It typically occurs during childhood or adolescence and affects the social and school life of young patients.
Most often, tics aren't the only symptoms of Tourette's syndrome; in many patients, they are accompanied by other neuropsychiatric disorders.
Unfortunately, there is no specific cure for Tourette's syndrome; however, the administration of certain drugs, psychotherapy, and specific educational and behavioral support can reduce the frequency of tics and abnormal behaviors.
The tics of Tourette's syndrome are quite another thing: they are exhausting, repeated many times during the day and long lasting (more than a year).
Tourette's Syndrome in Adulthood
In most patients with Tourette's syndrome, the tics disappear or subside considerably upon reaching adulthood.
After adolescence, there are few people who continue to present, with the same frequency, disorders typical of Tourette's syndrome.
Epidemiology: How common is Tourette's Syndrome?
Tourette's syndrome is quite common; according to some estimates, in fact, this disorder would affect one child out of every 162 considered (according to others, about one child out of every 100).
However, the above data must be taken with due caution, as the number of undiagnosed clinical cases is important.
For reasons still unknown, Tourette's syndrome affects males 3 to 4 times more often.
The spread of the disorder is the same for all populations of the world.
and the dopaminergic system: it seems, in fact, that the limbic areas, the basal ganglia and the pre-frontal cortex, present in the brain, are involved.
What is dopamine?
Dopamine is a neurotransmitter, produced in the brain. It has many functions: for example, it acts on behavior, voluntary movement, sleep, mood, motivation and learning.
Tourette's Syndrome and Environmental Factors
Experts have observed that Tourette's syndrome is more common in the children of women who have had problems during pregnancy (e.g. long labor, high maternal stress, low birth weight of the fetus, etc.).
However, there is no reliable scientific evidence to support these observations.
Another environmental factor that could play a role in the onset of Tourette's syndrome are streptococcal infections contracted at a very young age.
Even in this case, however, there is still talk of hypotheses lacking solid scientific confirmation.
Tic Motors
The classic motor tics observable in the presence of Tourette's syndrome are:
- Blinking of the eyelid (s);
- Shaking of the head;
- Twist your mouth;
- Contraction of the mouth;
- Extension of the limbs (for example, kicking);
- Shoulder shots.
Phonic tics
The most common phonic tics of Tourette's syndrome are:
- Throat clearing
- To cough;
- Sniff;
- Scream;
- Imitate the sounds of animals.
Other Symptoms of Tourette's Syndrome
Although less common than tics, other manifestations observable in the presence of Tourette's syndrome are also: coprolalia, palilalia, socially inappropriate non-obscene behavior, echolalia and ecopraxia.
- Coprolalia is the constant uttering of obscene and vulgar words or phrases.
Sometimes, the patient with Tourette's syndrome is the protagonist only of rude behavior, but not obscene; in this case, we speak of socially inappropriate non-obscene behavior (NOSI).
Coprolalia and NOSI are spontaneous acts, which should not be confused with the patient's lack of education or morality. Tourette's syndrome is often identified with these two symptoms, but it is fair to specify that they are rare manifestations, occurring only in 10-15% of patients. - Palilalia is the repetition of some of one's words, without any reason and out of place.
- Echolalia and ecopraxia are, respectively, the repetition of words spoken by others and the repetition of gestures made by others. Again, these are unjustified acts.
Please note
Some medical texts consider coprolalia, palilalia, echolalia and ecopraxia as complex phonic / motor tics.
When does Tourette's Syndrome arise?
Tourette's syndrome can occur between the ages of 2 and 14; however, in most cases, it appears at the age of 5-9 years.
Disorders associated with Tourette's Syndrome
Tourette's syndrome is often associated with other neurodevelopmental disorders and / or neuropsychiatric disorders.
There is no certain data regarding the frequency of these morbid associations: some studies report that 8-9 cases out of 10 manifest other disorders (in addition to Tourette's syndrome); other studies, however, speak of a lower frequency, around 4-5 cases out of 10.
The most important and serious disorders associated with Tourette's syndrome are:
- Attention Deficit Hyperactivity Disorder (ADHD or ADHD);
- Obsessive Compulsive Disorder (OCD).
Instead, they are less common:
- Learning difficulties;
- Self-harm;
- Changes in mood.
The presence of other disorders obviously worsens the clinical picture of the young patient as well as his insertion in the social and school context.
The following table summarizes the main characteristics of the different diseases associated with Tourette's syndrome.
Associated pathology
Patients are easily distracted, careless and disorganized. They play and talk loudly. They are always on the move and interrupt the activities of the people around them
Anxiety and loss of control, due to the fear of making inappropriate gestures or speaking vulgar words.
Obsessions are repetitive, aimless actions: for example, repeated hand washing or counting objects
Learning difficulties
It manifests itself with dyslexia and dysorthography
Tendency to bite, scratch, hit your head or punch yourself
Changes in mood
Tourette's Syndrome: Differential Diagnosis
Tics can be caused or confused with various other morbid conditions. For instance:
- Epilepsy;
- Brain abnormalities;
- Hypothyroidism;
- Drugs (ex: cocaine);
- Wilson's disease;
- Autism;
- Forms of Encephalitis (eg: Sydenham's chorea);
- Huntington's chorea;
- Klinefelter syndrome;
- Medicines;
- Tuberous sclerosis.
Therefore, it is true that there is no diagnostic test for Tourette's syndrome, but undergoing instrumental tests can be useful in ruling out some of the aforementioned diseases.
The recommended tests are: an electroencephalogram, a brain MRI and a urinalysis.
Please note
The motor tic and the phonic tic represent only one of the symptoms of the conditions present in the above list; each of them, in fact, presents with other manifestations, sometimes unequivocal.
; antipsychotics modulate some neurotransmitters in the brain, such as dopamine, noradrenaline and serotonin.These drugs do not guarantee absolute success and have several side effects, some even serious.
To act on obsessive-compulsive disorder anxiety, a benzodiazepine may be useful: clonazepam.
Unfortunately, administering this drug does not always have the desired effects.
Finally, a stimulant known as methylphenidate is used to stem attention deficits.
The table shows the drugs most used in cases of Tourette's syndrome.
Risperidone
Pimozide
Aripiprazole
Sulpiride
Reduce the frequency of tics and some obsessive behaviors
Antidepressant, sedative and anxiolytic
Stimulants of attention
Contain attention deficit due to ADHD (or ADHD)
Please note: these drugs are not currently approved for the treatment of Tourette's syndrome, due to side effects and uncertain success; some are indicated for associated diseases, such as methylphenidate, but again , there are conditions of use.
Psychotherapy
In the presence of Tourette's syndrome, the main psychological therapies are cognitive-behavioral psychotherapy (TCC) and the so-called Habit Reversal Training.
The aim is to reduce the frequency of tics, teaching the patient to master the need to perform them.
Being able to control tics is of enormous help in improving social inclusion and in the school environment.
Unfortunately, these two psychotherapies are not always successful.
Education and Support
Family members of Tourette's syndrome patients play a fundamental role during the therapeutic process; In fact, scientific studies have shown that the treatments are more effective in those patients who receive support from families.
In light of this, it is essential that parents document themselves on the appropriate behavior to adopt in these cases and that, subsequently, they put it into practice.
In addition to the family, the school plays an important role in the management of Tourette's syndrome: the headmaster and teachers must promote the patient's social integration, support him, understand his problems and make him feel accepted by other pupils.
A "hostile" school environment counteracts the efforts made by families, making recovery more difficult.
Surgery
For some years, experiments have been underway to test a surgical therapy known as deep brain stimulation (in English Deep Brain Stimulation, DBS).
This therapy involves the insertion, in the patient's brain, of some electrodes, with the aim of stimulating and normalizing those brain areas suspected of being responsible for Tourette's syndrome and
It is a method still being perfected, as it has so far been shown to have several side effects.
Should it ever prove applicable, it would be reserved only for cases that do not respond to drug therapy and psychological and behavioral therapy.
.jpg)
