The Disability called Tourette's

Tourette's Syndrome is a neurologic disorder characterized by multiple motor and vocal tics which persist at least one year. The onset of symptoms is before 18 years of age. Simple motor tics are usually the first manifestations of the disorder. These are brief, recurrent, involuntary movements, such as eye blinking, head jerking and facial grimacing. Later patients may develop complex motor tics which consist of coordinated movements, such as jumping, hitting or touching. Vocal tics include throat clearing, sniffing, grunting, and coughing. Patients may also involuntarily repeat their own words, or someone else's. Yelling out swear words is one of the most disconcerting and socially unacceptable tics, but fortunately occurs in only a minority of patients with Tourette's Syndrome.

The clinical course of Tourette's Syndrome is characterized by variation in tic frequency, location, type, and severity. Tics may occur from many times a minute, to very few per day. The tics spontaneously wax and wane and there may be a period of days to months when all symptoms disappear with another type of tic appearing. Patients may be able to voluntarily suppress tics for short periods of time so that fewer may be present when the patient is in a public place, compared to the privacy of home.

Tourette's Syndrome has been associated with Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD). As many as 50% of patients with Tourette's Syndrome have Attention Deficit Hyperactivity Disorder (ADHD) Symptoms include difficulty sustaining attention, the person is fidgety, easily distracted, and acts on impulse. Obsessive Compulsive Disorder (OCD) also occurs in Tourette's Syndrome patients more frequently then the general population. Symptoms may begin in early childhodd or adolescence and continue to progress into early adulthood. Behaviors include repetitive checking, arranging, counting, and making sure things are symmetrical. Older patients may express concerns about contamination and may perform washing rituals. In some patients with Tourette's Syndrome, the symptoms associated with Attention Deficit Hyperactivity Disorder or Obsessive Compulsive Disorder may be more disabling than the tics.

Tourette's Syndrome is felt to be relatively common neurological disease, although the exact prevalence is unknown. Estimates range from 2.9 to 49.5 per 100,000 children, but this may be an understimation since many mild cases probably go undiagnosed. Males are more commonly affected then females. The disorder is genetic, although the gene has not yet been localized. The mode of inheritance is most likely autosomal dominant, which means that an affected individual has a 50% chance of passing the gene to his or her child. There are many other genes that influence the expression of Tourette's Syndrome. The neurochemical basis for Tourette's Syndrome has not yet been determined. Many investigators feel there are abnormalities in the dopamine system, although imbalances in other neurotransmitter systems may play a role.

In patients whose tics are adversely impacting their academic or social functioning, treatment may be needed. Several medications have been found to be helpful in reducing tics. Other medications may be needed to control symptoms of Attention Deficit Hyperactivity Disorder or Obsessive Compulsive Disorder. Prognosis for Tourette's Syndrome is better than previously thought. Two thirds of patients will have significant improvement or complete remittance to their tics during late adolescence or early adulthood, with 1/3 continuing to be symptomatic. The associated symptoms of Attention Deficit Hyperactivity Disorder or Obsessive Compulsive Disorder may persist in some patients and continue to have an impact on their lives.