Category Archives: Tourette syndrome

Highlighting Tourettes Syndrome

Tourettes is often misunderstood by the general public. Many people associate the term Tourettes with persistent and involuntary swearing (coprolalia) whereas according to Tourettes Action (UK), only around 10 percent of Tourettes sufferers actually do this.

 

Radio One presenter Reggie Yates recently went on a mission to find talented musicians who also happened to be suffering from Tourettes Syndrome. In a recent BBC screening of ‘Let Me Entertain You’, Reggie introduced us to six young people with Tourettes, whose symptoms disappeared whilst they were performing. The reasons why this sometimes happens are not known.

 

Reggie gave us a unique and very positive insight into the difficulties faced by Tourettes sufferers and highlighted awareness of TS in an interesting and lighthearted way. It also gave the youngsters an opportunity they may never otherwise have had to showcase their talents. At the end of 12 weeks, the six performed on stage to a live audience and the results were spectacular with no evidence of Tourettes in sight.

 

So what do we know about Tourettes?

 

Not much really. Tourettes Syndrome or TS is an inherited neurological condition affecting around 1 percent of children, and for more than half of these children, the symptoms will persist into adulthood. It is characterized by involuntary tics which can be in the form of vocal sounds or sudden bodily movements. The tics vary widely from person to person in both the form and severity. It is more common in boys than in girls.

 

It’s important to stress that there is an irresistible urge to let the tics out, much like scratching an itch, sneezing or blinking your eye. Sometimes an individual with Tourettes is able to suppress the tics for a while, but the tics have to be let out eventually. Suppression of the tics can be exhausting and can cause tension and stress. Some people, even family and friends of TS sufferers, find it difficult to understand that the tics are completely involuntary, but they most definitely are.

 

Co morbidities are common

 

The vast majority of people with Tourettes (over 85 percent) have co morbidities too; this means they have additional conditions existing alongside the TS. These include Obsessive Compulsive disorder (OCD), Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD), Depression, Anxiety Disorders, Bipolar Disorder, Phobias, and so on. The point is, TS rarely exists by itself as many of the disorders are linked neuro-chemically.

 

At what age does Tourettes appear?

 

Most people develop TS in childhood between the ages of 5 and 7 with a peak in tics between the ages of 8 and 12 although this is not always the case. For 50 percent of sufferers the tics will gradually disappear throughout the teens.  Commonly, the first tics to appear are persistent blinking of the eyes, facial movements, throat clearing, and coughing. Again, this is not necessarily the pattern as no TS sufferers symptoms are the same.

 

What causes TS?

 

No one knows the exact cause of Tourettes syndrome but it is known that genetics play a role although no gene has been identified.

 

How is TS diagnosed?

 

There are no medical tests that can be used to identify TS. According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), a diagnosis of Tourettes can be made when a person shows multiple motor tics and one or more vocal tics over the period of  a year with no more than 3 consecutive months where no tics appeared. The tics must have appeared before the age of 18 and are not the result of a substance or medical condition.

 

What is the treatment for TS?

 

There is no cure for TS. Treatment generally consists of finding ways and strategies to help the TS sufferer cope with the symptoms. Medication is sometimes given but usually only when the symptoms are so severe they interfere with the individual’s ability to function on a day to day basis, or to deal with a co-morbid condition such as depression or an anxiety disorder. Often, the tics can be alleviated by cognitive behavioural therapy.

 

By far the most effective way of dealing with TS is by reassurance, understanding, and by providing a positive and supportive environment. Many Tourettes sufferers find that if they direct their energies into something they love doing, like the musicians in the BBC screening Let Me Entertain You, they can get temporary relief from the symptoms of TS.

 

Advantages of Tourettes

 

It may seem strange to be talking about the advantages of a condition that also involves distressing tics, however, research has indicated that when it comes to certain skills, TS sufferers perform faster and have better timing ability than those without TS and they also have superior grammatical abilities. Indeed, a number of notable people have suffered from Tourettes including actor Dan Aykroyd, author Samuel Johnson, Goalie Tim Howard and possibly the musical genius Mozart too.

 

 

 

 

CBT can reduce Tics and impact neurophysiology in people with Tourette syndrome

Tourette syndrome is a distressing neurological condition that is characterised by motor and vocal tics. Tics can be described as repetitive and involuntary movements or utterances which can range from facial grimacing, excessive eye blinking, jerky movements of the head, legs, shoulders, or any other part of the body, to constant throat clearing, sniffing, snorting or grunting or making other vocal noises.

No one knows what causes Tourette’s but many professionals believe that Tourette’s could be a result of a disturbance in cell to cell communication in the brain. The Tics tend to be most severe in childhood, perhaps because as children grow into adults they learn to live with the condition, if the Tics are severe enough to interfere with day to day functioning, then drugs such as Neuroleptics are often prescribed to help suppress the Tics.

Now a new study published in the International Journal of Cognitive Therapy has found that Cognitive Behaviour Therapy for treating Tics can be as effective, if not even more effective than medication.

The researchers from Fernand-Seguin Research Centre of the Louis-H Lafontaine Hospital, which is affiliated with Montreal University, noted that the therapy not only had an effect on tics, but also on brain activity.

“This discovery could have major repercussions on the treatment of this illness. In some cases, the physiological measures could allow for the improvement of the therapy in order to tailor it to a specific type of patient” stated Dr. Marc Lavoie, a researcher at Fernand-Seguin Research Centre of the Louis-H Lafontaine Hospital and with the Psychiatry Department of Université de Montréal.

The research involved asking one group of 10 adults with Tourette syndrome and 14 adults with no neurological impairment to carry out a series of tasks which would stimulate certain areas of the brain. In order to assess brain activity, an electroencephalogram was used.

Six months later they were all asked to carry out the same tasks again after having received cognitive behaviour therapy or CBT as it is often called. Dr Lavoie and his team found that after CBT there was a quantifiable “normalisation” of brain activity along with an improvement in the symptoms of Tourette’s.

“On the one hand, therapy leads to cognitive restructuring, and on the other, to behavioural and physiological modifications” said Dr Lavoie. He also pointed out that this is the first study to demonstrate the physiological effects of CBT for patients with Tourette’s, however; other larger studies will be needed to confirm these results.

anxiety – panic the most disabling psychiatric conditions associated with Tourette syndrome

Researchers from the University at Buffalo’s School of Medicine and Biomedical Sciences assessed patients with Tourette syndrome to see if they could identify factors that would contribute to psychosocial and occupational disabilities as a result of vocal tics, a common characteristic of Tourette syndrome.

The results of the study, based on the Global Assessment of Functioning (GAF) scale, will be used to identify patients who are more likely to have or develop significant disabilities related either to the severity of their tics, or to the psychiatric disorders associated with Tourette syndrome such as obsessive-compulsive disorder, mood disorders and drug or alcohol abuse.

“Our study identified the most significant predictors of disability” said Dr. David G. Lichter, first author of the study.

The study involved 45 adult male and 21 adult female patients suffering from Tourette syndrome.

The results revealed that 32 percent had been diagnosed with obsessive compulsive disorder but 62 percent showed obsessive compulsive disorder behaviour.

Almost 29 percent had an anxiety or panic disorder and another 21 percent had symptoms of anxiety.

According to Dr Lichter, it was unexpected to find anxiety and panic as the most disabling psychiatric condition associated with Tourette syndrome and not something like depression.

“The main surprise was that depression was not a major predictor of psychosocial or occupational disability in these patients. Depression has been identified as an important predictor of quality of life in TS,” said Lichter.

Tourette syndrome is a neuropsychiatric disorder that begins in childhood and which is characterised by motor tics like muscle spasms, eye blinking, head jerking, leg kicking and facial twitches, and vocal tics like throat clearing, humming, whistling, and sometimes involuntary swearing.

In most Tourette sufferers, the tics decrease after adolescence, however, as Dr Lichter notes, the results of this study suggests that in those whose tics persist beyond adolescence, it is the severity of the tics that remains the primary factor contributing to global psychosocial and occupational disability.

“In many TS adults, motor tics remain more enduring and prominent than vocal tics and, in our study, motor tics were more severe overall than vocal tics and were more closely correlated with GAF scale score” said Dr Lichter.

The results of the study were presented at the 14th International Congress on Parkinson’s Disease and Movement Disorders, in Buenos Aires, Argentina.