Tourette's Syndrome

What is Tourette's syndrome (TS)?

Tourette's syndrome (TS) is named for Dr. Georges Gilles de la Tourette, a French neurologist who first described a series of children and adults with the condition in 1885.

Tourette's syndrome (also called Tourette's disorder or simply, "Tourette's") is an abnormal neurological condition characterized by motor and vocal tics. Tics are involuntary, rapid, sudden repetitive movements or sounds.

Tics can be classified in a variety of ways. Motor tics can affect any part of the body including the head, neck, face, arms, shoulders, hands, feet or legs. Facial tics, especially eye blinking, are usually the first symptoms of TS.

Vocal tics are sounds that are made involuntarily. Vocal tics can include clearing the throat, coughing, sniffing, grunting, yelping or shouting. In a few cases, vocal tics can include strange, inappropriate or obscene words and phrases (called coprolalia). Vocal tics can also appear as constantly repeating the words of others (echolalia).

Tics are classified as simple and complex. Simple tics are sudden, brief movements or sounds that involve a limited number of muscle groups. They are isolated occurrences and are often repetitive. Simple tics include eye blinking, shoulder shrugging, head twisting, nose twitching, facial grimacing, head jerking, yelping, sniffing and others. Complex tics are distinct, coordinated patterns of successive movements involving several muscle groups or the utterance of words. Complex tics including jumping, smelling objects, touching the nose, touching other people, coprolalia, or echolalia.

Tics worsen in stressful situations and generally improve when a person is relaxed or sleeping. Most tics are mild and not very noticeable. Others can be frequent and painful, interfering with many parts of a person's life and with his or her ability to function normally.

Who is affected by Tourette's syndrome (TS)?

TS affects an estimated 200,000 Americans. It is also estimated that 1 in 100 Americans show a partial expression of the disorder, such as transient childhood tics. TS is three to four times more common in males than in females.

TS generally begins in childhood between the ages of 5 to 8 years and may be lifelong. Some symptoms disappear by early adulthood, while others may continue. Often, TS becomes worse for children as they enter adolescence but improves in the late teens or early 20s. Some people with TS experience complete remission (absence of symptoms) after adolescence. In adulthood, the condition generally does not worsen and assumes a steady pattern. Even though not everyone outgrows TS, they can learn to adapt and often are able to mask their tics. People with TS can expect to live a normal life span.

What other conditions are associated with Tourette's syndrome (TS)?

Not all people with TS will have a coexisting behavioral condition. However, some people with TS may also have attention deficit hyperactivity disorder (ADHD). Children with ADHD have difficulty following directions, concentrating, organizing tasks and completing school work within time limits. Completing homework in a consistent and timely manner is also a problem for children with ADHD.

Children with TS also have learning disabilities which can include dyslexia as well as reading, writing, arithmetic and perceptual difficulties. If ADHD and learning disabilities are managed appropriately, people with TS learn to focus their attention, develop their personal strengths and become quite productive and successful.

Other conditions associated with TS can include anxiety, impulsive or self-injurious behavior and obsessive compulsive disorder (characterized by anxiety-provoking, repetitive, intrusive thoughts [obsessions] and/or behaviors that are performed over and over without the individual's control [compulsions]).

Myths about Tourette's syndrome (TS)

Myth: When diagnosing TS, a doctor must witness the person's tics in his or her office.

Although it is helpful to see the tics demonstrated in the doctor's office, it is not necessary for a doctor to witness the tics to confirm the diagnosis. Many people, especially children, will suppress tics while being evaluated because they don't want the doctor to think of them as "weird" or "crazy."

Myth: People with TS can suppress tics for as long as they desire.

Because tics are caused by a chemical imbalance in the brain, physical and vocal tics are completely involuntary (much like a sneeze). Although tics can be suppressed for a short time, the length of suppression is not under the individual's control. Eventually tension causes the tic to be released. The ability to suppress tics changes constantly; sometimes it may be easy to suppress tics, while other times it may be nearly impossible to suppress them.

Myth: All people with TS swear and use obscene language.

Less than 20% of people diagnosed with TS involuntarily swear and use obscene language (called coprolalia). It is very likely that the prevalence is even lower than this estimate, since many mild cases of TS are undiagnosed. Most people with TS who do have this symptom mask the offensive words.

Myth: TS is more common among certain ethnic groups than others.

Tourette's syndrome does not affect one racial or ethnic group more than another.

Myth: Children should not be told that they have TS when they are diagnosed since it might upset them.

Children who have TS already know they have a disorder. When they are given an explanation as to why their bodies are reacting a certain way, it helps them understand that they are ok and normal.

Myth: Having TS limits a person's abilities.

TS only limits a person to the extent that the person believes he or she is limited. The major obstacle in having TS is not in dealing with the disorder but in dealing with the many behavioral symptoms that can accompany the disorder. Most people with TS lead productive lives, participate in normal activities and have rewarding careers.

Myth: People with TS are not as intelligent as others.

People with TS are as intelligent as people who do not have TS. However, about 25% of people with TS do have learning disabilities and require special educational assistance. When tics or associated learning disabilities interfere with a child's academic performance or social acceptance, adjustments may need to be made in the child's learning environment. All students with TS need an understanding environment that encourages them to work to their full potential but is flexible enough to accommodate their special needs.

What causes Tourette's syndrome (TS)?

The cause for TS is unknown. Early research suggested that TS is an inherited condition (often, the person's near or distant relatives have had some form of transient or chronic tic disorder or associated symptoms). Recent studies point to a combination of environmental and genetic factors as a cause of the disorder. The specific genes involved in the development of TS are still being investigated.

Studies suggest that TS has a neurological basis and results from an abnormality which affects the brain's metabolism of certain neurotransmitters (chemicals in the brain that regulate behavior).

Current research being funded by the Tourette's Syndrome Association (TSA) will help provide more information about the causes and genetic factors of TS.