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A.D.A.M. Medical Encyclopedia.

Gilles de la Tourette syndrome

Tourette syndrome

Last reviewed: February 20, 2014.

Gilles de la Tourette syndrome is a condition that causes a person to make repeated, quick movements or sounds that they cannot control.

The condition is commonly called Tourette syndrome.

Causes

Tourette syndrome is named for Georges Gilles de la Tourette, who first described this disorder in 1885. It is likely the disorder is passed down through families.

The syndrome may be linked to problems in certain areas of the brain. It may have to do with chemical substances (dopamine, serotonin, and norepinephrine) that help nerve cells signal one another.

Tourette syndrome can be either severe or mild. Many people with very mild tics may not be aware of them and never seek medical help. Far fewer people have more severe forms of Tourette syndrome.

Tourette syndrome is four times as likely to occur in boys as in girls.

Symptoms

Symptoms of Tourette syndrome is often first noticed during childhood, between ages 7 and 10. Most children with Tourette syndrome also have other medical problems. These can include attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), impulse control disorder, or depression.

The most common first symptom is a tic of the face. Other tics may follow. A tic is a sudden, fast, repeated movement or sound.

Symptoms of Tourette syndrome can range from tiny, minor movements (such as grunts, sniffling, or coughing) to constant movements and sounds that cannot be controlled.

Different types of tics can include:

  • Arm thrusting
  • Eye blinking
  • Jumping
  • Kicking
  • Repeated throat clearing or sniffing
  • Shoulder shrugging

Tics may occur many times a day. They tend to improve or get worse at different times. The tics may change with time. Symptoms usually get worse before the mid-teen years.

Contrary to popular belief, only a small number of patients use curse words or other inappropriate words or phrases (coprolalia).

Tourette syndrome is different from OCD. People with OCD feel as though they have to do the behaviors. Sometimes a person can have both Tourette syndrome and OCD.

Many people with Tourette syndrome can stop doing the tic for periods of time. But they find that the tic is stronger for a few minutes after they allow it to start again. Often, the tic slows or stops during sleep.

Exams and Tests

There are no lab tests to diagnose Tourette syndrome. A health care provider will likely do an examination to rule out other causes of the symptoms.

To be diagnosed with Tourette syndrome, a person must:

  • Have had many motor tics and one or more vocal tics, although these tics may not have occurred at the same time
  • Have tics that occur many times a day, nearly every day or on and off, for a period of more than 1 year. During this period, there must not have been a tic-free period of more than 3 months in a row.
  • Have started the tics before age 18
  • Have no other brain problem that could be a likely cause of the symptoms

Treatment

Persons who have mild symptoms are not treated. This is because the side effects of the medicines may be worse than the symptoms of Tourette syndrome.

Different medicines are available to treat Tourette syndrome. The exact medicine that is used depends on the symptoms and any other medical problems.

Deep brain stimulation may be recommended for the main symptoms of Tourette syndrome and the obsessive-compulsive behaviors, but not when these symptoms occur in the same person.

Support Groups

Tourette Syndrome Association - www.tsa-usa.org

Outlook (Prognosis)

Symptoms are usually worst during the teenage years and then improve in early adulthood. In some persons, symptoms go away entirely for a few years and then return. In a few persons, symptoms do not return at all.

Possible Complications

Conditions that may occur in people who have Tourette syndrome include:

These conditions need to be diagnosed and treated.

When to Contact a Medical Professional

Make an appointment with your health care provider if you have tics that are severe or persistent, or if they interfere with your daily life.

Prevention

There is no known prevention.

References

  1. Cohen S, Leckman JF, Bloch MH. Clinical assessment of Tourette syndrome and tic disorders. Neurosci Biobehav Rev. http://dx.doi.org/10.1016/j.neubiorev.2012.11.013. [PMC free article: PMC3674220] [PubMed: 23206664]
  2. Kurlan R. Clinical practice Tourette's Syndrome. N Engl J Med. 2010;363:2332-2338. [PubMed: 21142535]
  3. Ryan CA, Gosselin GJ, DeMaso DR. Habit and tic disorders. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 22.

Review Date: 2/20/2014.

Reviewed by: Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Cannabinoids for Tourette syndromeCannabinoids for Tourette syndrome
    Cannabinoid medication might be useful in the treatment of the symptoms in patients with Tourette's syndrome. At the present time only two relevant studies have been conducted. Both studies used tetrahydrocannabinol (Δ9THC). In both studies Δ9THC was associated with tic reduction. However the sample size was small and a large number of multiple comparisons were made . There were only 28 participants in total, since eight participants took part in both studies. Possibly the patients who derived the greatest benefit and experienced the least adverse effects would be the most inclined to participate in further studies. There were a high number of drop outs/exclusions in the six week study and it is unclear whether intention to treat analysis (ITT) was performed. The results that are reported are analyses done on the patients who remained in the study on the study medication at the correct dose. In reality, patients do opt not to continue treatment if there is limited efficacy or unpalatable side effects. This introduces attrition bias. Whilst there were some significant results, the authors themselves accept that very few of these results are significant if a Bonferroni correction is performed. It is possible that cannabinoid medication has a beneficial effect which is too weak to be detected using ITT and such a small sample size. There is some weak evidence that cannabinoid medication may have an effect on obsessive compulsive behaviour but the measure used was an addition to the TSSL which has not been validated.There were no data on the effect of Δ9THC on quality of life.There is not enough evidence to support the use of cannabinoids in treating tics and obsessive compulsive behaviour in people with Tourette's syndrome.
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