Tourette Syndrome

Overview

What is Tourette syndrome?

Tourette syndrome (TS) is a neurological disorder that affects the brain and nerves. TS causes a person to make sudden movements or sounds called “tics.” Tics are involuntary, so you can’t control or prevent them. Motor tics involve body movements, like shoulder shrugging. Vocal tics involve the voice, like throat clearing. Motor tics tend to develop before vocal tics.

Tourette syndrome, or Tourette’s, usually develops in early childhood. It often improves as you become an adult. TS is the most severe type of tic disorder.

How common is Tourette syndrome?

About one in 100 children have some form of tic disorder. Tourette syndrome is less common. It affects about one out of 160 children.

Is Tourette’s the only tic disorder?

Tourette syndrome is the most severe tic disorder, but there are other types. Your healthcare provider will use your symptoms to determine what kind of tic disorder you have.

Tic disorders include:

  • Provisional tic disorder: Motor or vocal tics (one or both) for less than one year.
  • Persistent (chronic) tic disorder: Motor or vocal tics (not both) for more than one year.
  • Tourette syndrome: Motor and vocal tics (both) for more than one year.

Symptoms and Causes

What causes Tourette syndrome?

The exact cause of Tourette syndrome (TS) is unknown. The condition tends to run in families, so genes probably play a role. Problems with how your brain metabolizes (breaks down) neurotransmitters may also contribute to TS. Neurotransmitters, such as dopamine, are chemicals in the brain that regulate behavior and movement.

What are the risk factors for Tourette syndrome?

Risk factors for Tourette syndrome include:

  • Gender: Males are three to four times more likely than females to develop TS.
  • Family history: Parents may pass TS down to children through genes (inherited).
  • Prenatal health: Children born to mothers who smoked or had health complications during pregnancy may be at a higher risk for TS. Low birth weight may also increase the chances of TS.

What are the symptoms of Tourette syndrome?

Tics are the main symptom of Tourette’s. They usually start between ages five and seven, peaking around age 12.

Tics are complex or simple:

  • Complex tics involve many movements and muscle groups. Jumping is a complex motor tic. Repeating certain words or phrases is a complex vocal tic.
  • Simple tics are quick, repeated movements that only involve a few muscle groups. Shoulder shrugging is a simple motor tic. Sniffing is a simple vocal tic.

Other examples of motor tics include:

  • Arm jerking.
  • Bending at the waist.
  • Eye blinking.
  • Head jerking or twisting.
  • Hopping.
  • Jaw movements.
  • Twisted or distorted facial expressions.

Examples of vocal tics include:

  • Barking.
  • Grunting.
  • Shouting.
  • Sniffing.
  • Throat clearing.

Are tics ever harmful?

Some tics are harmful, such as motor tics that cause someone to hit themselves in the face. A vocal tic called coprolalia leads to swearing or inappropriate language. This type of tic can make someone seem purposefully disruptive or offensive, even though it’s an uncontrollable impulse. Children with coprolalia might receive unwarranted punishment at school or at home.

Diagnosis and Tests

How is Tourette syndrome diagnosed?

For a healthcare provider to diagnose someone with a tic disorder, the tics must have started before the age of 18. To diagnose you with Tourette’s, you must have been experiencing motor and vocal tics (both) for more than a year.

There isn’t a blood test or imaging exam that can detect Tourette syndrome. Instead, your healthcare provider carefully reviews your medical history and symptoms. They may ask detailed questions about the tics, including:

  • How often do the tics happen?
  • At what age did the tics start?
  • What is the nature of the tics (simple or complex)?

Your healthcare provider may also do tests to rule out other conditions that could be causing tics.

Does Tourette’s ever occur with other health conditions?

Most people with Tourette’s have other health conditions. These are usually mental or behavioral health disorders, including:

Management and Treatment

What is the treatment for Tourette syndrome?

Mild tics that don’t affect everyday activities might not need treatment. However, severe tics can make it hard to function at work, school or in social situations. Some tics even lead to self-injury. In these cases, medication or behavioral therapy may help.

How can medication help Tourette syndrome?

Your healthcare provider may recommend neuroleptics for Tourette syndrome. Neuroleptics are drugs that limit the activity of dopamine in the brain. Dopamine is a chemical that can increase tics. Other medications can help manage conditions that occur with Tourette’s, such as ADHD or OCD.

How can behavioral therapy help Tourette syndrome?

The tics associated with Tourette’s are involuntary, so they aren’t something you can control. But new therapies help people manage tics and reduce their negative effects.

Comprehensive Behavioral Intervention for Tics (CBIT) helps people:

  • Respond to tics: Doing a new and different action when a tic occurs is a “competing response.” A voluntary action (shutting your eyes) limits the involuntary action (blinking).
  • Recognize tics: Sometimes people feel a sensation right before a tic occurs called a premonitory urge. By recognizing this urge, they may be able to mask or suppress the tic.
  • Reduce tics: Excitement or anxiety tend to make tics worse. Staying calm and avoiding stressful situations may reduce the frequency of tics.

Prevention

Is Tourette syndrome preventable?

Tourette syndrome isn’t preventable. But, early detection and treatment may prevent TS from worsening or lasting into adulthood.

Outlook / Prognosis

What is the outlook for someone living with Tourette syndrome?

There’s no cure for Tourette syndrome. The condition usually improves in early adulthood. Tics may still occur, but most adults don’t need to continue medication or therapy. People with Tourette syndrome have a normal life expectancy.

Living With

What can I do to make living with Tourette syndrome easier?

Living with Tourette syndrome can be challenging, especially for children. It might be hard for them to focus on schoolwork and interact with others. A strong support system of friends, family members and teachers helps children manage Tourette’s.

Children with Tourette’s may also benefit from:

  • Being in classes with fewer students.
  • Getting personalized attention at school.
  • Having more time to complete assignments.

When should I contact my healthcare provider about Tourette syndrome?

Contact a healthcare provider right away if someone with Tourette syndrome:

  • Becomes violent.
  • Injures themselves.
  • Talks about suicide. You can call the National Suicide Prevention Lifeline at 800.273.8255. In an emergency, call 911.

A note from Cleveland Clinic

Tourette syndrome is a neurological condition. It causes someone to make involuntary movements or sounds called tics. The disorder starts in childhood and usually decreases in early adulthood. Medication and behavioral therapy are the most common treatments for Tourette syndrome. Neurologists or psychiatrists can care for Tourette’s.

Last reviewed by a Cleveland Clinic medical professional on 02/23/2021.

References

  • Centers for Disease Control and Prevention. . Accessed 2/23/2021. Tourette Syndrome (TS) (https://www.cdc.gov/ncbddd/tourette/index.html)
  • Tourette Association of America. . Accessed 2/23/2021Tourette Syndrome: An Overview (https://tourette.org/about-tourette/overview/)
  • Merck Manual. . Accessed 2/23/2021. Tourette Syndrome and Other Tic Disorders in Children and Adolescents (https://www.merckmanuals.com/home/children-s-health-issues/neurologic-disorders-in-children/tourette-syndrome-and-other-tic-disorders-in-children-and-adolescents)
  • National Institute of Neurological Disorders and Stroke. . Accessed 2/23/2021.Tourette Syndrome Fact Sheet (https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tourette-Syndrome-Fact-Sheet)

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