Tourette syndrome: causes, symptoms, diagnosis and treatment
The Tourette syndrome is a neurological disorder that causes the affected person to perform movements and sounds involuntarily and without a specific purpose.
These movements are repeated intermittently and tend to increase in stressful situations. It is often considered an especially severe and chronic form of multiple tics.
In this article we will see what Tourette syndrome is and how it affects people who develop it.
What is Tourette Syndrome?
The symptoms that appear in the early stages of the development of Tourette syndrome begin between eight and eleven years of age, with their intensity being highly variable. The affected person may suffer periods of constant and frequent tics, and others in which the presence of these becomes practically non-existent. Boys are three to four times more likely to have Tourette syndrome than girls (1).
Tics can be classified as simple or complex tics:
- Simple tics: These are brief, involuntary and unexpected movements that affect a specific and limited number of muscle groups. Although they occur in isolation, they are repetitive. Examples of this type of affectation are: moving the head, blinking, shrugging the shoulders, breathing hard through the nose ...
- Complex tics: coordinated and cyclical movements that affect various muscle groups, such as kicking, jumping, sniffing at objects or people, coprolalia (issuing profanity and obscene words in an uncontrolled way), etc. That is, they require a more complex and abstract type of mental processing.
Thus, Tourette syndrome is characterized by tics and problems in inhibiting certain brief behaviors, which are expressed in a matter of seconds or fractions of a second.
Causes
The causes of Tourette syndrome they are still unknown and there is no scientific consensus on the matter. Some hypotheses suggest that its origin may be linked to affectations in some brain regions and alterations in chemical substances (dopamine, norepinephrine and serotonin) that provide interneuronal communication.
It has been scientifically proven that Tourette syndrome is a hereditary disease and that an affected person has a 50% chance of transmitting the syndrome to her child. This gives clues about the role played by differences at the brain level with respect to the rest of the population.
However, the fact that the genetic predisposition is inherited does not mean that the child will suffer all the symptoms associated with it. disorder, but will be statistically more likely to develop it compared to the rest of the population. It is possible to have certain gene variants that are never expressed, or that are expressed by combining with other genes and fail to generate appreciable symptoms.
Typically, it has been observed that children of people with Tourette syndrome may have some minor tics, some obsessive-compulsive behaviors, symptoms associated with attention deficit (without the presence of tics), or even a total absence of symptoms. This indicates that Tourette syndrome could present in a very varied spectrum of intensities, and that it does not exist as a closed category and of equal severity in all people.
On the other hand, it is assumed that the most characteristic syndromes of Tourette syndrome are due to a failure in pulse regulation due to dysfunctions in the frontal lobes, responsible for a good part of the executive functions and in the task of dampening the desire to perform actions at the moment.
Symptoms
Tourette syndrome appears during some time during the first two decades of life, and in the same family nucleus there may be great variability in the presence of associated symptoms. Usually, the first expression of the syndrome is usually a facial tic, and it is common for each affected person to present their own limited repertoire of tics, always repeating the same.
Over time, people with Tourette syndrome develop more motor tics of a variable nature. They encompass both the blinking or tics of the facial muscles, the emission of guttural sounds, the sudden inhalation of air, the kicking, shaking of the neck and head, and so on. It is unknown if the appearance of complex tics is a cause of the previous appearance of simple tics, or if both phenomena are the result of an alteration that causes them in parallel.
Patients also express annoying sensations in some parts of the body, such as itching, pressure, tingling, itching... These types of tics are called sensitive tics.
Verbal-type tics are less common than is popularly believed. Only 10% of patients have echolalia (repeat what is heard) or coprolalia (involuntary emission of rude words or phrases). Some patients also express tics such as spitting and / or or copromimia (offensive gestures).
The recurrence and intensity of the tics can get worse or better throughout the day, and can vary over time. The pathology tends to improve during and after adolescence, when the worst stage of Tourette syndrome is experienced, often being related to conduct disorders. In this way, the frequency of important tics and coprolalia (if any) is usually reduced when passing from adolescence to adulthood.
How are people affected by this syndrome?
People affected by Tourette syndrome have normal intelligenceAlthough they may have additional learning difficulties during childhood and adolescence, as a result of tics and associated behavioral and social pathologies. These pathologies are usually the obsessive compulsive disorder or attention deficit hyperactivity disorder (ADHD). It is also common for them to present behavioral disorders (social isolation, impulsiveness, aggressiveness) and of the dream.
Impulsivity problems often lead to depression Y anxiety, but these are not part of the neurobiology of the syndrome itself, but are part of the consequences of their way of interacting with the environment and with others.
Sometimes patients may be able to inhibit tics for a period of time, but finally these reappear in a more accentuated way, as if it were a way of compensating the inhibition. Thus, it seems desirable that people around the patient show understanding and behave naturally in the presence of tics.
Some affected have very mild symptoms, which do not require any treatment, and it is even common for their symptoms to disappear over time.
Treatment
No specific treatment is required for tics, except in cases of extreme severity or that affect muscle pain or disorders in school and social adjustment. In these types of cases, they are usually straightr neuroleptic drugs to reduce the intensity and frequency of tics., although always under medical indication and under his supervision.
Regarding the psychological therapy, it is effective to treat disorders related to Tourette syndrome, such as stress, depression or anxiety, learning and behavioral problems, and the social and affective consequences caused by syndrome.
If the syndrome is accompanied by obsessive-compulsive disorder or ADHD, it will be recommended, apart from the therapies already explained, appropriately treat these alterations that can negatively affect the quality of life of the person.
Three real cases
What is it like to live with Tourette syndrome? Several people with a notorious professional career bring us closer to this neurological syndrome.
1. Mahmoud Abdul-Rauf, an NBA player
Can you suffer Tourette and be successful in life? The case of Mahmoud Abdul-Rauf (whose birth name was Chris Jackson) is paradigmatic. We invite you to know his life in this article from the spanish newspaper Information.
2. Super Taldo: a Chilean boy with tics and coprolalia
An extreme case of Tourette Syndrome is the one that suffered Agustin Arenas, nicknamed "Super Taldo", a Chilean boy who became well known thanks to a newspaper report on Chilean television. You can know his story by entering this link.
Finally: an in-depth documentary on this condition
A documentary made by the Xplora channel he discovered the case of a 20-year-old boy who was diagnosed at the age of eight. In this brief extract from the report, the affected person tells us what it is like to live one day with constant tics. We offer it below.
Bibliographic references:
- Bloch, M.H., Leckman J.F. (2009). Clinical course of Tourette syndrome. J Psychosom Res (Review) 67 (6): pp. 497-501.
- Cavanna, Andrea. (2010). Tourette Syndrome. Editorial Alliance.
- Leckman, J.F., Cohen, D.J. Tourette's Syndrome — Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care. John Wiley & Sons, Inc., New York.
- Moe, Barbara. (2000). Coping with Tourette Syndrome and tic disorders. New York: Rosen Pub. Group.
- O'Rourke, J.A.; Scharf, J.M.; And you.; et al. (2009). The genetics of Tourette syndrome: A review. J Psychosom Res. 67 (6): pp. 533 - 545.
- (1) http://espanol.ninds.nih.gov/trastornos/sindrome_de_tourette.htm
