Tourette's syndrome

Tourette's syndrome is an inherited neuropsychiatric disorder. Symptoms usually develop in childhood and involve physical or vocal tics. Tourette's was once associated with the exclamation of inappropriate or obscene words but this symptom is fairly rare amongst Tourette's sufferers. So what causes Tourette's?

The exact causes of Tourette's have yet to be determined but research has shown that a combination of environmental and genetic factors are involved. Tourette's has a high level of heritability although the exact genes it occurs in is not known. But in some cases, Tourettes occurs in people with no family history of the disorder at all. Parents with Tourette's have around a 50% chance of passing the condition on to one of their children however tics are more likely to be expressed in men rather than women. It is also thought that some forms of obsessive-compulsive disorder may be genetically linked to Tourrette's and similarly there is evidence which suggests some forms of Tourette's are linked to attention-deficit hyperactivity disorder (ADHD).

Some research has shown that non-genetic factors may also influence the severity of Tourette's. These include environmental, infectious or psychosocial factors which can act in combination to increase the severity of symptoms. Also some events occurring around the time of birth such as maternal smoking, stress and obstetric complications can be risk factors for the severity of tics.

Tics are movements or noises which occur unpredictably and repetitively. Some of the most common movement-related (motor) tics include eye blinking, facial grimacing and head jerking. The usual vocal (phonic) tics include throat clearing, grunting and sniffing. Other symptoms include copying the words or actions of others or repeating your own words. But these simple tics can sometimes combine into more complex patterns. The involuntary exclamation of obscenities and other remarks (Coprolalia), while probably the most famous symptom is also one of the rarest. Young children will often develop a tic however these are usually minor and will dissipate within a year.

Unfortunately, Tourette's rarely occurs in isolation. And if a child develops Tourette's they are likely to have other related conditions. These include ADHD, OCD (obsessive compulsive disorder) and learning difficulties, amongst other behavioural problems. Self harming behaviours also occur in a minority of children with Tourette's.

Tourette's is diagnosed after a consultation, usually with a specialist neurologist. And although Tourette's can't be medically identified a physical examination is often performed to rule out any physical disorders which may be causing the tics.

Psychological therapies are the most favoured way of treating Tourette's. Commonly prescribed therapies include cognitive behavioural therapy, habit reversal training and social skills training. Hypnotherapy is also sometimes prescribed. These treatments help the sufferer to recognise and control their tics. Educating both the parents and children with Tourette's has been shown to generally improve the condition. It's also important that teachers and others involved in the child's care are informed about the best ways to manage the disorder.

In some cases medication can help to reduce the occurrence of tics. Commonly prescribed medications include haloperidolm risperidone, clonazepam and sulpiride. Although the tics may not disappear completely they can enable the sufferer to function well with minimal side effects.

Many children with Tourettes can improve over time. And in adulthood many of the tics will have greatly reduce or completely vanish. Unfortunately in some cases the tics can continue into adulthood and some sufferers may even develop new tics.