In popular culture, certain repetitive and "nervous" movements that some people exhibit in various situations are often portrayed with humor. However, few are aware that these movements may be due to a disorder, such as Tourette syndrome . Therefore, in the following article, we present a complete definition of Tourette syndrome, along with details about its symptoms, causes, comorbidity, diagnosis, and treatment.
What is Tourette syndrome?
Tourette syndrome, more commonly known as Gilles de la Tourette syndrome, is a neuropsychiatric disorder in which individuals exhibit involuntary verbal and motor tics. These symptoms may appear during the first 10 years of life but remain intermittent throughout the rest of their lives. It was described by the French neurologist Georges Gilles de la Tourette in 1885, and it is named in his honor.
The particularity of this syndrome lies, as already said, in the intermittency of its signs despite its chronic nature. These can manifest at any time between 2 and 18 years of age, remaining constant for a period of around 10 years. After that, these may disappear for a period of time ranging from days to months, and then manifest again. In addition, symptoms manifest with greater intensity during childhood.
Regarding its prevalence, statistics indicate that 30 out of every 10.000 children develop Tourette syndrome; it is also more common in males than in females. Furthermore, it is estimated that around 70% of those affected have a close relative with tics or related disorders , such as obsessive-compulsive disorder.
At this point, it's worth explaining what a tic is. A tic is a rapid, repetitive, and involuntary movement , usually stereotyped. Tics associated with Tourette syndrome are classified as simple or complex, depending on the number of muscles involved and the time between each movement. They are defined below:
- The simple tics They include those brief and unexpected movements, the development of which depends on a small number of muscles. They tend to repeat themselves, but over relatively long periods of time.
- The complex tics They are those coordinated movements in which several muscle groups intervene. Likewise, they have a repetitive and successive nature, that is, they are executed between very short periods.
This is a rare disorder. However, history indicates that famous personalities such as Napoleon and Mozart suffered from it. Especially the latter, in whose biographies he is described as a person with a tendency to make a lot of faces, he played excessively with his hands and with unexpected gestures.
Symptoms of Tourette Syndrome
Regarding the signs of this syndrome, it's important to explain the two different types of tics that manifest: vocal and motor , which in turn can be simple or complex. All of these are involuntary, and although the patient may be able to suppress them for certain periods of time, they inevitably reappear.
vocal tics:
Simple:
- Flash continuously.
- Shake your head.
- Shrug.
- Grimaces and facial gestures.
Complexes:
- Jump, touch people or things.
- Turn around.
- Sniff.
- Echopraxia, a tic that consists of the involuntary repetition of the gestures and movements of another person.
- Copropraxia, a tic characterized by the tendency to make rude or obscene gestures.
Motor tics:
Simple:
- Cough.
- Hawk.
- Breathe in through your nose loudly.
- Blow.
- Click with your tongue.
Complexes:
- Expression of words or phrases outside the context of a conversation.
- Coprolalia, which occurs between 10% and 30% of cases, and consists of the use of phrases or words considered inappropriate in certain contexts. It is usually maintained during a single stage of life.
- Palilalia, which consists of the repetition of one's thoughts.
- Echolalia, which consists of the continuous repetition of words or phrases that have just been heard.
- In general, symptoms usually appear between 7 and 10 years of age. Among the first to manifest are simple ones at the level of the head and face, such as blinking, making recurring facial gestures and shaking the head. However, it is normal for the syndrome to appear suddenly, and for the individual to exhibit various motor and vocal symptoms.
- It is important to highlight that with regard to complex motor tics, coprolalia, echolalia and palilalia represent the most representative signs of the syndrome. Furthermore, they are the ones that make the patient's integration into different social environments the most difficult, since these behaviors are unpleasant or offensive for most people.
Comorbidity
Tourette syndrome has a high rate of comorbidity ; that is, its coexistence with other unrelated conditions. In fact, patients with this syndrome may also present with obsessive-compulsive disorder (60% of cases), attention deficit hyperactivity disorder (ADHD) (50% of cases), along with learning disabilities , and even anxiety and mood disorders.
Causes of Tourette syndrome
a) Genetic causes:
The main cause of TS is heredity. There is a dominant gene that is transmitted with a 50% probability, from parents to descendants, causing the tics that can trigger the diagnosis of the syndrome, or other related disorders. However, the conclusion is that the probability of developing it is greater in those people belonging to families in which there have already been cases.
b) Neurological causes:
Currently, it has been suggested that Tourette syndrome originates from a malfunction of the basal ganglia in the brain; these are the mechanisms responsible for motor control. Furthermore, it is also attributed to alterations in the dopaminergic, serotonergic, and adrenergic systems.
c) Gender:
It is a syndrome with a higher incidence in males than in females. Thus, the probability of a boy developing TS is four times greater than that of a female from the same family.
d) Other diseases:
First, there are cases in which this disease originates simultaneously with the cortical-striatal-pallidal-thalamo-cortical disorder, which results from an autoimmune lesion in the putamen. In this case, this injury may be hereditary. Second, it is likely to develop due to an autoimmune disorder as a result of pharyngitis caused by bacteria such as group A beta-hemolytic streptococci.
Diagnosis of Tourette syndrome
The diagnosis of Tourette syndrome is based primarily on careful observation of the affected person's behavior; together with an inquiry into their history, it takes into consideration the age at which the tics began to manifest.
The main criteria for the specific diagnosis of this disorder are:
- Manifestation of several motor tics, and some vocal tics.
- Onset of symptoms at an age less than 20 years.
- The patient must present true motor and vocal tics, which must be differentiated from other abnormal movements, such as dystonia, chorea, ballismus, athetosis, hemifacial spasm, myokymias or myoclonus. Tics are sudden and repetitive movements, while these others go from one part of the body to another, at high speed but not repetitively. The exception here is hemifacial spasms, which do recur, but in Tourette syndrome grimaces do not.
- The intensity, frequency and form of the tics have varied throughout the patient's life.
- Tics should not have their origin in the administration of medications, and another similar disorder.
It is important to note that this condition cannot be diagnosed through blood tests or other laboratory studies. However, given the nature of the symptoms described, a specialist may suggest neurological studies , such as an electroencephalogram (EEG) or magnetic resonance imaging (MRI), to rule out other disorders like hyperactivity, obsessive-compulsive disorder (OCD), or attention deficit hyperactivity disorder (ADHD).
Once these other diseases have been ruled out through examinations and careful study of the signs, we then proceed to rule out the disorders most related to tics. Patients who develop vocal or motor tics for a year are diagnosed with transient nervous tic disorder. However, if their duration exceeds one year, then the diagnosis may be Tourette syndrome or chronic tic disorder.
Tourette syndrome treatment
The treatment of TS is based on the use of a variety of drugs that will help inhibit the most prominent symptoms.
There are different medications used in the treatment of Tourette syndrome. However, there is still no specific criterion based on which to prescribe them, in addition to comorbidity with other disorders. The most common compounds are antipsychotics, alpha-2 autoreceptor blockers, cyclic antidepressants and/or benzoadiazepines.
Antipsychotics
The most commonly recommended antipsychotics are olanzapine, risperidone, ziprasidone, haloperidol, and pimozide . Treatment typically begins with low doses, which are then gradually increased to the maximum or average effective dose.
Antipsychotics are the most commonly used treatment for this disorder, as they have proven most effective in managing symptoms. However, their use is associated with side effects. In fact, selecting the appropriate antipsychotic is complex, as it involves assessing the patient's tolerance to minimize side effects as much as possible.
For example, treatment is generally started with olanzapine and risperidone, which have a lower risk of causing akathisia and tardive dyskinesia in the patient, but could also cause weight gain, risk of diabetes, as well as dysphoria and depression. , in the exclusive case of the administration of risperidone.
Alpha-2 autoreceptor blockers
In this group are guanfacine and clonidine, the latter being the most used. Clonidine, compared to antipsychotics, has a much slower response that can even be seen months after starting its administration. That is why its doses tend to be increased gradually; However, this is done by stopping from the beginning, in order to verify its effects, and once they are stabilized, continue the treatment with a higher dose, repeating this method. The average dose comprises 0,5 mg.
Tricyclic antidepressant
As for cyclic antidepressants, desipramine is used, highly recommended in adult patients, but not for children, since for them it results in cardiotoxicity. Its doses start with 25 mg, and are increased over the days until reaching approximately 100 mg, which is the average dose. At this point special attention is paid to the evolution of the individual.
Benzoadiazepine
The benzodiazepine used to treat Tourette syndrome is clonazepam, with an initial dose of 0,5 mg. This dose is gradually increased over several days until the desired effects are observed or, conversely, side effects occur. The average dose is 2 mg, and the maximum is 4 mg.
We hope that this article about this syndrome has been detailed enough to leave no doubt. However, you are free to leave any questions, opinions or experiences in the comment box; We will try to respond to you as soon as possible.