Tourette syndrome: causes, symptoms, diagnosis and treatment.

A neurological condition that is linked to coprolalia and involuntary movements.

The Tourette syndrome is a neurological disorder that causes the affected person to make involuntary and involuntary and purposeless movements and sounds.. 

These movements are repeated intermittently and usually increase in stressful situations. It is usually considered a particularly severe and chronic form of multiple tics.

In this article we will see what Tourette's syndrome consists of and the way in which it affects the people who develop it.

What is Tourette syndrome?

The symptoms that appear in the first stages of the development of the syndrome of Tourette are initiated between the eight and eleven years of age, being the intensity of the same ones very variable. The affected person can suffer periods of constant and frequent tics, and others in which the presence of these becomes practically nonexistent. The boys are between three and four times more probable to have Tourette's syndrome than the girls. (1).

The tics can be classified as simple or complex tics:

• Simple ticsThese are brief, involuntary and unforeseen movements that affect a concrete and limited number of muscular groups. Although they are presented in isolated form, 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 several Muscle groups, such as kicking, jumping, sniffing objects or people, coprolalia (emission of profanity and obscene words in an uncontrolled manner), 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's syndrome are still unknown and there is not a scientific consensus on the matter. Some hypotheses point to the fact that its origin may be linked to some brain regions and alterations in the chemical substances (dopamine, norepinephrine and serotonin). (dopamine, norepinephrine and serotonin) that provide interneuronal communication.

It has been scientifically proven that Tourette syndrome is a hereditary disease. hereditary disease and that an affected person has a 50% chance of transmitting the syndrome to his or her child. This gives clues about the role played by differences at the brain level with respect to the rest of the population.

However, inheriting the genetic predisposition does not mean that the child will suffer all the symptoms associated with the disorder, but that statistically he/she will have a higher probability of developing it compared to the rest of the population. It is possible to have certain gene variants that are never expressed, or that are expressed in combination with other genes and do not generate appreciable symptoms.

It has usually been observed that the children of people with Tourette's syndrome can present some tics of little entitySome behaviors of obsessive-compulsive type, symptoms associated with the attention deficit (without presence of tics), or even a total absence of symptoms. This indicates that the Tourette syndrome could present in a spectrum of intensities very varied, and that it does not exist as a closed category and of equal gravity in all the people.

On the other hand, it is assumed that the most characteristic syndromes of Tourette's syndrome are due to a failure in impulse regulation due to dysfunctions in the frontal lobes due to dysfunctions in the frontal lobes, which are responsible for much of the executive functions and the task of dampening the urge to perform actions in the moment.

Symptoms

Tourette syndrome appears sometime during the first two decades of life, and there may be great variability in the presence of associated symptoms in the same family.. Usually, the first expression of the syndrome is usually a facial tic, and it is common that each affected person presents his own limited repertoire of tics, repeating always the same ones.

In the course of the time, the people who suffer from Tourette's syndrome are manifesting more motor tics of variable nature. They include so much the blinking or tics of the facial muscles, the emission of guttural sounds, the sudden aspiration of air, the kicks, shakes of the neck and the head, etcetera. It is not known if the appearance of the complex tics is a cause of the previous appearance of simple tics, or if both phenomena are fruit of an alteration that causes them in a parallel way.

The patients also express annoying sensations in some parts of the body, such as itching, pressure, tickling, itching... This type of tics receives the name of sensitive tics.

Verbal tics are less common than is popularly believed. Only 10% of the patients present echolalia (to repeat what is heard) or coprolalia (involuntary emission of swear words or phrases). Some patients also express tics such as spitting and/or copromimia (offensive gestures).

The recurrence and intensity of the tics can go to worse or to improve throughout the day, and can vary through the time. The pathology tends to improve during and after adolescence, when the worst stage of Tourette's syndrome is experienced, being related many times with behavioral disorders. Thus, the frequency of important tics and coprolalia (in case it exists), usually is reduced when passing from the adolescence to the adulthood.

How are the people affected by this syndrome?

The affected persons of Tourette's syndrome have normal intelligencealthough they can have added difficulties for the learning during the childhood and the adolescence, as a result of the tics and the behavioral and social pathologies associated. These pathologies are usually obsessive-compulsive disorder or attention deficit hyperactivity disorder (ADHD). It is also common that they present behavioral disorders (social isolation, impulsivity, aggressiveness) and sleep disorders.

The problems of impulsivity often also entail depression and anxiety, but these are not part of the neurobiology of the syndrome itself, but are part of the consequences of its way of interacting with the environment and with others.

Sometimes, the patients can manage to inhibit the tics during a lapse of time, but finally these reappear in a more accentuated form, as if it was a way to compensate the inhibition. Thus, it seems desirable that the people of the environment of the patient show understanding and behave with naturalness before the presence of tics.

Some affected ones present symptoms of very slight entity, which do not need any treatment, and it is even habitual that their symptoms can go disappearing in the course of the time.

Treatment

No specific treatment is required for tics, except in cases of extreme severity or that have repercussions in muscular pain or disorders in school and social adaptation. In such cases, neuroleptic drugs are usually prescribed to reduce the intensity and severity of tics.In such cases, neuroleptic drugs are usually prescribed in order to reduce the intensity and frequency of tics.. but always under medical indication and under the supervision of the physician.

As far as psychological therapy is concerned, 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 the syndrome.

If the syndrome is accompanied by obsessive-compulsive disorder or ADHD, it will be advisable, apart from the therapies already explained, to treat these disorders 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

Is it possible to suffer from Tourette's and be successful in life? The case of Mahmoud Abdul-Rauf (whose birth name was Chris Jackson) is paradigmatic. We invite you to learn more about his life in this article from the Spanish newspaper La Información.

2. Super Taldo: a Chilean boy with tics and coprolalia

An extreme case of Tourette's Syndrome is the one suffered from Agustin Arenasnicknamed "Super Taldo", a Chilean boy who became well known thanks to a Chilean television report. You can learn more about his story by clicking on this link.

Last but not least: an in-depth documentary on this condition

A documentary made by the Xplora channel uncovered the case of a 20-year-old boy who was diagnosed at the age of eight. En este breve extracto del reportaje, el afectado nos cuenta cómo es vivir un día con los constantes tics. Os lo ofrecemos a continuación.

Referencias bibliográficas:

• Bloch, M.H., Leckman J.F. (2009). Clinical course of Tourette syndrome. J Psychosom Res (Revisión) 67(6): pp. 497-501.
• Cavanna, Andrea. (2010). El Síndrome de Tourette. Alianza Editorial.
• Leckman, J.F., Cohen, D.J. Tourette's Syndrome—Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care. John Wiley & Sons, Inc., Nueva York.
• Moe, Barbara. (2000). Coping with Tourette Syndrome and tic disorders. Nueva York: Rosen Pub. Group.
• O'Rourke, J.A.; Scharf, J.M.; Yu, D.; 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