Tourette+Syndrome

= __Tourette Syndrome__ =

__Basics__
**__Basic Information__** **Tourette syndrome**, **Gilles de la Tourette Syndrome** or **TS** is a neurological disorder in which the affected individual makes quick, repeated movements or sounds uncontrollably. Tourette syndrome presents itself in early childhood or adolescence, before the age of 18. It's common name is simply "Tourette's". **(1)** Tourette syndrome usually starts with **involuntary** movements, or tics, with the face, arms, limbs or torso. These movements are frequent but rapid, usually starting with facial tics before moving on to the neck, limbs and torso. Some tics may involve bigger movements involving the whole body, like kicking or stamping. Tourette syndrome can also be the frequent compulsion to carry out a motor activity, or repetitive thoughts. Some TS tics are **verbal**, usually occurring in synchronization with movement tics. Some common verbal tics involve shouting, barking, throat clearing and grunting. Verbal tics can also be categorized as [|coprolalia], or [|copropraxia], a tic involving using inappropriate or socially unacceptable words and obscene gestures respectively. **(2)** Video of kids with Tourette syndrome commenting on the disease click [|here] **__History__** Some TS tics are verbal, usually occurring in synchronization with movement tics. Some common verbal tics involve shouting, barking, throat clearing and grunting. Verbal tics can also be categorized as coprolalia, or copropraxia, a tic involving using inappropriate or socially unacceptable words and obscene gestures respectively. In 1825 the first case of TS was reported in medical literature with a description of the Marquise de Dampierre, a noblewoman whose symptoms included involuntary tics of many parts of her body and various vocalizations including coprolalia and echolalia.

19th century French neurologist Jean-Marc Itard described his patient as having motor tics, echolalia and coprolalia. His unfortunate patient, the Marquise de Dampierre, was a French noblewoman who developed motor tics at age 7 years and shortly thereafter developed involuntary vocalizations consisting of screams and strange cries. Several years later she developed coprolalia. With this host of problems, the Marquise was forced to live in seclusion and continued her involuntary cursing until her death at age 85.

Some 50 years after Itard's report, in 1885, another French neurologist Georges Gilles de la Tourette produced a detailed account of several patients with a similar condition, including the Marquise in her later years, that clearly established this entity. Jean Martin Charcot, one of the leading European neurologists of the 19th century and Gilles de la Tourette's supervisor at the Salpetriere, attached his pupil's name to this syndrome. **(4)**

__Diagnosis and Treatment__
__**Diagnosis**__ Tourette Syndrome is typically not diagnosed until after a year of a patient exhibiting both multiple motor tics and one or more vocal tics. The patient cannot have had more than three consecutive months without experiencing tics. For a diagnosis to occur, the patient must also have experienced the onset of tics before age 18.

Another requirement for diagnosis is that the symptoms cannot be attributed to the physiological effects of a substance or other medical condition. Other medical conditions that involve tics or disorders such as autism must also be ruled out before Tourette's can be diagnosed.

Tourette's can be difficult to diagnose. Many mild cases are never diagnosed, as they may not be severe enough for medical attention or may be considered just part of a child's normal developmental phase. Also, some symptoms of the tics involved with Tourette's such as eye blinking may be associated with other disorders. There are also no specific medical or screening tests used to diagnose Tourette's. However, physical and neurological examinations may be used for a diagnosis. Family history is a factor in diagnosis. Children of parents with Tourette's are more likely to have the disorder. In fact, some parents become aware that they too had tics as a child after bringing their child in to a physician for an evaluation. However, other secondary causes of tics must be ruled out before a diagnosis occurs. People with Tourette's may also be diagnosed with Attention–Deficit Hyperactivity Disorder or Obsessive–Compulsive Disorder. Learning disabilities and sleep disorders are also associated with Tourette's.

There can be confusion between tics and seizures. When this is the case, the physician can request an EEG, CT or an MRI to rule out brain abnormalities. Samples from the body may also be taken to rule out hypothyroidism, which can be a cause of tics. A urine test may also be taken to rule out the use of drugs such as stimulants. **(5)**

The goal of treating Tourette's Syndrome is to help the individual manage the disorder. The majority of people with Tourette's have a mild form of the disorder and do not need pharmaceutical treatment. For many, psychobehavioral therapy and education are sufficient to help them manage the disorder. There is no cure for Tourette's.
 * __Treatment__**

For more severe cases, medications may be prescribed for the disorder. However, there is no medication on the market that has been invented specifically for treating Tourette's. Clonidine, or the clonidine patch is typically one of the first prescribed mediations for a patient with Tourette's. It is a type of medication prescribed historically as an antihypertensive and has become more accepted in treating insomnia.

Another class of medications called neuroleptics are also used in treating tics. However, the side effects can be adverse, both long–term and short–term. Stimulants and other medications may be used if the patient also has Attention–Deficit Hyperactivity Disorder.

Because children with Tourette's typically have symptoms that wax and wane, it is not recommended that a patient begin the use of medication immediately or that their medication be changed often. The tics may subside in lieu of medication through other disorder management tools such as counseling, reassurance, and a supportive environment. When a child with Tourette's also has Obsessive Compulsive Disorder, cognitive behavioral therapy is used. Other treatment methods used include habit reversal training or relaxation techniques, such as meditation, biofeedback, yoga, or other forms of exercise, which can relieve the stress that aggravates tics. **(3)**

__References__
1. Dugdale, D. (2011). //Gilles de la Tourette Syndrome,// 18-8-11, __[]__

2. Tourette Syndrome Association. (n.d.). //What is Tourette Syndrome?.// 18-8-11 [|__http://www.tsa-usa.org/Medical/whatists.html__]

3. Tourette Syndrome Association. (n.d.). //Guide to the Diagnosis and Treatment of Tourette Syndrome.// 18-8-11 __[]__

4. Tourette Syndrome Support. (2002). //Georges Gilles de la Tourette and the History of Tourette Syndrome.// 22-8-11 __[]__

5. Tourette Syndrome.Org. (2011). //Tourette Syndrome Diagnosis.// 22-8-11 __[]__

Christie Wong 9.6