Hiccups every day
Everyone has had the hiccups. They often start for no apparent reason and usually disappear after a few minutes. Now imagine having the hiccups every day, and having no control over them. That’s what it’s like to have Tourette syndrome, a neurological disorder characterized by repetitive involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition in an 86-year-old French noblewoman. It’s unknown how many people in this country have the disorder but the Centers for Disease Control and Prevention estimates that around 138,000 children between the ages of 6 and 17 have moderate to severe forms of the condition. In most cases, tics decrease during adolescence and early adulthood, and sometimes disappear entirely. However, many experience tics into adulthood and, in some cases, tics can become worse in adulthood.
The most common signs of Tourette syndrome are the repetitive involuntary movements and vocalizations known as tics. Tics are classified as either simple or complex. Simple tics involve just a few parts of the body. They may range from eye blinking, shoulder shrugging and head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds. Complex tics are distinct, coordinated patterns of movements involving several muscle groups. Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug. Other complex motor tics may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting. Perhaps the most dramatic tics include motor movements that result in self-harm such as punching oneself in the face or vocal tics like involuntarily shouting out swear words or constantly repeating the words of other people.
An inherited disorder
The exact cause of Tourette syndrome remains a mystery, although current research has shown considerable evidence that the disorder stems from the abnormal activity of at least one chemical in the brain, the neurotransmitter called dopamine. Other neurotransmitters, such as serotonin, may be involved as well. Some studies of twins and families suggest that Tourette’s is an inherited disorder. Having no identifiable cause makes it difficult to identify the condition. There’s no specific test that can diagnose Tourette’s. Instead, doctors must rely on the history of the person’s symptoms to determine the course of treatment. In most cases, both motor and vocal tics must be present for at least a year because some tics are transient, lasting a few months before going away on their own. Because tics and movement problems can be the result of other serious health conditions, other tests such as MRI and CT scans may be necessary to rule out other problems.
The first step in the treatment of a patient with Tourette syndrome is the education of family members and others who interact with the patient. People with TS cannot help having tics, and are not being disruptive on purpose. When others understand these facts, people with TS might receive more support, which might, in turn, help lessen some tic symptoms. Medications are usually considered when symptoms begin to interfere with academic or job performance or daily living. Some medications can be used to help control or minimize tics. These may include certain anti-psychotic medications, anti-depressants and stimulant medications. None of them, however, eliminate the symptoms completely and the side effects they cause, such as sedation and weight gain, may outweigh any benefits they provide. Psychotherapy can help with the problems that accompany Tourette’s, such as ADHD, depression and anxiety, and it can also help people cope emotionally.
A healthy life
People with Tourette syndrome will likely have a normal life span and often lead a healthy, active lifestyle. Although there is no cure for Tourette’s, the condition in many individuals improves in the late teens and early 20s. As a result, some may actually become symptom-free or no longer need medication for tic suppression. Although the disorder is generally lifelong and chronic, it is not a degenerative condition. Individuals with Tourette’s have a normal life expectancy. And the condition does not impair intelligence. Students with Tourette’s need a tolerant and compassionate setting that both encourages them to work to their full potential and is flexible enough to accommodate their special needs. Although tic symptoms tend to decrease with age, it is possible that neurobehavioral disorders such as ADHD, OCD, depression, generalized anxiety, panic attacks and mood swings can persist and cause impairment in adult life.
Trusted by thousands of listeners every week, T. Glenn Pait, M.D., began offering expert advice as the host of UAMS’ “Here’s to Your Health” program in 1996. Dr. Pait began working at UAMS in 1994 and has been practicing medicine for over 20 years.