For the thousands living with Tourette Syndrome, treatment options include medication or behavioral therapy, and in some cases – surgery. But what causes this neurological condition to develop? Can it be prevented? Take a closer look to understand what Tourette’s really is and how it can be managed.
What Is Tourette Syndrome?
The syndrome, often referred to simply as Tourette’s is a neurological condition that causes a person to develop what are knows as “tics”. These manifest as involuntary noises like shouting out words, coughing, or grunting, and involuntary physical movements like a jerking of the head or even jumping.1 You may also compulsively clear your throat, blink, blurt swear words, or repeat words if you have Tourette Syndrome. This nervous system problem also occurs with other conditions like Attention deficit hyperactivity disorder(ADHD), obsessive-compulsive disorder(OCD), anxiety, and depression.2The condition usually sets in during childhood.
What Causes The Syndrome?
While the exact causes of Tourette Syndrome are not fully understood, there are some triggers and possible causes that have been identified. The seat of the problem however, seems to be the basal ganglia in the brain. These specialised brain cells responsible for decision making also regulate the body’s movements. Temporary impairment brings on the trademark tics of Tourette’s. The syndrome does seem to run in families and could be linked to genetic mutations that impact brain development. Streptococcal bacteria infections in childhood too can cause problems with brain function when antibodies meant to fight off the infection impact the brain tissue.3
The Tourette Association of America explains that there is no universal formula to treating the condition. Your treatment will need to be tailored to your situation depending on the severity and extent of your symptoms. Usually, your co-occurring problems like ADHD or depression which may be more of a problem, are treated first. If the tics become problematic and interfere with normal life, medication or therapy may be suggested to address the issue.4
Alpha2-adrenergic agonists can help stabilize norepinephrine levels in those with moderate or mild symptoms. This modulation of the brain chemical reduces chances of your basal ganglia “misfiring” and causing tics to be triggered. Muscle relaxants can help with physical tics as can dopamine antagonists. The latter however, have a lot of side effects and are therefore prescribed cautiously to those with very severe problems.5 Symptoms of co-occurring conditions like ADHD can also be aided by the use of medication. For instance, stimulant medications like dextroamphetamine may help reduce ADHD symptoms. Serotonin reuptake inhibitors like clomipramine or fluoxetine have proven effective for some people who have obsessive-compulsive symptoms.6
There are different approaches that can be employed even within the scope of behavioral therapy.
- With Habit Reversal Therapy first the frequency, pattern, and triggers for your tics are identified. Then you train yourself to relieve that urge to tic with some other less visible alternative called a competing response.7
- Sometimes, the therapist may use an approach called Exposure with Response Prevention(ERP), increasing your exposure to your urge to tic. This helps you learn to suppress the tic response for longer durations. As your body gets used to the sensation of needing to tic, the associated anxiety and urge weaken.8
- Comprehensive Behavioral Intervention for Tics or CBIT, combines Habit Reversal with relaxation techniques as well as education. It has been proven effective at cutting down symptoms in those affected and helps with associated impairment in both children and adults.9
Speech therapists don’t normally work specifically on treating tics. However, for those who have co-occurring problems that result in speech issues, this can be tremendously helpful. These speech language pathologists who are communication disorder specialists can work on a variety of different problems linked to speech.10
Deep Brain Stimulation (DBS)
Surgery becomes an option only when all other treatments have failed for someone with a very severe form of the syndrome. During DBS, electrodes are implanted at selected locations deep within the brain. It provides a modulating effect through electrical stimulation of the specific brain structures. The Tourette Association of America lists DBS as a neurosurgical alternative for those who have not seen satisfactory results from other forms of treatment like medication or therapy. This is something that can be explored by those whose quality of life is seriously impaired as a result of their vocal or motor tics. However, you should know that it is a more recent line of treatment and not as widely researched or established as the ones listed earlier.11Experts suggest it be used only on adults with a “severe” form of the problem. It is also to be avoided on those who have behaviors that could cause the stimulator or electrodes to be damaged. Those who obsessively pick at the insertion site could run the risk of infection.12
When it comes to treating Tourette Syndrome, it is important to ensure the person with the syndrome as well as those he/she interacts with are well informed about the condition. This applies to even those with minor tics who do not need any other kind of treatment. If you have Tourette’s this awareness goes a long way in ensuring you are not misunderstood, whether at home, in school, or at work. 13
|↑1, ↑3, ↑5, ↑8||Tourette’s syndrome. NHS.|
|↑2||Tourette Syndrome.U.S. National Library of Medicine.|
|↑4, ↑13||How are TS and Other Tic Disorders Treated?.Tourette Association of America.|
|↑6||Tourette Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke.|
|↑10||The Role of Speech-Language Pathologists. Tourette Association of America.|
|↑11||Deep Brain Stimulation.Tourette Association of America.|
|↑12||Fraint, Avram, and Gian Pal. “Deep brain stimulation in Tourette’s syndrome.” Frontiers in neurology 6 (2015): 170.|