What are the common types of tics in Tourette syndrome. How do tics differ from other involuntary movements. When should tics be treated and what are the available treatment options. Who is most commonly affected by Tourette syndrome and how does it progress over time.

Understanding Tourette Syndrome: A Neurological Condition

Tourette syndrome is a complex neurological disorder characterized by repetitive, involuntary movements and vocalizations known as tics. These tics can range from mild to severe and often begin during childhood. To better understand this condition, it’s essential to explore its key aspects, including symptoms, diagnosis, and treatment options.

What Exactly Are Tics?

Tics are sudden, brief, and repetitive movements or sounds that individuals with Tourette syndrome experience. They are often preceded by an uncomfortable sensation or urge that builds up and is temporarily relieved by performing the tic. This cycle of tension and release is a hallmark feature of tics in Tourette syndrome.

When Do Tics Typically Begin?

Tics usually start during elementary school age, typically between the ages of 5 and 10. However, the onset can vary from person to person. Early identification of tics is crucial for proper diagnosis and management of Tourette syndrome.

Types of Tics: Motor and Vocal Manifestations

Tics in Tourette syndrome are classified into two main categories: motor tics and vocal (or phonic) tics. Understanding these different types can help in recognizing and addressing the symptoms more effectively.

Motor Tics: Simple and Complex

Motor tics involve involuntary movements of the body. They can be further divided into simple and complex motor tics:

• Simple motor tics: These are brief, sudden movements involving a single muscle group. Examples include:
  • Excessive blinking or eye squinting
  • Facial grimacing
  • Nose twitching
  • Head or neck jerking
  • Shoulder shrugging
  • Arm or hand movements
  • Abdominal tensing
• Complex motor tics: These involve coordinated patterns of movement using multiple muscle groups. Examples include:
  • Touching, rubbing, or tapping objects or people
  • Sticking out the tongue or lip-biting
  • Clapping, throwing, or pinching
  • Making kissing motions or silly facial expressions
  • Bending or gyrating
  • Imitating others’ movements

Vocal Tics: From Simple Sounds to Complex Utterances

Vocal tics, also known as phonic tics, involve the production of sounds or words. Like motor tics, they can be simple or complex:

• Simple vocal tics: These are sudden, meaningless sounds. Examples include:
  • Throat clearing
  • Coughing
  • Sniffing or snorting
  • Whistling or hissing
  • Grunting or gurgling
• Complex vocal tics: These involve words, phrases, or more elaborate vocalizations. Examples include:
  • Repeating words or phrases (echolalia)
  • Sudden changes in volume or pitch
  • Uttering phrases like “shut up” or “stop that”
  • Making animal or bird noises

Diagnosing Tourette Syndrome: Beyond Simple Tics

While tics are the primary symptom of Tourette syndrome, a formal diagnosis requires meeting specific criteria. Understanding these criteria can help differentiate between isolated tics and Tourette syndrome.

Criteria for Tourette Syndrome Diagnosis

To receive a diagnosis of Tourette syndrome, an individual must meet the following criteria:

1. The presence of both motor and vocal tics (at least two motor tics and one vocal tic)
2. Tics occurring for at least one year since the onset of the first tic
3. Onset of tics before the age of 18
4. Tics not caused by other medical conditions or substance use

It’s important to note that many people with tics may eventually meet the criteria for Tourette syndrome as their symptoms evolve over time.

Does a Tourette Syndrome Diagnosis Indicate Worsening Tics?

Contrary to common misconceptions, a diagnosis of Tourette syndrome does not necessarily mean that tics will worsen over time. The severity of tics varies widely among individuals, and for many people with Tourette syndrome, tics never become significantly bothersome. Some may require medication or other interventions, while others may experience minimal impact on their daily lives.

The Prevalence and Demographics of Tourette Syndrome

Understanding who is affected by Tourette syndrome can provide valuable insights into its prevalence and potential risk factors.

How Common Are Tics and Tourette Syndrome?

Tics are relatively common, especially in children. It is estimated that approximately 1% of children and teenagers have tics that persist for more than one year. However, not all of these cases will meet the full criteria for Tourette syndrome.

Gender Differences in Tourette Syndrome

Tourette syndrome shows a significant gender disparity, affecting males four times as often as females. This difference in prevalence between genders suggests possible genetic or hormonal factors influencing the development of the condition.

The Genetic Component of Tourette Syndrome

While the exact causes of Tourette syndrome are not fully understood, there is strong evidence suggesting a genetic component to the condition.

Is Tourette Syndrome Hereditary?

Tics and Tourette syndrome tend to run in families, indicating a genetic predisposition. However, the specific gene or genes responsible have not been identified in most cases. This suggests a complex genetic interplay rather than a single gene mutation.

Associated Conditions and Comorbidities

Individuals with Tourette syndrome or their family members may also exhibit behaviors related to other neuropsychiatric conditions, particularly:

• Obsessive-Compulsive Disorder (OCD)
• Attention-Deficit/Hyperactivity Disorder (ADHD)

These associated conditions can significantly impact the overall presentation and management of Tourette syndrome, highlighting the importance of comprehensive evaluation and treatment approaches.

The Course of Tourette Syndrome: Prognosis and Long-term Outlook

Understanding the typical progression of Tourette syndrome can help individuals and families better prepare for the future and manage expectations.

Do Tics Improve with Age?

For many individuals with Tourette syndrome, tics may be at their most severe between the ages of 10 to 12. Following adolescence, a significant number of patients experience a decrease in symptom severity. In some cases, symptoms may resolve almost entirely. However, it’s crucial to note that this improvement is not universal, and some individuals may continue to experience tics into adulthood.

Factors Influencing Tic Severity Over Time

Several factors can influence the course of Tourette syndrome and tic severity over time:

• Stress levels
• Overall health and well-being
• Environmental factors
• Comorbid conditions (e.g., ADHD, OCD)
• Treatment adherence and effectiveness

Understanding these factors can help individuals with Tourette syndrome and their families develop strategies to manage symptoms more effectively throughout their lives.

Diagnosis and Treatment: When to Seek Professional Help

Proper diagnosis and treatment of Tourette syndrome are crucial for managing symptoms and improving quality of life. Understanding when and how to seek professional help is an essential part of this process.

Who Can Diagnose Tourette Syndrome?

Several types of medical professionals can diagnose tics and Tourette syndrome:

• Pediatricians
• Neurologists
• Child psychiatrists
• Movement disorder specialists (neurologists with additional training in involuntary movements)

These professionals will conduct a thorough evaluation, including a full neurological examination, to distinguish tics from other abnormal movements or compulsive behaviors.

The Importance of Comprehensive Evaluation

When diagnosing Tourette syndrome, it’s crucial to consider the full clinical picture. This includes:

• Assessing the nature and severity of tics
• Evaluating the functional consequences of tics on daily life
• Exploring the patient’s clinical history for co-occurring disorders (e.g., ADHD, OCD)
• Considering family history and genetic factors

A comprehensive evaluation helps in developing an effective treatment plan tailored to the individual’s specific needs.

When Do Tics Require Treatment?

Not everyone with tics or Tourette syndrome requires treatment. Tics only need to be treated when they are causing significant distress or interfering with daily activities. The decision to treat tics should be made on a case-by-case basis, considering factors such as:

• Tic severity
• Impact on quality of life
• Presence of associated conditions
• Individual preferences and goals

Treatment Options for Tourette Syndrome

When treatment is necessary, several options are available:

• Medications: Various medications can help reduce tic frequency and severity
• Behavioral therapy: Comprehensive Behavioral Intervention for Tics (CBIT) is an effective non-pharmacological approach
• Psychoeducation: Helping individuals and families understand and cope with Tourette syndrome
• Supportive therapies: Occupational therapy, speech therapy, or counseling may be beneficial in some cases
• Deep brain stimulation: In severe, treatment-resistant cases, this surgical option may be considered

The choice of treatment depends on individual factors and should be made in consultation with a healthcare professional specializing in Tourette syndrome.

Living with Tourette Syndrome: Coping Strategies and Support

While Tourette syndrome can present challenges, many individuals with the condition lead fulfilling and successful lives. Developing effective coping strategies and accessing appropriate support can make a significant difference in managing the condition.

Education and Awareness

Educating oneself, family members, and others about Tourette syndrome can help reduce stigma and promote understanding. This includes:

• Learning about the nature of tics and Tourette syndrome
• Understanding that tics are involuntary and not a sign of misbehavior
• Sharing information with teachers, employers, and peers as needed

Stress Management Techniques

Since stress can exacerbate tics, developing effective stress management strategies is crucial. Some helpful techniques include:

• Mindfulness and meditation
• Regular exercise
• Adequate sleep and nutrition
• Time management and organization skills
• Engaging in enjoyable hobbies and activities

Building a Support Network

Having a strong support network can make a significant difference for individuals with Tourette syndrome. This may include:

• Family and friends who understand the condition
• Support groups for individuals with Tourette syndrome and their families
• Online communities and forums for sharing experiences and advice
• Professional counseling or therapy when needed

Advocacy and Self-advocacy

Learning to advocate for oneself or a loved one with Tourette syndrome is an important skill. This may involve:

• Communicating needs and accommodations in school or workplace settings
• Educating others about Tourette syndrome to reduce misconceptions
• Participating in awareness campaigns or support organizations
• Seeking appropriate medical care and treatment when needed

By developing these coping strategies and accessing available support, individuals with Tourette syndrome can effectively manage their symptoms and lead fulfilling lives.

Tics and Tourette syndrome 101

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What’s a tic?

Tourette syndrome is a neurological condition in which affected persons demonstrate brief, repetitive movements and vocalizations called tics. Tics are often associated with a preceding uncomfortable sensation or urge that builds, then is resolved by the action for a period of time, and then builds again. 

When do tics begin? What are some common tics?

Tics typically begin during elementary school age. Movements are referred to as motor tics, and vocalizations are referred to as vocal or phonic tics. Common tics include excessive blinking, facial grimacing, shoulder-shrugging, sniffing and grunting. Profane gestures (copropraxia) or utterances (coprolalia) may also be present, but occur in a small percentage of patients with persistent tics, despite what some movies and television shows may suggest. 

What’s the difference between tics and Tourette syndrome?

The movements and vocalizations are called tics. A formal diagnosis of Tourette syndrome is met when at least one year has passed since the onset of the first tic, and the patient has experienced at least one phonic tic and at least two motor tics. Many people with tics will eventually meet criteria for Tourette syndrome. 

Does the diagnosis of Tourette syndrome mean the tics will worsen?

Not at all. The severity of tics varies widely. For many people with Tourette syndrome, tics never become bothersome. Others with tics may need medication or other types of intervention to treat them. There is nothing particularly special or distinct about tics in people with Tourette syndrome compared to those who do not have the diagnosis. 

Someone told me the tics will go away with age. Is this true?

For many, tics may be at their worst between the ages of 10 to 12. During the years following adolescence, symptoms will decrease in severity for many patients, and symptoms may resolve or nearly resolve for some patients. However, this is not true for everyone. 

Who can be affected by Tourette syndrome?

Tics are very common. It is estimated that approximately 1 percent of children and teenagers have tics that persist for more than one year. Tourette syndrome affects males four times as often as females.

Are tics genetic? Are there other associated conditions?

Tics tend to run in families, although the responsible gene or genes have not yet been identified in most cases. Some people with tics, or family members of people with tics, may exhibit behaviors related to obsessive-compulsive disorder (OCD) or attention-deficit/hyperactivity disorder (ADHD).

Who can diagnose and treat tics?

A pediatrician, neurologist or child psychiatrist will usually diagnose tics in children and adolescents. Movement disorder specialists are neurologists who have additional training in the diagnosis and treatment of involuntary movements, including tics.  

When diagnosing Tourette syndrome or other tic disorders, tics need to be distinguished from other abnormal movements (e.g., stereotypy, chorea) or compulsive behaviors. Evaluation must include a full neurologic examination. Understanding the nature, severity and functional consequences of tics is integral to the development of an effective treatment plan.

Your child’s clinical history must also be carefully explored for co-occurring disorders (e.g., ADHD, OCD), as these can significantly impact a child experiencing tics and paint a clearer picture during evaluation. 

When do tics need to be treated? How are they treated?

Tics only need to be treated when they are bothering the person who has them. Not everyone needs to take medications for tics. While medication is the mainstay of tic treatment, some patients are good candidates for other interventions, including a form of behavioral therapy called CBIT. There are other interventions for tics, as well.  

Types of tics

Simple motor tics involve abrupt, brief, repetitive motor movements. Examples include:

• Blinking or squinting
• Grimacing
• Nose twitching
• Head/neck jerking
• Shrugging
• Arm or hand movements
• Abdominal tensing
• Rapid jerking of any part of body

Examples of complex motor tics include:

• Eye movements (e.g., rolling upwards or side-to-side)
• Touching, rubbing and tapping objects or people
• Sticking out the tongue or lip-biting
• Clapping, throwing or pinching
• Kissing or silly facial expressions
• Bending or gyrating
• Imitating movements
• Making obscene gestures (rare)

Examples of simple and complex vocal tics, also called phonic tics, include:

• Throat clearing
• Coughing
• Sniffing or snorting
• Whistling or hissing
• Grunting or gurgling
• Squeaking or screeching
• Animal or bird noises
• Phrases (e. g., “shut up,” “stop that” and “wow, that’s it”)
• Sudden changes in volume or pitch
• Repeating sounds or phrases
• Obscenities (rare)

If you’re interested in learning more about the Pediatric Movement Disorders Program at Texas Children’s Hospital, click here. 

Tourette Syndrome (for Teens) – Nemours KidsHealth

What Is Tourette Syndrome?

Tourette syndrome is a disorder that affects the body’s brain and nervous system by causing tics — sudden, repetitive movements or sounds that some people make, seemingly without realizing it. A person with Tourette syndrome has multiple motor tics and at least one vocal tic.

Tics are fairly common in teens. You may know someone who has either a motor tic (sudden, uncontrollable movements like exaggerated blinking of the eyes) or a vocal tic (sounds such as throat clearing, grunting, or humming).

What Causes Tourette Syndrome?

Tourette syndrome is a genetic disorder, which means it’s the result of a change in genes that’s either inherited (passed on from parent to child) or happens during development in the womb.

The exact cause of Tourette syndrome isn’t known, but some research suggests that it happens when there’s a problem with how nerves communicate in certain areas of the brain. An upset in the balance of neurotransmitters (chemicals in the brain that carry nerve signals from cell to cell) might play a role.

People with Tourette syndrome usually first notice symptoms while they’re kids or teens. The condition affects people of all races and backgrounds, although more guys than girls have the condition.

Tourette syndrome is not contagious. You can’t catch it from someone who has it.

What Are the Signs & Symptoms of Tourette Syndrome?

The main symptoms of Tourette syndrome are tics — multiple motor tics and at least one vocal tic. Motor tics can be everything from eye blinking or grimacing to head jerking or foot stomping. Some examples of vocal tics are throat clearing, making clicking sounds, repeated sniffing, yelping, or shouting. In rare cases, people might have a tic that makes them harm themselves, such as head banging.

At certain times, like when someone is under stress, the tics can become more severe, happen more often, or last longer. Or the type of tic may change.

Some people may be able to suppress their tics for a short time. But tension builds, and eventually it must be released as a tic. And if a person is concentrating on controlling the tic, it may be hard to focus on anything else. This can make it hard for teens with Tourette syndrome to have a conversation or pay attention in class.

Many teens with Tourette syndrome also have other conditions like ADHD, obsessive-compulsive disorder (OCD), learning disabilities, and anxiety.

How Is Tourette Syndrome Diagnosed?

Tics should be checked out by a doctor. Some family doctors may refer a person with Tourette symptoms to neurologist (a doctor who specializes in problems with the nervous system). The neurologist may ask the person to keep track of the kinds of tics involved and how often they happen.

To be diagnosed with Tourette syndrome, a person must have several different types of tics — specifically, multiple motor tics and at least one vocal tic for at least a year. They may happen every day or from time to time throughout the year.

There isn’t a specific test for Tourette syndrome. Instead, the doctor looks at the family history, the medical history, and the person’s symptoms to make a diagnosis. Sometimes, imaging tests like magnetic resonance imaging tests (MRIs), computerized tomography (CT) scans, electroencephalograms (EEGs), or blood tests can rule out other conditions that might cause symptoms similar to TS.

How Is Tourette Syndrome Treated?

Just as Tourette syndrome is different for every person, treatment can be different too. While there isn’t a cure for Tourette syndrome, most tics don’t get in the way of day-to-day life. If they do, doctors may suggest medicines to help control symptoms.

Tourette syndrome is not a psychological condition, but doctors sometimes refer teens to a psychologist or psychiatrist. Seeing a therapist won’t stop their tics, but it can help to talk to someone about their problems, cope with stress better, and learn relaxation techniques.  A therapist also can help them with any other problems, like ADHD, OCD, and/or anxiety. 

Dealing With Tourette Syndrome

Many people don’t understand what Tourette syndrome is or what causes it, so they might not know what to make of someone who has it. And if people stare, it can feel embarrassing or frustrating. Someone who has it might have to explain their condition a lot or have to deal with people thinking they’re strange.

Although it’s not easy to have Tourette syndrome, there’s good news — the tics usually get milder or go away during adulthood. In the meantime, it can help to focus on something else.

Things that someone with Tourette syndrome can do include:

• Get involved. Some people say that when they’re focused on an activity, their tics are milder and less frequent. Sports, exercise, or hobbies are great ways to focus mental and physical energy.
• Lend a helping hand. Dealing with Tourette syndrome often makes people more understanding of other people’s feelings, especially other teens with problems. Use that special sensitivity by volunteering.
• Embrace creativity. Creative activities such as writing, painting, or making music help focus the mind on other things.
• Find support. The Tourette Syndrome Association sponsors support groups with others who understand the condition’s challenges.
• Take control. People with Tourette syndrome can feel more in control of their lives by researching, asking their doctors plenty of questions, and taking an active role in their treatment.

Each person with Tourette syndrome will cope differently with its physical, emotional, and social challenges. Tourette syndrome doesn’t usually restrict activities, so people who have it can enjoy themselves and pursue their dreams and goals just as their friends do.

Reviewed by: Shirin Hasan, MD

Date reviewed: June 2020

How people with Tourette’s syndrome live

In Tourette’s syndrome, a person suffers from tics – from nervous twitches to shouting obscene words. There is no cure for the disease, and the tics cannot be controlled. Afisha Daily talked to people with this diagnosis about their lives.

“I have been living in Germany since I was 19. The problems started at the age of 21, when I was studying at the Academy of Arts. First, there was aggression directed at myself: I constantly cut myself, beat me, put my hands on a hot stove, grabbed bare wires. And I couldn’t control it all. At some point, I made a promise to myself that if I did something with myself at least once more, I would go to the doctor. Soon I went to a psychiatrist who misdiagnosed me. Four years later, I was shown to a specialist from the Hannover Medical School, who determined that I had Tourette’s syndrome.

I managed to complete my studies at the university – of course, I had to concentrate a lot. My friend is sure that it all started because of her studies, but I think that there were other equally important factors that led to the disease. Then I was not treated much. There was psychotherapy, but it only made things worse.

The peak of the illness came ten years ago. It was very difficult for me. At some point, I could not drive a car, and over time I even stopped eating on my own. In the clinics that I visited more than once, I was often tied up to be fed. To some extent, I was a danger to myself and to others. I was transported from hospital to hospital, to a hostel for the disabled and back. At that time, I poked my finger in my left eye with force, hit him, and now he can’t see anything at all without glasses. The right one sees a little. I have a friend with Tourette syndrome from Austria who gouged out both of his eyes during tics and is now completely blind. I also had tics when I just waved my arms and couldn’t even sleep because of it. As a result, I tore a ligament in my shoulder, I had an operation.

I didn’t want to live with it, so I tried to commit suicide several times. I have a friend with whom we have been together for nine years – it was she who motivated me to radical changes. One day she came from the store and saw blood in the apartment. By that time, I was lying on the mattress for almost 24 hours a day, since it was the only place where I felt more or less safe from myself. The mattress was lying on the floor, because by that time I had broken the bed along with other furniture. A friend saw this hell, cried and said that either she was leaving me, or I was doing brain surgery.

In 2011, I had deep brain stimulation, which is brain surgery. In my case, it looks like a cable that goes behind the ear, two probes in the brain and the stimulator itself – it is in the chest. I had this device surgically changed twice. With stimulation, I feel much better, although, of course, Tourette’s syndrome has not gone away. But I stopped taking one of the hardest drugs. Although medicines, of course, also help.

I have had a disability since I was diagnosed. Receiving it came as a shock to me, because I hoped that it would someday pass. But I was told that this is an incurable neurological-psychiatric feature.

Now I have vocal tics that are very annoying. Unfortunately, I am screaming. I struggle with it, but it takes a lot of energy to suppress, so I can’t control it to a greater extent. There are also motor tics. All this escalates when I am emotionally or physically overwhelmed. In general, I am now in a normal state – I can go to the store and do some shopping, and I also go to the gym in the morning. In the evening, of course, it gets worse, so I stay at home.

I don’t have a job, but I receive benefits. Not so long ago, I made a film with which I was invited to Moscow to a film festival. I would really like to find a normal job, but the state did everything to prevent me from working, and it is impossible to find a menial job in Germany. But I am such a person that I can’t do nothing, so I always think of something to do with myself.

A film by Kirill Glazunov, with which he was invited to the festival

Even before the brain surgery, and especially during my studies, every time I went out into the street was accompanied by a negative reaction from those around me. Sometimes this drove me to despair, since there were a huge number of people who did not want to hear any arguments, much less enter into my position. And two years ago I was in a psychiatric hospital and left there for a short time to withdraw money from the bank. Then I had loud tics, I screamed. And the bank employee said: “Go away, otherwise I will call the police.” I tried to explain to her that I have such a disease, but she still caused it. At first, the police showed aggression, but then they realized what was the matter, and one of them even apologized. The manager did not ask for forgiveness, but when I asked if she would call the police for her relative in such a situation, she answered “yes”.

The attitude towards people with Tourette’s syndrome is complicated everywhere. A year ago, I came to Russia, where I had not been for 17 years. To be honest, I was amazed: in Russia, open, tolerant people. Those unfortunate five days that I was there, attacks occurred every day in public places, but I did not meet aggression.

One day I realized that I had to show people how I live with my illness so that they know that it happens. And I launched my YouTube channel about Tourette syndrome. They write letters to me. Basically, people ask: how are you, how do I feel. Sometimes other people write with Tourette’s syndrome. It is important for me to get to know them, I would like to help people with this disease. Maybe God gave me the disease so that I could help other people.”

“The first symptoms of the disease appeared at the age of 6 — I blew on my hands. When I went to school, I also found stiffness in my hands – it was hard to move them, write, tie my shoelaces. The guys in the class didn’t think I was sick, they just thought I was slow.

At first, my parents scolded me and tried to re-educate me, but then they realized that I did not control it, and they began to take me to the doctors with a complaint that I write slowly and feel uncomfortable at school. As a result, I was observed by various doctors from the first class, but I was diagnosed with Tourette’s syndrome already in adulthood – this was done by a neurologist. Before that, doctors constantly made other diagnoses.

My mother asked me not to work too hard in my studies, but I have such a temper that I did not allow myself to slip. I have an excellent memory, and I had good grades in oral subjects. The doctors didn’t want to release me from writing assignments – they said it was self-hypnosis, they didn’t believe me. In the ninth grade, I switched to home schooling – and it became easier.

Now I have a disability and rarely move normally. During movements, an electric discharge passes through the body – it doesn’t hurt, it’s more like muscle contraction. At such moments, some part of the body seems to turn to stone and I cannot move it for several seconds. It’s almost impossible to control, and it happens that when you try to suppress this feeling, it becomes even worse. It happens so often that I have difficulty taking care of myself. Sometimes I want to go and I can’t. And vice versa: when I want to stop, I take extra steps. I also have mobile motor tics: involuntary head turns, stereotyped hand movements, tapping on the table or on my side. These tics happen when I plan to do something with that part of the body. Suppose I sit down to write, and my hand itself knocks on the table and does not obey. Sometimes my eyes close involuntarily – I can control this in extreme situations, when, for example, I cross the road.

I am not in therapy, it does not help me. Sometimes I drink herbal medicines. I’m not the only one – many people do not help drugs. When I started taking them, I got much worse. The pills intensified the spasms, it was almost impossible to sleep – I couldn’t even lie down and sit still. Now I am 24 years old, and only this year I entered college, although I graduated from school 7 years ago. All this time I was very ill. A year ago it became a little easier – I think it’s because of the sport. I will study to be a teacher, but I’m not going to work yet. I just want to socialize, and then we’ll see.

During this seven-year period of intense tics, no one supported me. We just lived and hoped that someday it would get easier. I have a normal relationship with my mother, but I don’t communicate with other relatives because they treat me badly. When I was diagnosed with neurosis, my grandmother started visiting relatives and lying that I had schizophrenia. She was annoyed that my hands did not obey me well and that I could not cope with household chores. She thought I was faking. Now she knows nothing about me. My father drank, and then he and his mother separated.

Sometimes people push me away in public transport because they think I’m healthy and it’s easy for me to get in. And I can be paralyzed for a few seconds. It’s still hard to climb stairs. In general, everywhere I have to explain that I am disabled. In a crowded place, I feel awkward because of my tics, but I put up with it, otherwise I will have to stay at home. After I was given the final diagnosis, it became easier to make new acquaintances. But building relationships with guys is difficult – I only dated those who also have a disability. Recently, I learned that I would participate in the Republican beauty contest for people with disabilities, and the other day, measurements were taken from all the girls for future evening dresses.

“Sometimes I want to lift my leg, tense up a lot, make a sound, like hiss or scream. At the same time, I always feel that I must complete the tick, finish it to the end. Sometimes I just think about a tick, when the desire to fulfill it immediately appears. I manage to control it, but not always. It happens that when I communicate in a company, I seem to forget about the syndrome and it leaves me for a while.

It all started with a neurosis and strange symptoms: sometimes it hurts there, sometimes it burns here. This alarmed me. At the same time, I began to feel anxiety. In February last year, tics also began to appear – and so intensely that closer to summer I could no longer walk. The peak of the disease cannot be described in words. It was hard to sleep: as soon as you lie down in bed, a feeling of discomfort appears, everything interferes, you want to perform tics, arch your back. Still often I wanted to squeeze my neck – once I choked myself so that bruises appeared on both sides. Somehow there was a desire to bend over the railing of the balcony. At some point, I felt so bad that I made a video with my tics and wrote to the Ukrainian reality show “I’m ashamed of my body” – people are treated there. They replied that they were taking care of me, and now I am waiting to be called. At first I doubted, because I didn’t want the audience to see it, but then I decided that they should watch it. The main thing is to solve the problem. Moreover, my young man supports me.

I went to the doctor: he said that it was most similar to Tourette’s syndrome, and prescribed me drugs. Thanks to the doctor, I remembered that I had similar tics in the first grade. My parents noticed that I was walking strangely, arching my leg. Then they took me to a neurologist and gave me some medication. In adolescence, everything disappeared.

Now I’m on psychotropic drugs: they help, but also cripple. There is a side effect on the liver, you can still gain weight on these pills. Once I tried to stop taking the drugs, but I survived without them for only a month and two weeks. In the end, I returned to them.

Tourette’s syndrome greatly interferes with work. I am often late because it takes a lot of time to tiki. The syndrome is exhausting, reduces the quality of life. Although some live peacefully with him. Recently, I was walking home from work and saw a group of men. Suddenly one of them started screaming. I doubted whether to approach or not, suddenly the person would become unpleasant. As a result, I approached, and he told me that he did not take drugs, because he had it since childhood and he was already used to it.

If I am in a company and I have a desire to tick, I try to do it quietly, although I do not always succeed. This, of course, confuses me – you can say that I feel a sense of shame.

I participate in Tourette Syndrome communities on social media because I feel not alone. It turned out that many people with the syndrome do not drink anything and try to cope on their own. Many say that the problem can be solved by neurostimulation of the brain, but brain surgery is a very responsible step. It should be carried out only by highly qualified specialists. As far as I know, neurostimulation is when the body is destroyed with electrodes, where a lot of dopamine accumulates. For now, I’m just thinking about it. Perhaps the TV show will offer me such an option. Things are going to 30 years, so I would, of course, like to recover, give birth to a child, become a mother.

“Tourette’s Syndrome manifests itself in tics – it used to be called Maine’s bouncing Frenchman’s disease.” These can be motor tics: bouncing, grimacing, winking, wrinkling the face, stereotypical, that is, repetitive movements, obscene gestures, echolalia (uncontrolled repetition of words heard in someone else’s speech. – Note ed. ). Experts most often consider the clinical variant to be the one where coprolalia is present – the involuntary pronunciation of indecent expressions. Sometimes these are whole sentences of obscene content. There may be individual snorts, hissing, whistling, a louder voice – this is how vocal tics manifest themselves.

Most often, the first symptoms occur between the ages of 7 and 12 years. It mostly happens during adolescence. In the future, either some stabilization may be observed, or, conversely, progressive symptoms. At an older age, the syndrome appears much less frequently – it usually turns out that the symptoms were in childhood, but went unnoticed. It could be, for example, simple winks, mannerisms, certain gestures.

Tourette’s syndrome is treated by neurologists, psychiatrists, and neuropsychiatrists – most often doctors work together. Here, the presence of psychotherapy is necessary, because often the cause of the onset of the disease is psychogenic (caused by external negative factors. – Note ed. ), stressful situations.

The exact cause of the disease is still unknown, although the first cases were described as early as the 15th century. There are ideas that this disease can be caused by stress. A genetic predisposition is not excluded – there are known cases of a family disease. A dopaminergic theory has also been established – when dopamine is intensely released through neurotransmitter mediators (signal transmitters between neurons. – ed. ), which causes such impulsive and compulsive manifestations of clinical symptoms. Statistics show that Tourette’s syndrome in some cases manifests itself in children from families with a more strict upbringing. But all authors who have been studying this disease for several centuries recognize the factor of a psychogenic cause. That is why a psychotherapist should be involved.

There are various treatment options. Scientists recognize the action of neuroleptics (drugs intended for the treatment of psychotic disorders. – Note ed. ). There is some evidence that antihypertensive drugs that are used for high blood pressure help. It is also believed that vitamin B6 and magnesium preparations have a positive effect.

In recent years, neurosurgical stereotaxic operations have begun to be performed (they are performed using special microinstruments that are inserted into strictly defined areas of the brain. — Note ed. ). This is a deep stimulation of the brain structures. Previously, thalamotomy (an operation in which separate parts of the thalamus are destroyed. – Note ed. ) and lobotomy (partial removal of the frontal lobes. – Note ed. ) were used.

The most common symptom reduction is observed with treatment, and stable remissions are described in 20% of cases. But Tourette’s syndrome is not amenable to complete treatment, often people suffer from the disease all their lives.

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Natalia PrikhodkoKirill Glazunov

Look at the device that stops tics in Tourette’s syndrome

Arthur
Kireev

Author

Arthur
Kireev

Author

Clinical trial results of a new wrist device designed to control the symptoms of Tourette’s syndrome have shown that it significantly reduces the severity and frequency of tics.

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Prototype wrist device delivers electrical impulses to reduce the number and severity of tics experienced by people with Tourette’s disease. The device has been tested by 121 people across the UK. The results were published in MedRxive.

The device was developed by scientists at the University of Nottingham and sister company Neurotherapuetics Ltd, who recently received an additional £1 million in funding to commercialize the Neupulse device with a device and app within the next 3 years.

Tourette syndrome (TS) is a neurodevelopmental disorder that is usually diagnosed between the ages of eight and 12. It causes involuntary sounds and movements called tics. Tics are repetitive, stereotyped movements and vocalizations that come on in fits, usually many times in a single day, and are often preceded by a strong tic urge called an alert call (PU).

Previous research by scientists at the School of Psychology and School of Medicine at the University of Nottingham used repetitive sequences of electrical stimulation of the median nerve (SNS) at the wrist to induce rhythmic brain electrical activity known as brainwaves associated with motion suppression. They found that rhythmic SNS significantly reduced the frequency and intensity of tics and eliminated the urge to tics in people with Tourette’s syndrome.

Participants used the device at home at the same time every day for 15 minutes for one month. Some people also filmed videos every day. Each week, participants provided feedback on their experiences.

The results of the study showed that people who received active stimulation significantly reduced the severity and frequency of tics. On average, they experienced a reduction in tic frequency of more than 25% during stimulation.

After using the device for four weeks, the severity of tics decreased by more than 35% in people who received active stimulation. Overall, 59% of people who received active stimulation experienced a reduction in tic severity of at least 25% from baseline.

13-year-old Milo was one of the participants in the research process. His parents noticed unusual symptoms when he was a toddler, but he was not diagnosed until he was 10 years old, when his tics became more prominent.