Tourette’s Syndrome & Treatments

No one enjoys being subjected to bad language. Even if it is not explicitly directed at someone, its employment still has the potential to sour a conversation at best and end it at worst. It has in all probability happened to you. But have you ever considered the possibility that the person who’s swearing isn’t being vulgar but is in fact displaying a symptom of Tourette’s?

Tourette Syndrome (TS) gains its name from Dr. Georges Gilles de la Tourette (1857-1904). A neurosurgeon whose fields of expertise were hypnotism and hysteria, he first described the symptoms of the condition which bears his name in 1885 when he was treating a French noblewoman. He went on to record nine more cases, prompting his mentor Jean-Martin Charcot to bestow the name “Gilles de la Tourette’s illness” on his findings.

TS is classified as a disorder whose primary symptoms are repetitive moments or unwanted sounds, known as ‘tics’, that are very difficult to control. These generally emerge during childhood, typically between the ages of five and nine. The severity of the tics ranges from mild to severe. Mild tics are sudden and repetitive but brief and involve only a limited number of muscles, whereas complex tics involve several muscle groups and are coordinated and distinct in their appearance. Simple motor tics commonly associated with TS include rapid eye blinking, nose twitching, mouth movements and the shrugging of shoulders. Complex motor tics include obscene gestures, touching or smelling, bending or twisting and stepping in a certain pattern.

Regarding vocal or guttural tics, simple ones include grunting, throat clearing and coughing, while complex ones include repetition and, of course, swearing. These tics follow no set patterns. They vary in both frequency and severity, they worsen during bouts of illness, stress, anxiety or excitement, they are known to occur during sleep and they are known to worsen during teenage years and early adulthood. Certain people with TS can hold back a tic, but only with considerable effort.

It is common for people with TS to be afflicted with other neuro-behavioral problems too. In many cases, these can prove more problematic than the tics themselves. Hyperactivity, problems with reading and writing and obsessive-compulsive traits such as repetitive behaviours and persistent worrying are just some examples of such additional issues. Also, these neuro-behavioral issues may persist well into adulthood, even after vocal and motor tics have subsided in late adolescence to early adulthood. Therefore, any course of treatment prescribed for someone with TS should ideally seek to address both the physical traits and any accompanying psychological issues too.

The exact cause of TS remains unknown, although it is generally considered to be influenced by genetic and environmental factors. Chemicals in the brain concerned with the transmission of nerve impulses (dopamine and serotonin chiefly among them) are theorized to play a role as well.

In order to be diagnosed with TS, the patient has had to have experienced vocal and motor tics for at least twelve months. The diagnosis may be made easier if the doctor can also identify any accompanying neurological and psychological complications. It is not uncommon for patients to self-diagnosis after conducting extensive research into TS. It is also not unheard of for cases of TS to be misdiagnosed as another condition, particularly ones in which tics are known to be a regular symptom.

There is no known cure for TS and indeed, depending on the severity of the symptoms, some people with the condition will not require treatment of any kind. In other cases, treatment may be recommended to help the person control their tics. This treatment usually comes in one of two ways: behavioural therapy and medication.

A psychologist or other appropriately-trained therapist will administer the therapy and there are two forms which have been found helpful in the reduction of tics. The first of these is called “habit reversal training”. This involves identifying the feelings that can trigger the tics.

Once done, an alternative and more inconspicuous means of relieving the urge to tic is sought. The second form of therapy is known as “exposure with response prevention”, or ERP for short. The aim of this therapy is to teach the person with TS how to manage their tics. This is done by training them how to tolerate the feeling by simulating the urge and resisting it until it passes.

Alternatively, medication may be prescribed, although usually this is only done if the tics are especially severe and have a more profound effect on the sufferer. Common medication prescribed for TS include fluphenazine, haloperidol (known as Haldol) and risperidone (known as Risperdal). These are not guaranteed to work for everyone and can produce side effects such as weight gain and involuntary repetitive movements. Tetrabenazine may also be prescribed to combat tics, although this carries a risk of developing severe depression.

Numerous people from the celebrity world have struggled with and overcome TS.

These include the actor Dan Aykroyd, the footballer David Beckham, the billionaire businessman Howard Hughes, the writer Samuel Johnson and the composer Wolfgang Amadeus Mozart.

Research into potential new treatments for TS are ongoing. In June 2020, the University of Nottingham’s School of Psychology and School of Medicine jointly announced that they had made a breakthrough in perfecting a technique which was dubbed median nerve stimulation or MNS. It was found to drastically reduce both the frequency and intensity of tics and was hailed as a potentially life-changing treatment.

Ultimately, TS can be a debilitating and long-term illness and the severity of the symptoms can vary quite considerably, but with the correct support & training, located here, it is entirely possible to both live with and in time to overcome its effects.

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