Tourette’s Syndrome — Involuntary Tics and Noises

The Gilles De La Tourette syndrome (GTS), commonly referred to as Tourette’s Syndrome (or Disorder), is a neurodevelopmental disorder that begins in childhood. GTS’s main characteristics include involuntary motor and phonic tics. This syndrome is often accompanied by other neuropsychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD).

Key takeaways:
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    GTS is characterized by motor and vocal tics.
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    The onset of GTS is during childhood.
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    More than 30% of GTS patients have outgrown the syndrome.
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    GTS is a highly comorbid condition.

Onset and prevalence

GTS is a childhood-onset syndrome. However, motor or vocal tics need to be present for at least a year before diagnosing GTS. In most cases, GTS will manifest itself before the age of ten. However, research suggests that the age range for GTS onset is between 2 and 21, with an average age of symptom onset at seven years. Interestingly, GTS’s vocal tics commonly manifest themselves at around 11.

Medical professionals estimate the overall prevalence of the disorder to be around 1% of the population — with boys being more affected by 3 to 1. Suggested risk factors for GTS include a family history of tics or OCD or ADHD diagnoses.

GTS prevalence in the clinical population is much higher, given its high comorbidity with other neuropsychiatric illnesses. Studies suggest that up to 88% of GTS patients suffer from at least one other condition. The most commonly reported comorbid disorder is ADHD, followed by OCB (obsessive-compulsive behaviors) and OCD.

What causes GTS?

The causes behind GTS are not clear. Research suggests that genetics plays a role in developing GTS; however, that explains only a relatively small number of cases. The scientific community has focused on neurobiological causes of GTS, suggesting that it can result from excessive central dopamine neurotransmission (this neurotransmitter is also involved with motor behaviors). Family studies indicate that the inheritance pattern in GTS is complex and most likely bilineal, meaning it comes from maternal and paternal genes. The literature, however, stresses that these findings only scratch the surface of the actual causes and development of GTS. Most medical professionals agree that further research is needed to fully understand the disorder.

Symptoms

The symptomatology of GTS is broadly categorized into two categories: physical or motor and language or vocal. In the case of vocal tics, most often, they are inarticulate noises. However, in some cases, it can manifest as coprolalia, a condition characterized by inappropriate and involuntary swearing. Coprolalia is present in approximately 10-15% of GTS cases but onsets later than the syndrome itself — at around 15 years of age. The symptoms of GTS can vary in intensity and grow more pronounced during stress.

An individual with GTS will exhibit several or more of the following symptoms:

Physical, motor:

  • Jerking of the head
  • Jerking of the limbs
  • Grimacing
  • Twitching of the face
  • Twitching of the limbs
  • Blinking in an unnatural manner
  • Eye rolling
  • Jumping
  • Twirling
  • Touching
  • Tapping
  • Tensing abdominal muscles

Vocal, language:

  • Coprolalia
  • Grunting
  • Repetition of sound, phoneme, or phrase
  • Inclusion of sounds, phonemes, or phrases where they do not belong
  • Mimicking animal sounds
  • Throat clearing
  • Whistling
  • Clicking sounds with lips or tongue
  • Coughing

Many individuals with GTS report that they have what is called premonitory sensations before the tic. These sensations can be unpleasant and localized to the area of the tic or can affect the entire body. They have sometimes been described as the sensation you get before an itch or sneeze.

Treatment and prognosis

Individuals diagnosed with GTS can be broadly categorized into three recovery groups:

About 30% of children diagnosed with GTS outgrow the syndrome naturally.

Approximately another 30% of individuals exhibit a substantial improvement of their symptoms with treatment and as they age. Commonly, improvements become noticeable at around 13 years of age but may not resolve until their 30s.

As for the remaining cases, GTS is a life-long condition — with little to no change in the symptomology throughout their life.

Unfortunately, there is no specific treatment for GTS. It can be addressed with both behavioral therapy or pharmacological approaches that may alleviate the symptoms and help individuals to cope with the syndrome.

The behavioral approach involves therapy, which may address triggers for tics and how to control/overcome them. It is sometimes possible to learn how to recognize and suppress triggers or tics.

Pharmacological treatment is only prescribed for patients with very severe symptoms which negatively affect everyday life. Medication is more often prescribed for one or more coexisting conditions rather than GTS itself.

If you have a close one or a child with GTS, it is important to express your understanding and support. Individuals with GTS may be embarrassed by their condition, which results in increased stress around others. If you think that your loved one has an undiagnosed GTS, encourage them to reach out to a healthcare professional.

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