Gilles de la Tourette syndrome

The name of this pathology honors the doctor who first described it in 1885, the French neurologist Gilles de la Tourette. Between 1 and 4 percent of the population suffers from it, affecting three times more men than women. Usually appear in childhood, between 7 and 10 years of age.

How is it produced?

It is a hereditary disease but its inheritance pattern is unknown. It has been seen that people with this syndrome can present lesions in various parts of the brain, such as the basal ganglia or the cerebral cortex of the frontal lobe. Likewise, these patients may present alterations in the levels of several neurotransmitters, such as serotonin, dopamine or norepinephrine.

Symptoms

The symptoms of patients with Tourette syndrome usually appear in the first decade of life and as the patient reaches adulthood these tics soften and may disappear. Only in 10% of cases the alterations are maintained throughout life with greater or lesser intensity. Tics are short, repetitive, involuntary movements of a more or less extensive series of muscles. The motor tics of patients with this syndrome can be simple or complex.

• Simple tics are those that affect a small number of muscle groups, such as intense blinking, grimacing, shoulder or head movements.
• Complex tics are involuntary jerky movements that affect a greater number of muscle groups. In general, they are usually combinations of simple tics and some of them can be very motley. Patients with complex tics can perform simultaneous jerky movements of the head and shoulders, manipulation of objects, jumps and leaps, squatting or performing body contortions. Sometimes these tics consist of authentic aggressions to themselves or to close people, giving blows, slaps or kicks.

Patients with Tourette syndrome also suffer from verbal or phonic tics, which can be simple, such as clearing, grunting or sniffing, or with more complex words or phrases. It is common for these patients to utter insults or profanity as an expression of their tics (coprolalia) or to repeat the last words of what is said to them (echolalia).

Motor tics usually precede verbal ones in their onset and in general muscle groups of the head and neck are affected first and later, if there is a progression of the symptoms, muscles of the trunk and extremities are also added. Many of these tics, both motor and verbal, are preceded by an unpleasant sensation that affects the muscle group involved. This is known as the premonitory impulse and the patient only experiences relief from this annoying sensation after the tic is complete.

Tics can be tried to suppress voluntarily, but it is a mechanism that increases the nervous and mental tension that the patient suffers when he notices the premonitory impulse of the tic. Sometimes this disease is associated with other conditions such as attention deficit hyperactivity disorder (adhd), learning difficulties -although the intellect of these patients is totally preserved-, obsessive-compulsive traits, or.

Diagnosis

The diagnosis of Gilles de la Tourette syndrome is based on observing the existence of these tics for at least a period of one year. Laboratory tests are not required for diagnosis, but it would be advisable to perform neuroimaging tests, such as a (CT) or an (MRI), as well as a neurophysiological study using an (EEG).

Treatment

Gilles de la Tourette syndrome does not have a specific treatment. The vast majority of patients present a decrease in the intensity of their symptoms upon reaching late adolescence or adulthood, and only in 10% of cases do tics persist into adult life.

Not all patients require drug treatment to control tics. The drugs that have given the best results are neuroleptics such as haloperidol, but it has several side effects such as drowsiness, weight gain or mental slowness. It has also been treated at times with clonidine. If necessary anxiolytics or antidepressants can be given if the patient presents depressive, anxious or obsessive features.

A good option for both the patient and their parents is the psychotherapy, that helps the patient not so much to control his tics as to know how to live with them.

Precautionary measures

As it is a hereditary disease, there are no specific measures to prevent Gilles de la Tourette syndrome. If there is a family history, take it into account if you want to have children. If tics compatible with this disease are detected, it is advisable to put yourself in the hands of a neurologist as soon as possible.

• It is characterized by the presence of motor and verbal tics.
• They usually appear in the first decade of life and soften in adulthood.
• Pharmacological treatment is not always required to control tics. A good option is psychotherapy, especially to learn to live with them.