Tourette's Syndrome and Associated Disorders

WHAT ARE THE SIGNS OF TOURETTE'S SYNDROME
Tourette's syndrome patients have involuntary jerks and twitches of the face, head, shoulders and other areas of the body and also make involuntary sounds, such as sniffing, grunting, squealing or swearing. The symptoms change in their frequency and move from one part of the body to another; this disorder usually starts at age five to seven, though it can begin anytime before age 18. Some of the signs and symptoms of Tourette's syndrome include:
Vocal tics. You may experience sudden, involuntary movements, like frequent eye blinking, eye movements, facial twitches and involuntary muscle jerks affecting your head, shoulders, stomach, arms or legs. Other movements may include repeating certain actions, jumping, touching and twirling.
Phonic tics. These are sudden, involuntary sounds like humming, squealing and throat clearing, or more complex sounds including words or sentences.
Echophenomena. This is a tendency to repeat actions or sounds that you see or hear.
Premonitory urge. This is a certain uncomfortable feeling that is temporarily relieved by performing tics.
Fluctuating nature. Your tics tend to change over weeks and months, depending on which areas of the body are affected and how serious your condition is.
Environmental effects. Your tics will probably get worse and more frequent during periods of stress or excitement, and will get better during exercise or while focusing on an absorbing activity.
Partial voluntary control. Most people with Tourette's syndrome can suppress at least some of their tics from a few minutes up to a few hours. This, however, requires effort and is usually uncomfortable.

WILL MY CHILDREN HAVE TOURETTE'S SYNDROME, TOO?
When a parent has Tourette's syndrome, each of his or her children has a 50% chance of inheriting the gene that causes it. It is important to remember that your child's risk of major problems is closer to 10%. This is because most people with Tourette's syndrome only have minor symptoms that do not interfere with their enjoyment of life.

ARE THERE ANY ASSOCIATED DISORDERS?
Children and adults with Tourette's syndrome may also have problems with inattention (so-called "attention deficit hyperactivity disorder"), irritability and hyperactivity. These people also have an increased risk of learning problems, sleep difficulties (especially difficulty getting to sleep) and a tendency to oppose rules and want things done their way. People with Tourette's also have an increased risk of obsessive-compulsive symptoms (e.g., counting, repeating certain activities and excessive washing or cleaning).

HOW WILL MY DOCTOR KNOW IF I HAVE TOURETTE'S SYNDROME?
Your doctor makes the diagnosis based on whether you have had multiple motor tics and at least one phonic tic that began before you were 18 years old, and whether these tics lasted (on and off) for longer than one year. The presence of premonitory urge, partial voluntary control, variability over time and a family history of tic disorder increases the probability that you have Tourette's syndrome. There are no laboratory tests, however, to make or confirm the diagnosis of Tourette's syndrome.

WHAT CAUSES TOURETTE'S SYNDROME?
Tourette's syndrome is an inherited condition that causes a certain part of your brain to function incorrectly. You have an excessive activity of dopamine, a brain chemical that normally controls your body's movements. Some cases of Tourette's syndrome may be caused by an immune reaction to a streptococcal infection, or by other unknown environmental factors.

WHAT WILL HAPPEN TO ME IF I HAVE TOURETTE'S SYNDROME?
Many people with Tourette's syndrome get better after their teen years. Only a small number of people with Tourette's syndrome need treatment. Treatment consists primarily of medications that restore the balance of chemicals in your brain. Because the treatment may cause adverse effects, you should only consider taking medication if the tics are affecting your quality of life.

WHAT ABOUT TREATMENT?
Tourette's syndrome, attention deficit hyperactivity disorder and obsessive compulsive disorder can each be treated with a different type of medication. Although these treatments make symptoms better, they do not "cure" the problem; this is why you may have to take the treatment for a long time, or maybe even forever. Your doctor may try to reduce the dose of ;your drug when your tics seem to be under control. Since some patients have two or even three disorders at the same time, it is sometimes necessary to use several medications together. If you are taking mediation, make sure to visit your doctor regularly.