What are the other Names for this Condition? (Also known as/Synonyms)

• Chronic Motor and Vocal Tic Disorder
• GTS (Gilles de la Tourette's Syndrome)
• TS (Tourette Syndrome)

What is Tourette Syndrome? (Definition/Background information)

• Tourette Syndrome is a disorder of complex origin that generally affects young children. It causes uncontrolled body movements (called motor tics) with characteristic sounds (called vocal tics)
• The disorder is believed to be a result of environmental and genetic factors that affected the development of the child before and after birth
• Tourette Syndrome is treated using medications, behavioral therapy, and botulinum toxin injections. With proper treatment, the disorder can be managed and individuals can lead near normal lives
• Generally, as the child grows older and becomes an adult, the frequency of tics reduces. The prognosis is normally good; but in some individuals, there may be severe neurological complications

Who gets Tourette Syndrome? (Age and Sex Distribution)

• Tourette Syndrome mostly affects children, but they may be seen in teenagers and adults too
• The incidence of Tourette Syndrome may vary from 1 in 100 to 1 in 1000 children being affected, and thus, it can be termed as a common condition
• Both males and females are affected, but the incidence of the condition in males is higher
• There is no racial, ethnic, or geographical predilection observed

What are the Risk Factors for Tourette Syndrome? (Predisposing Factors)

• Unidentified environmental agents and genetic factors are responsible for Tourette Syndrome
• There are many environmental, psychological factors, infections, or other non-genetic acquired causative factors that may aggravate the condition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Tourette Syndrome? (Etiology)

The exact cause and development of Tourette Syndrome is complex.

• Multiple factors (environmental and genetic) are believed to play a role in its development, both during the fetal stage and after the birth of the child
• In a few individuals, genetic mutations have been identified in the SLITRK1 gene, which is responsible for providing instructions to a specific protein that is the key to nerve cell development. In many individuals, however, there is no genetic mutation observed in the SLITRK1 gene
• Even though in some cases a family history of Tourette Syndrome is observed, the pattern of inheritance remains unexplained and is random
• It is believed by some researchers that the abnormal functioning of neurotransmitters in the brain, causes the involuntary body movements and accompanying sounds

What are the Signs and Symptoms of Tourette Syndrome?

Tourette Syndrome is characterized by uncontrolled and jerky body movements (that involves the body muscles) and sporadic sound outbursts (that involves the vocal cords). The signs and symptoms of the condition, which may be mild or severe, include:

• Simple motor movements, such as shrugging of the shoulder or rapid blinking of the eye, may indicate onset of this disorder
• There could also be complex motor movements, such as kicking or jumping
• Similarly, vocal tics may be simple or complex and these may include grunting sounds and repeating what one says (or others say)

How is Tourette Syndrome Diagnosed?

The diagnosis of Tourette Syndrome may involve the following tests and procedures:

• Complete physical examination with evaluation of medical history
• Neurological examination: The tics have to be present for over a year, with an onset before age 18 years, to confirm Tourette Syndrome
• CT scan of head and neck
• MRI scan of brain
• Electroencephalography (EEG) to study electrical activity of the brain
• Differential diagnosis to eliminate other similar conditions

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Tourette Syndrome?

The complications of Tourette Syndrome include:

• Attention deficit hyperactivity disorder leading to inattention
• Spontaneous impulsive actions
• Inappropriate behavior or use of abusive language and obscene words during bouts of the ‘tic’ disorder
• Obsessive compulsive disorder; repetitive behavior
• Problems concentrating on studies - both reading and writing
• Excessive anxiety, worry, and depression due to self-image issues; social isolation
• Side effect of medications used, such as weight gain, dullness of mind and body, etc.
• The chronic use of neuroleptics may cause Tardive dyskinesia (a nervous, involuntary body movement disorder)

How is Tourette Syndrome Treated?

Tourette Syndrome cannot be cured, but the severity of the condition may reduce as the child gets older and reaches adulthood. An individualized treatment is planned and provided to improve the quality of life, based on the specific conditions/complications that are present and identified.

• If the tics interfere with daily life activities or day-to-day functioning, or are severe, then neuroleptic drugs or botulinum toxin injections may be prescribed. In a majority of the individuals, the symptomatic tics do not cause any functional impairment
• Medications used to treat the associated complications and neurological behavior problems include antiseizure medicines, stimulants, and serotonin reuptake inhibitors
• Behavioral intervention, awareness training, and other supportive care therapies have demonstrated a significant reduction in the symptoms
• Providing reassurance and helping with feelings of stress and anxiety
• Follow-up care with regular screening and checkups are important, since the condition lasts for many years

How can Tourette Syndrome be Prevented?

• Tourette Syndrome is a very complicated medical condition related to genetic and non-genetic causes; it cannot be prevented
• If there is a family history of the condition, then genetic testing of the expecting parents (and related family members) and prenatal diagnosis (molecular testing of the fetus during pregnancy) may help in understanding the risks better during pregnancy
• Also, in such cases, genetic counseling will help assess risks, before planning for a child
• Regular medical screening at periodic intervals with neurological scans and physical examinations are advised

What is the Prognosis of Tourette Syndrome? (Outcomes/Resolutions)

• Individuals with milder forms of Tourette Syndrome form the majority of patients. They may not require any treatment and can lead relatively normal and healthy lives without any intellectual impairment
• Medical support and therapy is normally required during the teenage years, the period when the symptoms peak. Tourette Syndrome improves as a child enters into adulthood
• There may be periods (often years), when the symptoms cease or are absent; however, they usually recur afterwards
• A few individuals may have severe complications and neurological behavioral problems necessitating medical support and therapy

Additional and Relevant Useful Information for Tourette Syndrome:

There are voluntary organizations and support groups that provide help and understanding to the individuals, families, and parents of the Tourette Syndrome affected.