Tourette syndrome

The Tourette syndrome is a neurological disorder characterized by the appearance of motor and vocal tics.

They are often accompanied by obsessive-compulsive behaviors, attention and hyperactivity disorders, learning disabilities, and behavioral disturbances.

Causes of Tourette syndrome

Although it is a hereditary disease in more than 50% of cases, in most of them its origin is unknown. There is some form that appears secondarily as a result of another process (infections, etc.), but this is rare. Studies are currently underway in which an organic cause of the syndrome is being sought.

In 50% of cases it is a hereditary process (linked to chromosome 18 or chromosome X), but many times the origin is unknown. There are studies that link this disease with an increase in brain dopamine , since it has been proven that the symptoms improve with the administration of drugs that decrease this substance (eg Haloperidol) and vice versa, drugs that increase the action of brain dopamine worsen the illness. In any case, there is no conclusive data on the form of production of this process.

Tourette syndrome symptoms

The typical symptoms of Tourette syndrome usually appear between 5 and 15 years of age, being more frequent in males. There is no relationship with race, social status, or abnormalities during pregnancy. The clinical course of the disease is chronic and varies in time, so that the patient may have phases in which the clinical manifestations are more intense and others in which they are practically asymptomatic.

The initial symptom is usually tic, which can initially be interpreted as a nervous tic. In 80% of the cases they are motor tics and in 20% they are verbal. Motor tics usually affect the face, appearing winks, excessive blinking, grimaces, etc. When they only affect one muscle group in the face, they are called simple motor tics. In 50% of these motor tics, more elaborate movements may appear, affecting other parts of the body (pulling the hair, biting nails, scratching the nose, etc.) these would be complex motor tics and can become very limiting.

Verbal tics usually appear later, although it is sometimes the initial symptom. They are characterized by the emission of noise in a repetitive and uncontrollable way. These noises can be grunting, barking, sighing, hissing, coughing, throat clearing, and would be called simple verbal tics. When what they repeat are verbal expressions, words or phrases with linguistic meaning, they are called complex verbal tics and thus, we will call echolalia when they repeat words said by another person, coprolalia when they refer obscene or profane words and palilalia when they repeat their own words or phrases. Sometimes mental coprolalia can appear, that is, obscene thoughts without the existence of verbal coprolalia and echopraxia that consists of the imitation of acts performed by another person.

Finally, a self-injurious attitude may appear (biting the lips, hitting the head) and behavioral anomalies, presenting obsessive compulsive disorders and hyperactivity.

Sometimes tics are simply sensory manifestations, such as a tickling or burning sensation. In any case, this disease has many forms of manifesting itself and can become very disabling. It should be borne in mind that in childhood there are many children who have transient or chronic tics that have a good prognosis and that many disappear spontaneously in adolescence.

How is it diagnosed?

There are some diagnostic criteria for this disease:

• Multiple motor tics accompanied by one or more vocal tics that appear at some point in the disease and not always at the same time.
• Frequent tics – Occur many times a day, almost every day, or intermittently for more than a year.
• Tics that change over time, both the type, its severity, location and frequency.
• Tics that cannot be explained in any other way.
• Appearance before age 21.
• Tics that have been observed by a reliable examiner or recorded on video.

Tourette syndrome treatment

It is very important to inform the patient and their environment that it is not a mental illness and that these tics appear involuntarily and cannot be controlled. When the child simply has non-disabling simple motor tics, they may be transient childhood tics that then disappear and no treatment is necessary.

When these tics are very disabling, it is necessary to carry out pharmacological treatment. Clonidine improves verbal and motor tics in 50% of children, but can cause low blood pressure, diarrhea, sedation, and dry mouth.

Benzodiazepines can also be started initially as they reduce anxiety and can improve tics.

In cases where it does not respond to the previous medication or when the disease is very disabling, neuroleptics (haloperidol and primocide) will be indicated, which are drugs that act on dopamine. It should be started with the lowest dose and will be increased according to the clinical response or until significant side effects appear.

Psychotherapy is also being used in the treatment of this disease, being very useful when there is an emotional problem that triggers it or worsens it, but it should never be the primary treatment.

In the case of attention deficit disorders, psychostimulants such as amphetamines and methylphenidate may be useful, which do not appear to increase tics. In obsessive-compulsive disorder, they can improve with psychotherapy, antidepressants (especially serotonin reuptake inhibitors ) or clonidine.

How can I avoid this disease?

As we have said previously, Tourette’s syndrome is characterized by the appearance of involuntary tics, which we cannot prevent from appearing. The only thing we can act on is avoiding situations of physical and emotional stress that can aggravate the condition.

We must go to the doctor when we see that tics appear that can become dangerous or when we see any alteration in the patient’s behavior.