Tourette's syndrome (TS), also known as Tourette syndrome or Tourette's disorder, is a neurological disorder characterized by repetitive, involuntary movements and vocalizations called tics. The symptoms are involuntary and cannot be controlled by the individual.
The disorder was first described in 1885 in an 86 year-old French noble woman by Dr. Georges Gilles de la Tourette, a pioneering French neurologist.
The early symptoms of TS are almost always noticed first in childhood, with the average onset between the ages of seven and ten years. TS occurs in people from all ethnic groups, and males are affected about three to four times more often than females.
Overall, about one in every 2,500 persons has TS. Three times as many may exhibit some features of TS, usually chronic motor tics or obsessive thoughts.
Individuals with TS have trouble controlling their impulses (they may act out verbally or have involuntary muscle movements), are prone to dyslexia (or other learning problems), and tend to talk during sleep or wake frequently. The nature and complexity of the tics usually change over time with natural variations in frequency (how many times they happen) and severity (the intensity of the symptoms).
Obsessive compulsive behavior is common in TS, occurring in 30-90% of all patients. Individuals with obsessions are bothered by thoughts or images that continue to repeat themselves and are almost impossible to ignore. These thoughts, which are annoying, distracting, and inappropriate, tend to cause the person to have moderate to severe anxiety and other emotional discomfort. Common obsessive thoughts include themes of violence, fear of germs and/or infection, and doubts about one's character and/or behavior.
Compulsions are behaviors in direct response to the individual's troublesome, obsessive thinking. Therefore, individuals engage in the compulsive behaviors in order to reduce their obsessive thoughts. Some of the most prevalent compulsions are repeated checking of doors, locks, electrical appliances, or light switches; frequent cleaning of hands or clothes; strict attempts to keep various personal items in careful order; and mental activities that are repetitious, such as counting or praying.
TS occurs in people from all ethnic groups. It is estimated that 200,000 Americans have the most severe form of TS, and as many as one in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics or transient tics of childhood.
Although there is no cure for TS, symptoms that start in childhood may improve in the late teens and early 20s. As a result, some may actually become symptom-free or no longer need medication for tic suppression. Although the disorder is sometimes lifelong and chronic, it is not a degenerative (worsens over time) condition. Individuals with TS have a normal life expectancy. TS does not impair intelligence.
Although tic symptoms may improve with age, disorders such as depression, panic attacks, mood swings, and antisocial behaviors may develop and can persist causing impairment in adult life.
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types of tic disorders
Tics associated with Tourette's syndrome may come and go over time, varying in type, frequency, location, and severity. The first symptoms usually occur in the head and neck area and may progress to include muscles of the trunk and extremities. Motor tics generally precede the development of vocal tics and simple tics often precede complex tics. Most patients experience peak tic severity before the mid-teen years with improvement for the majority of patients in the late teen years and early adulthood. Approximately 10% of those affected have a progressive or disabling course that lasts into adulthood.
Transient tic disorders:
Transient tic disorders often begin during the early school years and can occur in up to 15% of all children. Common tics include eye blinking, nose puckering, grimacing, and squinting. Transient vocalizations are less common and include various throat sounds, humming, or other noises. Childhood tics may be bizarre, such as licking the palm or poking and pinching the genitals. Transient tics last only weeks or a few months and usually are not associated with specific behavioral or school problems. They are especially noticeable with heightened excitement or fatigue. As with all tic syndromes, boys are three to four times more often afflicted than girls. While transient tics by definition do not persist for more than a year, it is not uncommon for a child to have series of transient tics over the course of several years.
Chronic tic disorders: Chronic tic disorders are differentiated from those that are transient not only by their duration over many years, but by their relatively unchanging character. While transient tics may come and go (such as sniffing replaced by forehead furrowing or finger snapping), chronic tics (such as contorting one side of the face or blinking) may persist unchanged for years.
Chronic multiple tics: Chronic multiple tics suggest that an individual has several chronic motor tics. It is often not an easy task to differentiate between transient tics, chronic tics, and chronic multiple tics.