics.

      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 may be recommended for the main symptoms of Tourette syndrome and the obsessive-compulsive behaviors, but not when these symptoms occur in the same person.

  • Support Groups
  • Outlook (Prognosis)
    • Symptoms are often worst during the teenage years and then improve in early adulthood. In some people, symptoms go away entirely for a few years and then return. In a few people, symptoms do not return at all.

  • Possible Complications
    • Conditions that may occur in people who have Tourette syndrome include:

      • Anger control issues
      • Attention deficit hyperactivity disorder (ADHD)
      • Impulsive behavior
      • Obsessive-compulsive disorder
      • Poor social skills

      These conditions need to be diagnosed and treated.

  • When to Contact a Medical Professional
    • Make an appointment with your provider if you or child has tics that are severe or persistent, or if they interfere with daily life.

  • Prevention
    • There is no known prevention.

  • References
    • Jankovic J. Parkinson disease and other movement disorders. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SK, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 96.

      Murphy TK, Lewin AB, Storch EA, Stock S; American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Practice parameter for the assessment and treatment of children and adolescents with tic disorders. J Am Acad Child Adolesc Psychiatry. 2013;52:1341-1359. PMID: 24290467

      Ryan CA, Trieu ML, DeMaso DR, Walter HJ. Motor disorders and habits. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 24.