A brief overview of Tourette's Syndrome

Tourette syndrome is a neurological, genetic condition that causes individuals to make involuntary sounds and movements called tics. These tics usually start in childhood and are often linked to other co-morbid conditions which individuals have alongside their tics. More often than not the co-morbid conditions present themselves as/ but not limited to, obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), Anxiety Disorder and/ or learning difficulties. These and other co-morbid conditions are discussed more in the ‘co-morbid’ blog.

Tics happen

‘Tics’ really are just the tip of an iceberg of a very complex and misunderstood condition, the co-morbidities that exist with Tourettes are often more complex for the individual then the tics themselves. (These will be discussed more in the "it's not just tics" blog.

FACT: 90% of people with Tourettes are NOT compelled to swear.

Tourette Syndrome is part of a spectrum of Tic Disorders. Within the spectrum you will hear of:

**Tourette Syndrome ~ this is when you have multiple motor and one or more vocal tics present for a minimum of one year. These can wax & wane in this time but must be present. **Transient tic disorder (also known as provisional tic disorder) ~ this is where you have motor tics that are usually confined to the face and neck, however it has been known to affect other body parts. These type of tics usually last a few weeks or months.

**Chronic tic disorder ~ this is where your tics may be blinking, sniffing of neck movements, the tics tend to persist instead of being transitory. These types of tics last more than a year. **Non specified tic disorder ~ tics are present but do not meet the criteria for any specific tic disorder.

The clinical pathway of Tic disorders is that they usually start around the age of 6, peaking between the ages of 10 & 13 and reducing by adolescents. This however, varies greatly, anecdotally a large percentage of individuals with TS often do find that their tics and other symptoms have improved after several years and in some cases have gone away completely by late teens/ early adult hood. however, just as many report that they have stayed the same or actually increased with age.

There's no cure for Tourette syndrome, but there is treatment that can help manage symptoms, these come in forms of medication and behavioural therapy. (more can be read on these in upcoming blogs on these topics).

Individuals with Tourette syndrome experience a strong urge before they tic, the only way to stop the urge is to tic. Imagine an itch, it gets worse and worse and worse until you scratch it. These feelings are known as premonitory sensations. Premonitory sensations are only relieved after the tic has been carried out. Some individuals can supress their tics, this can usually only be done for a short while, individuals may choose to do this in certain social situations, like in a classroom. It takes a lot of concentration and can be very tiring however it gets easier with practise. Alternatively, people can use a competing response to redirect the tic but still relieve the urge. These methods can be learnt by engaging in Comprehensive Behavioural Intervention for tics (CBiT) which is the recommended as the first line intervention before medication by the American Academy of Neurology. (more information can be found in the upcoming Tic Management Blog)

Tourette syndrome is not diagnosed by a test however tests and scans, such as an MRI, may be used to rule out other conditions during a diagnosis process. To get a diagnosis, you will need a referral from your GP to a specialist, such as a neurologist To be diagnosed with Tourette syndrome you need to of had several tics for at least a year. These must consist of at least two motor tics and one vocal tic. By getting diagnosed you open doors to support and understanding, resulting in acceptance and access to treatments where needed.

Examples of Motor Tics: •Blinking •Flapping arms or legs •eye rolling •grimacing •shoulder shrugging •Belly rolling •jerking of the head or other limbs •jumping •twirling •touching objects and other people Examples of Vocal Tics: •grunting •throat clearing •Licking lips •whistling •coughing •tongue clicking •animal sounds •saying random words and phrases •repeating a sound, word or phrase •swearing

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