Wednesday, November 26, 2014

Tourette's Syndrome

Definition

This is a neurological disorder characterized by involuntary movements (motor tics) and vocalizations (phonic or vocal tics).

The disorder generally begins before the individual is 21 years old and is usually lifelong, with symptoms following a waxing and waning course.

Description

The hallmark of Tourette's syndrome (TS) is a succession of chronic motor and vocal tics that begin in childhood, but psychiatric comorbidity also appears to be a primary feature.

Motor tics, which are repetitive, involuntary stereotyped movements, most often involve the mouth, face, head or neck muscles, but may also involve the trunk and extremities.

Physicians often mistake the disorder for a psychological problem, partly because most with the problem are able to suppress their symptoms for varying lengths of time and because symptoms typically disappear during sleep, sexual activity, and periods of intense concentration.

However, for a person with continuing symptoms, deliberate efforts to suppress symptoms can only last so long and are usually followed by uncontrollable bursts of rapid-fire symptoms as soon as the person lets go, perhaps after escaping to the privacy of a restroom.

Causes

TS is often associated with obsessive-compulsive symptomatology (e.g., excessive hand washing, checking rituals, or hoarding behaviors), attention deficit hyperactivity disorder, and other behavioral problems, although these are not part of the current diagnostic criteria.

For most of the 20th century, TS was considered a psychiatric disorder because of the voluntary suppressibility, stress-associated exacerbation, and bizarre forms of many of the tics. But because of the identification of many biological factors over the past 20 years, including the efficacy of pharmacologic therapy and the heritability of the disorder, TS has been reclassified as a neurological movement disorder.

Symptoms

Motor tics can be simple, such as forceful eye blinking, or complex, such as bending over and touching the ground.

Vocal tics, which are repetitive involuntary stereotyped vocalizations, are usually unintelligible sounds, such as sniffing, grunting or throat clearing, but they can also be complex, such as uttering whole phrases.

Other complex motor and vocal phenomena, which are much less common than simple tics, include coprolalia (involuntary and affectively inappropriate swearing), copropraxia (involuntary and affectively inappropriate use of obscene gestures), echolalia (involuntary repetition of speech of others), echopraxia (involuntary imitation of the actions of others), and palilalia (involuntary repetition of parts of the individual's own speech).

Treatment

People with life-disrupting symptoms can often suppress them with one of several drugs that affect the chemistry of the brain, including haloperidol (Haldol), clonidine (Catapres), pimozide (Orap), fluphenazine (Prolixin), clomipramine (Anafranil), and fluoxetine (Prozac).

However, the medications have side effects that themselves can be life-disrupting, like somnolence, and some people with Tourette's refuse medication, finding its symptoms less troublesome than those caused by drugs.

Family counseling and psychotherapy may be useful to help cope with adjustment problems associated with the social stigma common in more severe cases.

Questions

Do the symptoms equate with a diagnosis of Tourette's syndrome?

How can the symptoms be controlled?

What medication do you prescribe?

What are the side effects of the medication?

Will the condition get worse?

Do you recommend counseling and psychological help?