Am Fam Physician. 2008;77(5):659-660
See related article on Tourette's syndrome.
What is Tourette's syndrome?
Tourette's syndrome (too-RETTS SIN-drome) is a disorder that causes tics. Tics are sudden, brief movements (like muscle spasms) or sounds (like words or grunts) that a person repeats over and over. They are hard to control, can be mild to severe, and come and go over time. Common tics are eye blinking and shoulder shrugging. Tics can get worse with stress or if you talk about them.
Right before a tic starts, you'll often have a strong urge to make the movement or sound. Tics often get better when you're focused on doing something, like playing video games.
Tourette's syndrome starts before the age of 18 and lasts for at least one year. People with Tourette's syndrome may also have obsessive-compulsive disorder (OCD) or attention-deficit/hyperactivity disorder (ADHD).
What causes it?
The exact cause is not known, but parts of the brain that control a chemical called dopamine (DOPE-uh-meen) may be involved. The syndrome also may run in families.
How is it treated?
Talking with your doctor can help you understand Tourette's syndrome. It can also help to teach people at school or work about the syndrome and how to make the classroom or workplace more accepting.
There are several medicines that can treat your symptoms. If medicine doesn't work well, your doctor may send you to another doctor who deals with mental health or the nervous system.
What other conditions are associated with Tourette's syndrome?
Tourette's syndrome is often associated with ADHD and OCD, but other mood and behavior problems are also possible. People with ADHD tend to be hyperactive, impulsive, and find it hard to pay attention.
People with OCD may have strong, intrusive thoughts that are hard to get rid of. They may also feel the need to do something a certain way until it “feels right.” Examples of obsessions are checking behaviors (such as needing to check several times that the doors to your house are locked or that the clothes iron is turned off, even if you just checked a minute ago), or a need for things to be exact, balanced, and neat. Examples of compulsions are counting, frequent hand washing, or touching. Depression, anxiety, anger, aggression, and doing things to hurt yourself may also occur in Tourette's syndrome.
How are ADHD and OCD treated?
Treating ADHD and OCD is important because they often cause more problems than the tics do. ADHD can affect how you do in school or at work. For example, you may have trouble learning because it's hard to concentrate. You may have a hard time starting and finishing your work. You also may act out in class or at work.
ADHD is usually treated with medicines called stimulants. Usually, these medicines won't make your tics worse. If they do, your doctor should treat the tics before adding the stimulant. Your doctor will determine which medicines are best for you.
What's the long-term outcome of Tourette's syndrome?
ADHD usually starts at age four, and OCD usually starts by age seven. Tics often appear between three and eight years of age, and are the most severe by puberty. After this, about one half of patients with Tourette's syndrome will stop having tics by age 18, and ADHD and OCD also often improve. Many children will be able to take fewer medicines or stop taking them completely by the time they are ready to start college. With diagnosis and treatment from a doctor, most children with this syndrome can have a normal life.
Where can I get more information about Tourette's syndrome?
Tourette Syndrome Association
Web site: http://www.tsa-usa.org
Worldwide Education and Awareness for Movement Disorders (WE MOVE)
Web site: http://www.wemove.org