2023-06-07 00:34:33
“Tourette” stands for “Gilles de la Tourette Syndrome”. The name is intended to commemorate the French doctor who first described the neuropsychiatric disease in detail in 1885. Tourette’s syndrome is characterized by so-called tics: short, quick movements or noises that those affected repeat over and over again and can only control to a limited extent. These tics are often particularly pronounced in childhood and adolescence, and they can diminish or even disappear completely as we grow up – but that is not always the case.
According to the Tic & Tourette Syndrome interest group, there are more than 805,000 people with Tourette Syndrome in Germany – this corresponds to around one percent of the total population. In order to improve knowledge about this neurological disorder among the general public and to break down prejudices, 7 June was declared “European Tourette Syndrome Awareness Day”.
What do tics look like?
There are two types of tics: motor and vocal. Motor tics are sudden, repetitive movements—often in the form of blinking, grimacing, wrinkling the nose, or jerking the head. More complex motor tics affecting multiple muscle groups are also possible. Those affected then jump or hop, for example, pull up their arm or turn in circles.
Vocal tics, on the other hand, are unintentional noises such as clearing the throat, coughing or sniffling. In rare cases, people with Tourette’s also involuntarily utter whole words or swear words, but this “coprolalia” is not an essential feature of Tourette’s syndrome. The image of the loudly swearing Tourette sufferer is more a creation of film and television.
What motor and vocal tics have in common is that they occur randomly and therefore quickly appear inappropriate and confusing in public or in a conversation. However, which tics occur and how severe they are is different for each person affected. Tourette is therefore also referred to as a spectrum disorder.
But even in a single Tourette sufferer, the tics fluctuate over time, sometimes affecting other muscles, sometimes being more complex, sometimes more frequent, sometimes less common. “The fluctuations occur spontaneously, i.e. completely independently of external influencing factors. It is not possible to predict how long such ‘good’ or ‘bad’ phases will last,” explains the Tourette Society Germany. While most people’s tics stop after puberty, for others they last a lifetime.
Enlarge image
Simple motor tics are sudden, purposeless, repetitive movements that most commonly occur on the face and head and are therefore often misinterpreted as nervousness, irritability, or quirkiness.
Can you suppress tics?
Tourette sufferers have limited control over their tics. For those who are not affected, this can best be compared to a sneeze or hiccups. Tics can sometimes be delayed or even suppressed, but this is only possible with conscious effort and not in the long term. Adolescents and adults with Tourette syndrome report that they perceive the onset of a tic as a kind of internal pressure or feeling of warmth in the relevant area. If you suppress a tic, this anticipation is typically more intense for the next tic.
What other symptoms are there?
It is also typical of Tourette’s that it is often accompanied by so-called “comorbidities”, i.e. accompanying symptoms or diseases. “Tourette syndrome without comorbidities only occurs in about ten to 20 percent of patients,” reports the Hannover Medical School. In children and adolescents, Tourette is associated with attention-deficit hyperactivity disorder (ADHD) in half the cases and with obsessive-compulsive disorder in 30 percent of cases.
“Studies of the quality of life of children with Tourette syndrome have shown that ADHD and OCD tend to be far more debilitating than the tics. Therefore, these symptoms must be given special attention and treated if necessary,” the university continued. Other accompanying symptoms are sleep disorders, depression, learning disorders and disorders of social behavior. In adults, it is usually depressive symptoms and compulsions that have a worse effect than the tics themselves.
How is Tourette made?
“Even if considerable progress has been made in research into Tourette’s syndrome in recent years, the cause is still unclear,” explains the Tourette Society Germany. However, Tourette’s is largely considered to be genetic. In 2017, researchers identified four genes that are noticeably often altered in affected children. Together, such variants in these four genes increase the risk of Tourette’s disease by 70 to 90 percent.
However, these genetic changes can only explain around twelve percent of all Tourette cases. Scientists therefore assume that there must be other, previously undiscovered genetic triggers. These presumably affect brain development and the messenger system, which in turn impairs the control of sounds and movements.
How do you diagnose Tourette’s?
To be diagnosed with Tourette’s, people must have had a variety of motor and vocal tics for at least a year before their 18th birthday. If only one of the two tic categories occurs, those affected receive the diagnosis of a chronic tic disorder instead. Boys are affected by Tourette’s much more often than girls, but in adulthood the gender ratio is largely balanced again.
Can the disease be treated?
Since the tics disappear by themselves in most of those affected after puberty, they are usually not treated in childhood and adolescence. Instead, treatment focuses on the various comorbidities such as ADHD or depression. It is also more about sensitizing the family and school environment to the tics in order to alleviate the psychological suffering of Tourette sufferers.
“Many non-affected people cannot imagine that these behaviors and vocalizations are actually involuntary and disease-related, for example since those affected can at least temporarily gain control of their tics. Some people feel provoked by the tics,” explains the Tourette Society Germany. “On the other hand, many of those affected are well integrated socially, provided the symptoms are not too pronounced or they grow up in an enlightened environment.”
If those affected still suffer from tics in adulthood, they can be treated with behavioral therapy methods, for example. For example, those affected practice an alternative behavior instead of the tic in “Habit Reversal Training”. So you learn to consciously perceive the premonition of a tic and then to carry out a different movement that is anatomically incompatible with the tic.
With “exposure and response prevention”, on the other hand, patients should learn that a premonition does not necessarily have to be followed by a tic in order to interrupt Tourette’s automatism. Both methods do not make the tics disappear completely, but they do reduce them by a third. If the tics are to be treated (additionally) with medication, so-called neuroleptics are usually used. The funds dampen nerve activity and thus also reduce twitching.
#Tourettes #syndrome #living #tics