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Paging Dr. Frischer - Tourette's syndrome
WRITTEN BY :   Dr. Alan Frischer

Do you have the repetitive and uncontrollable urge to move a body part, make a sound, or close your eyes? These actions are known as tics and you may have Tourette’s syndrome. Named after the French neurologist who first described the condition in 1885, it is considered a neurological disorder.
Symptoms of TS typically first appear in childhood, often between the ages of three and nine. It occurs in all ethnic groups, although males are affected far more often than females. Although TS can have symptoms that last a lifetime, for most the worst tics are experienced in the early teens, with improvement starting in the late teens and continuing into adulthood.
Other conditions can look like TS. Transient tic disorders begin during the early school years and affect perhaps 18% of children. Common tics include eye blinking, nose puckering, grimacing and squinting. Transient vocalizations are less common and include various throat sounds or humming. Transient tics may last only a few weeks or months and may appear in times of heightened excitement or fatigue. As with Tourette’s syndrome, boys are more often affected by transient tics than are girls.
TS, in contrast to transient tic disorders, is diagnosed after verifying that the patient has had both motor and vocal tics for at least one year. There are no blood or lab tests to help make the diagnosis, although MRI, CT, EEG, or blood tests may be used to rule out other conditions. It is not uncommon for TS to go undiagnosed, as parents might think eye blinking is related to vision problems, or sniffling related to allergies.
What is a tic? They can be simple or complex. Simple tics are sudden, brief, repetitive movements. Some examples include eye blinking or other eye movements, facial grimacing, shoulder shrugging, or head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing sounds, sniffing, or grunting. Complex tics are coordinated movements involving several muscle groups. These might include facial grimacing combined with a head twist and a shoulder shrug. More complex vocal tics include words or phrases. The most dramatic and perhaps most disabling tics include motor movements that result in self-harm, or vocal tics including corprolalia (uttering socially inappropriate words) or echolalia (repeating the words or phrases of others).
Some people with TS will describe a need to complete a tic in a certain way or a certain number of times in order to relieve an urge or decrease a sensation in a muscle group. Tics are often made worse with excitement or anxiety, and are better during calm, focused activities. Some experiences can trigger or worsen tics, such as tight collars or neckties, or hearing another person having vocal tics. Tics come and go over time, and vary in type, frequency, location, and severity. Although these tics are involuntary, sometimes they can be suppressed, camouflaged, or otherwise managed. However, there can be a substantial buildup in tension when suppressing the tics to the point where there is a feeling that the tic must be expressed.
A number of neurobehavioral problems are associated with TS, and may actually cause more difficulties than tics. These include inattention, hyperactivity and impulsivity; attention deficit hyperactivity disorder (ADHD); problems with reading, writing, and arithmetic; and obsessive-compulsive symptoms (OCD) such as intrusive thoughts, worries and repetitive behaviors. Some with TS report problems with depression or anxiety. Although most of those with TS experience a significant decline in tics as they leave adolescence behind, these associated neurobehavioral conditions may continue.
The majority of people with TS do not treat it with medication. There is no one medication that is helpful to all people with TS, nor does any medication completely eliminate symptoms. All of them, however, have significant side effects such as sedation, weight gain, and cognitive dulling. Withdrawal from these medications can also make the tics worse. Some behavioral alternatives include awareness training and competing response training, but other behavioral therapies such as biofeedback have not been shown to be effective.
The cause of TS is unknown, and presently there is no cure. Active research is looking at the basal ganglia, frontal lobes, and cortex, and the circuits that interconnect these regions in the brain; along with the neurotransmitters dopamine, serotonin, and norepinephrine. Twin and family studies suggest that TS is inherited.
Tourette’s syndrome is a complex disease and may result in physical, behavioral and social disability. If you or a loved one experience its signs or symptoms, seek professional help.
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: July 26, 2012 – Volume 11 – Issue 15



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