Index
T is a common neuropsychiatric disorder in childhood and is characterized by multiple motor tics and at least one vocal tic (phonic).
It is also known as TS or simply Tourette’s.
These tics characteristically increase and decrease, can be temporarily suppressed, and are usually preceded by an unwanted impulse or sensation in the affected muscles.
Some common tics are blinking of the eyes, cough, throat, sniffing, and facial movements. Tourette’s does not adversely affect intelligence or life expectancy.
It is defined as part of a spectrum of tic disorders, which includes provisional, transient, and persistent (chronic) tics. Although the exact cause is unknown, it is believed to involve a combination of genetic and environmental factors.
There are no specific tests to diagnose Tourette’s; It is not always identified correctly because most cases are mild. The severity of tics decreases for most children as they pass through adolescence.
The extreme Tourette in adulthood, although sensationalist in the media, is a rarity; the tics usually go unnoticed by casual observers.
In most cases, medication for tics is not necessary. Education is an integral part of any treatment plan, and explanation and reassurance alone are often sufficient treatment.
Many people with Tourette’s are not diagnosed or never seek medical attention. Attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) are present at higher rates among those seen in specialized clinics.
These concurrent diagnoses often cause more harm to the individual than tics; therefore, it is essential to identify the associated conditions and treat them correctly. About 1% of children and adolescents of school age have Tourette’s.
It was once considered a rare and strange syndrome, most often associated with coprolalia (the expression of obscene words or socially inappropriate and pejorative comments), but this symptom is present only in a small minority of people with Tourette’s.
The condition was named by Jean-Martin Charcot (1825-1893) on behalf of its resident, Georges Albert Édouard Brutus Gilles de la Tourette (1857-1904), a French physician and neurologist who published a report of nine patients with Tourette in 1885
Classification
Tics are sudden, repetitive, non-rhythmic movements (motor tics) and sentences (phonic tics) that involve discrete muscle groups.
Motor tics are movement-based tics, while phonic tics are involuntary sounds produced by air movement through the nose, mouth, or throat.
It was classified by the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as one of several tic disorders “generally diagnosed for the first time in childhood, childhood or adolescence” according to type (motor or phonic tics) ) and duration (transient or chronic).
Transient tic disorders consisted of multiple motor tics, phonic tics, or both, lasting four weeks and twelve months.
Chronic tic disorder was simple or multiple tics, motor or phonic (but not both), which were present for more than a year. Tourette’s is diagnosed when multiple motor tics, and at least one phonic tone, are present for more than a year.
The fifth version of the Diagnostic and Statistical Manual (DSM-5), published in May 2013, reclassified Tourette and tic disorders as motor disorders listed in the category of neurodevelopmental disorders and replaced transient tic disorder with a provisional tic disorder but reduced a few other changes.
ICD disorders are defined slightly differently by the International Statistical Classification of Diseases and Related Health Problems of the World Health Organization, ICD-10; code F95.2 is for the combined disorder of vocal and multiple motor tics of Tourette.
Although Tourette syndrome is the most severe expression of the spectrum of tic disorders, most cases are mild. Symptoms vary widely among people with Tourette’s, and mild cases may go undetected.
characteristics
Tics are movements or sounds “that occur intermittently and unpredictably from a background of normal motor activity,” having the appearance of “normal behaviors went wrong.”
The tics are associated with the change of Tourette in number, frequency, severity, and anatomical location. Waxing and diminishing- the constant increase and decrease in the severity and frequency of tics- occur differently in each individual.
Tics can also appear in “attack episodes,” which vary for each person.
Coprolalia (spontaneous expression of socially objectionable words or phrases or taboo) is the most publicized symptom of Tourette’s. However, it is not necessary to diagnose Tourette’s, and only about 10% of Tourette’s patients exhibit it.
Echolalia (repeat the words of others) and palilalia (repeat the words themselves) occur in a minority of cases. At the same time, the most common initial motor and vocal tics are, respectively, eye and throat blinking.
Unlike the abnormal movements of other movement disorders (for example, choanae, dystonia, myoclonus, and dyskinesia), Tourette’s tics are temporarily suppressible, not rhythmic, and often preceded by an unwanted premonitory impulse.
Immediately before the tic onset, most people with Tourette’s know an impulse similar to sneezing or scratching.
Individuals describe the need for tics as an accumulation of tension, pressure, or energy that they consciously choose to release as if they “had to” relieve the sensation or until they feel “okay.”
Examples of the premonitory impulse are the sensation of having something in the throat or a localized discomfort in the shoulders, which leads to the need to clear the throat or shrug.
The actual tic can be felt as relieving this tension or sensation, similar to scratching an itch. Another example is blinking to relieve an uncomfortable feeling in the eye.
These impulses and sensations, which precede the expression of movement or vocalization as a tic, are known as “premonitory sensory phenomena” or premonitory impulses.
Due to the impulses that precede them, tics are described as semi-voluntary or “involuntary” rather than specifically involuntary; they can be experienced as a voluntary and repressive response to the unwanted premonitory impulse.
Published descriptions of Tourette’s tics identify sensory phenomena as the main symptom of the syndrome, although they are not included in the diagnostic criteria.
While people with tics can sometimes suppress their tics for limited periods, doing so often results in stress or mental exhaustion.
People with Tourette’s may look for an isolated place to release their symptoms, or there may be a marked increase in tics after suppression at school or work.
Some people with Tourette’s may not be aware of the premonitory impulse. Children may be less aware of the premonitory impulse associated with tics than adults, but their knowledge increases with maturity.
They may have tics for several years before they realize the premonitory impulses. Children can suppress tics while in the doctor’s office, so they may need to be watched until they know they are being observed.
The ability to suppress tics varies among individuals and may be more developed in adults than children.
Although there is no “typical” case of Tourette syndrome, the condition follows a fairly reliable course regarding the age of onset and history of symptom severity. Tics can appear until the age of eighteen, but the most typical age of onset is five to seven.
A 1998 study published by Leckman and colleagues at the Yale Child Study Center showed that the most severe ages of tics are from eight to twelve (an average of ten), with tics that decrease steadily for most patients as they pass through. Adolescence.
The most common tics that appear for the first time are the blinking of the eyes, the facial movements, the sniffing, and the clearing of the throat. Initial tics occur most frequently in the midline regions of the body where there are many muscles, usually the head, neck, and facial region.
This can be contrasted with the stereotyped movements of other disorders (such as the stimuli and stereotypes of autistic spectrum disorders), which typically have an earlier onset age, are more symmetrical, rhythmic, and bilateral, and affect the extremities ( for example, hands).
Tics that appear early in the condition are often confused with other conditions, such as allergies, asthma, and vision problems: pediatricians, allergists, and ophthalmologists are often the first to see a child with tics.
The majority of Tourette cases in older adults are mild and almost unrecognizable. When the symptoms are severe enough to warrant referral to clinics, obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) are often associated with Tourette’s.
In children with tics, the additional presence of attention deficit hyperactivity disorder is associated with functional impairment, disruptive behavior, and severity of tics.
Compulsions that resemble tics are present in some people with obsessive-compulsive disorder.
The ” t obsessive-compulsive rastorno associated with tics” is hypothesized as a subset of obsessive-compulsive disorder, which differs from obsessive-compulsive disorder unrelated to tics by the type and nature of obsessions and compulsions.
Not all people with Tourette’s have attention deficit hyperactivity disorder or obsessive-compulsive disorder, or other comorbid conditions. In clinical populations, many patients who present for attention have attention deficit hyperactivity disorder.
One author reports that a ten-year overview of patient records revealed that approximately 40% of patients with Tourette have “only Tourette’s syndrome” or “pure Tourette’s syndrome.”
About Tourette syndrome in the absence of hyperactivity disorder and attention deficit disorder, obsessive-compulsive disorder, and other disorders.
Another author reports that 57% of the 656 patients with tic disorders had uncomplicated tics, while 43% had tics plus comorbid conditions. People with “full-blown Tourette” have necessary comorbid conditions in addition to tics.
Causes
The exact cause of Tourette’s is unknown, but it is well established that both genetic and environmental factors are involved.
Genetic epidemiology studies have shown that the overwhelming majority of Tourette cases are hereditary. However, the exact mode of inheritance is not yet known, and no gene has been identified.
In other cases, tics are associated with disorders other than Tourette’s, a phenomenon known as “tourism.”
A person with Tourette’s has about a 50% chance of transmitting the gene or genes to one of their children, but Tourette’s is a condition of variable expression and incomplete penetrance.
Therefore, not all those who inherit genetic vulnerability will show symptoms; even close family members may show different severities of symptoms or no symptoms at all.
The genes can be expressed as Tourette, as a mild tic (provisional or chronic tics), or as obsessive-compulsive symptoms without tics.
Only a minority of children who inherit the gene (s) have symptoms severe enough to require medical attention. Gender seems to have a role in expressing genetic vulnerability: men are more likely than women to express tics.
Non-genetic, environmental, postinfectious, or psychosocial factors, although they do not cause Tourette’s syndrome, can influence its severity. Autoimmune processes can affect the onset of tics and exacerbation in some cases.
In 1998, a team from the US National Institute of Mental Health UU proposed a hypothesis based on the observation of 50 children that both obsessive-compulsive disorder (OCD) and tic disorders may arise in a subgroup of children due to a post-streptococcal autoimmune process.
Children who meet five diagnostic criteria are classified, according to the hypothesis, as patients with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. This controversial hypothesis focuses on clinical and laboratory research but has not yet been demonstrated.
Some forms of obsessive-compulsive disorder may be genetically related to Tourette’s.
It is believed that a subset of obsessive-compulsive disorder is causally related to that of Tourette and maybe a different expression of the same factors that are important for the expression of tics.
However, the genetic relationship between attention deficit hyperactivity disorder with Tourette syndrome has not been fully established.
Pathophysiology
The exact mechanism affecting the vulnerability inherited from Tourette’s has not been established, and the exact cause is unknown. It is believed that tics result from a dysfunction in the cortical and subcortical regions, the thalamus, the basal ganglia, and the frontal cortex.
Neuroanatomical models involve faults in the circuits that connect the cerebral cortex and the subcortex, and imaging techniques involve the basal ganglia and the frontal cortex.
After 2010, the role of histamine and the H3 receptor focused on the pathophysiology of TS as “key modulators of the striated circuit.” A reduced histamine level in the H3 receptor can alter other neurotransmitters, causing tics.
Diagnosis
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Tourette’s can be diagnosed when a person exhibits multiple vocal tics and one or more vocal tics during one year; motor and vocal tics do not need to be concurrent.
The onset must have occurred before the age of 18 and can not be attributed to the effects of another condition or substance (such as cocaine).
Therefore, other medical conditions that include tics or tic-like movements, such as autism or other tourism causes, should be ruled out before conferring the diagnosis of Tourette’s.
Since 2000, the DSM has recognized that doctors treat patients who meet all other Tourette criteria but have no anguish or impairment.
There are no medical tests that can be used to diagnose Tourette’s; it is often misdiagnosed or insufficiently diagnosed, in part due to the broad expression of severity, which varies from mild (in most cases) or moderate to severe (rare cases, but more widely recognized and published).
Coughs blink, and tics that simulate unrelated conditions like asthma are usually misdiagnosed.
Diagnosis is based on observing the individual’s symptoms and family history, and after ruling out secondary causes of tic disorders.
An essential physical and neurological examination may be sufficient for patients with a typical onset and family history of tics or obsessive-compulsive disorder.
There is no need for other comorbid conditions (attention deficit hyperactivity disorder or obsessive-compulsive disorder). However, if a doctor believes that another condition is present that could explain the tics, the tests may be ordered as necessary to rule out that condition.
An example of this is when there is a diagnostic confusion between tics and seizure activity, which would require an electroencephalogram, or if there are symptoms that indicate an MRI to rule out brain abnormalities.
TSH levels can be measured to rule out hypothyroidism, which can cause tics. Brain imaging studies are usually not justified.
In adolescents and adults who have a sudden onset of tics and other behavioral symptoms, a urine drug test for cocaine and stimulants may be necessary.
If there is a family history of liver disease, serum copper and ceruloplasmin levels may rule out Wilson’s disease. Most cases are diagnosed simply by observing a history of tics.
Secondary causes of tics (not related to inherited Tourette syndrome) are commonly known as tourism.
Dystonia, choanae, other genetic conditions, and secondary causes of tics should be ruled out in the differential diagnosis of Tourette syndrome.
Other conditions that can manifest tics or stereotyped movements include developmental disorders, autism spectrum disorders, and stereotypic movement disorder.
Sydenham’s chorea; idiopathic dystonia; genetic conditions such as Huntington’s disease, neuroacanthocytosis, Hallervorden-Spatz syndrome, Duchenne muscular dystrophy, Wilson’s disease, and tuberous sclerosis.
Other possibilities include chromosomal disorders such as Down syndrome, Klinefelter syndrome, XYY syndrome, and fragile X syndrome.
Acquired causes of tics include drug-induced tics, head trauma, encephalitis, stroke, and carbon monoxide poisoning. The symptoms of Lesch-Nyhan syndrome can also be confused with Tourette syndrome.
Most of these conditions are rarer than tic disorders, and a thorough history and examination may be enough to rule them out without medical or screening tests.
Although not all people with Tourette’s have comorbid conditions, most Tourette patients who present for clinical care in specialized referral centers may have symptoms of other conditions along with their motor and phonic tics.
Associated conditions include attention deficit hyperactivity disorder (ADD or ADHD), obsessive-compulsive disorder (OCD), learning disorders, and sleep disorders.
Disruptive behaviors, impaired functioning, or cognitive impairment in patients with comorbid Tourette’s disorder and attention deficit hyperactivity disorder can be explained by hyperactivity disorder with comorbid attention-deficit, highlighting the importance of identifying and treating comorbid diseases.
The interruption of the tics is overshadowed by the comorbid conditions that present a more significant interference to the child.
Tic disorders in the absence of attention deficit hyperactivity disorder are not associated with disruptive behavior or functional deterioration. In contrast, deterioration in school, family, or peer relationships is more significant in patients with more comorbid conditions and often determines if therapy is needed.
Because comorbid conditions such as obsessive-compulsive disorder and attention-deficit / hyperactivity disorder may be more harmful than tics, these conditions are included in an evaluation of patients with tics.
“It is fundamental to bear in mind that comorbid conditions can determine functional status more strongly than tic disorder,” according to physician Samuel Zinner.
The initial evaluation of a patient referred for a tic disorder must include a thorough evaluation, including a family history of tics, attention deficit hyperactivity disorder, obsessive-compulsive symptoms, and other chronic medical, psychiatric, and neurological conditions.
Children and adolescents with Tourette syndrome who have learning difficulties are candidates for psychoeducational tests, especially if the child also has an attention deficit hyperactivity disorder.
Undiagnosed comorbid conditions can cause functional impairment, and it is necessary to identify and treat these conditions to improve functioning.
Complications may include depression, sleep problems, social distress, self-harm, anxiety, personality disorders, oppositional defiant disorder, and behavior disorders.
Treatment of Tourette’s syndrome
Tourette’s treatment focuses on identifying and helping the individual manage the most disturbing or damaging symptoms.
Most cases of Tourette’s are mild and do not require pharmacological treatment; On the other hand, psychobehavioral therapy, education, and tranquility may be enough.
Treatments, when justified, can be divided into those that address tics and comorbid conditions, which, when present, are often a more significant source of impairment than the tics themselves.
Not all people with tics have comorbid conditions, but they often have treatment priority when those conditions are present.
There is no cure for Tourette’s and no medication that works universally for all people without significant adverse effects. Knowledge, education, and understanding are the main ones in management plans for tics disorders.
The treatment of Tourette’s symptoms can include pharmacological, behavioral, and psychological therapies.
Although pharmacological intervention is reserved for more severe symptoms, other treatments (such as supportive psychotherapy or cognitive behavioral therapy ) can help avoid or improve depression and social isolation and improve family support.
Educating a patient, the family, and the surrounding community (such as friends, school, and church) is a crucial treatment strategy and maybe all that is required in mild cases.
The medication is available to help when symptoms interfere with functioning.
The classes of drugs with the most proven efficacy in the treatment of typical and atypical neurotics of tics, such as risperidone (trade name Risperdal), pimozide (Orap), and fluphenazine (Prolixin), can have a long-term effect and adverse effects to short term.
Antihypertensive agents clonidine (trade name Catapres) and guanfacine (Tenex) are also used to treat tics; the studies show variable efficacy but a lower side effect profile than the neuroleptics.
Stimulants and other medications may be helpful in the treatment of attention deficit hyperactivity disorder when it occurs in conjunction with tic disorders.
Medications of several other classes of medications may be used when trials with stimulants fail, including guanfacine (trade name Tenex), atomoxetine (Strattera), and tricyclic antidepressants.
Clomipramine (Anafranil), a tricyclic and selective serotonin reuptake inhibitor: a class of antidepressants that include fluoxetine (Prozac), sertraline (Zoloft) and fluvoxamine (Luvox): may be prescribed when a Tourette patient also has symptoms of disorder obsessive-compulsive.
Several other medications have been tried, but the evidence to support their use is not convincing.
Because children with tics often present themselves to doctors when their tics are more severe, and because of the increasing and shrinking nature of tics, it is recommended that medications do not start immediately or change frequently.
Frequently, the tics refer to explanation, tranquility, understanding of the condition, and a supportive environment.
When medicine is used, the goal is not to eliminate the symptoms: it should be used at the lowest possible dose to administer the symptoms without adverse effects since these may be more bothersome than the symptoms for which they were prescribed.
Cognitive-behavioral therapy (CBT) is a valuable treatment when there is an obsessive-compulsive disorder. There is increasing evidence to support habit reversal (HRT) in the treatment of tics.
There is evidence that the reversal of habit reduces tic severity. However, the studies have methodological limitations and a need for more qualified specialists and better studies on a large scale.
Relaxation techniques, such as exercise, yoga, or meditation, may help relieve stress that aggravates tics. However, most behavioral interventions (such as relaxation training and biofeedback, except habit reversal) ) have not been systematically evaluated and are not empirically compatible therapies for Tourette’s.
Deep brain stimulation has been used to treat adults with severe Tourette’s that do not respond to conventional treatment. However, it is considered an invasive and experimental procedure that is unlikely to be generalized.
Forecast
Tourette syndrome is a spectrum disorder: its severity varies in a spectrum from mild to severe. Most cases are mild and do not require treatment.
In these cases, the impact of the symptoms on the individual may be slight, to the extent that casual observers may not know their condition.
The overall prognosis is favorable, but a minority of children with Tourette syndrome have severe symptoms that persist into adulthood.
A study of 46 subjects at 19 years of age found that symptoms of 80% had a minimum to mild impact on their overall functioning and that the other 20% experienced at least a moderate impact on their overall functioning.
The rare minority of severe cases can prevent people from working or having a whole social life.
In a follow-up study of thirty-one adults with Tourette’s, all patients completed high school, 52% completed at least two years of university, and 71% were full-time employees or were in higher education.
Regardless of the severity of symptoms, people with Tourette’s have an average lifespan.
Although the symptoms can be lifelong and chronic for some, the condition is not degenerative or life-threatening. Intelligence is average in those with Tourette’s, although there may be learning problems.
The severity of tics in early life does not predict the severity of tics later in life, and the prognosis is generally favorable. However, there are no reliable means to predict the outcome for a particular individual.
The gene or genes associated with Tourette’s have not been identified, and there is no possible “cure.” A higher rate of migraines is reported than the general population and sleep disorders.
Several studies have shown that the condition in most children improves with maturity.
The tics can be at their most profound when diagnosed and often improve with the understanding of the condition by people and their families and friends.
The statistical age of greatest severity of tics is typically between eight and twelve. Most individuals experience a steady decline in the severity of tics as they pass through adolescence.
One study showed no correlation between the severity of tics and the onset of puberty, in contrast to the popular belief that tics increase at puberty. In many cases, a complete remission of tic symptoms occurs after adolescence.
However, a study that used a videotape to record tics in adults found that, although tics decreased in comparison to childhood, and all measures of tic severity improved in adulthood, 90% of adults still had tics.
Half of the adults who considered themselves free of tics still showed evidence of tics.
Many people with Tourette syndrome may not realize they have tics; Because tics are most often expressed in private, Tourette’s syndrome may go unnoticed or not be detected.
It is not uncommon for parents of affected children to be unaware that they too may have had tics.
Because Tourette tends to diminish with maturity, and Tourette’s milder cases are now more likely to be recognized. The first realization that a father has child tics may not come until his offspring is diagnosed.
It is not uncommon for several members of a family to be diagnosed together since parents who bring their children to a doctor for an assessment of tics will realize that they also had tics when they were a child.
Children with Tourette’s may suffer socially if their tics are considered “strange.” If a child has crippling tics or tics that interfere with social or academic functioning, supportive psychotherapy or accommodation at school may be helpful.
Because comorbid conditions (such as attention deficit hyperactivity disorder or obsessive-compulsive disorder) can significantly impact overall functioning more than tics, a comprehensive comorbidity assessment is required when symptoms and deterioration justify.
A supportive environment and the family, in general, give those with the skills of Tourette to handle the disorder. People with Tourette’s can learn to camouflage socially inappropriate tics or channel the energy of their tics in a functional effort.
Accomplished musicians, athletes, public speakers, and professionals from all walks of life are among people with Tourette’s.
The results in adulthood are associated more with the perceived importance of having severe tics as children than with the actual severity of the tics.
A person who was misunderstood, punished, or teased at home or school will have worse results than children who enjoyed an environment of understanding and support.
Epidemiology
Tourette syndrome is found among all social, racial, and ethnic groups and has been reported in all parts of the world; It is three to four times more frequent among men than among women.
The tics of Tourette syndrome begin in childhood and tend to subside or disappear with maturity; therefore, a diagnosis may no longer be justified for many adults, and the observed prevalence rates are higher among children than among adults.
As children pass through adolescence, about a quarter become tic-free, almost half see their tics diminish to a minimum or mild level, and less than a quarter have persistent tics.
Only 5% to 14% of adults experience worse tics in adulthood than in childhood.
Up to 1% of the general population experiences tic disorders, including chronic tics and transient tics of childhood.
Chronic tics affect 5% of children, and transient tics affect up to 20%. Prevalence rates in special education populations are higher.
The reported prevalence of Tourette syndrome varies “according to the source, age and sex of the sample, the determination procedures and the diagnostic system,” with a reported range between .4% and 3.8% for children of 5 to 18 years old.
Robertson (2011) says that 1% of school-age children have Tourette’s. According to Lombroso and Scahill (2008), the emerging consensus is that .1 to 1% of children have Tourette’s, with several studies supporting a tighter range of .6 to .8%.
Bloch and Leckman (2009) and Swain (2007) report a range of prevalence in children of .4 to .6%, Knight et al. (2012) estimate .77% in children and Du et al. (2010) report that 1 to 3% of Western children of school age have Tourette.
Singer (2011) states that the prevalence of Tourette syndrome in the general population at any time is .1% for cases of deterioration and .6% for all cases, while Bloch and colleagues (2011) declare the prevalence general between .3 and 1%.
Robertson (2011) also suggests that the Tourette rate in the general population is 1%. Using data from the 2000 census, a prevalence range of .1 to 1% yields an estimate of 53,000-530,000 school-age children with Tourette’s in the US. UU
Moreover, a prevalence estimate of .1% means that in 2001 about 553,000 people in the UK who were five years or more would have Tourette’s.
At one time, it was thought that Tourette’s syndrome was rare: in 1972, the US National Institutes of Health. UU (NIH) believed that there were less than 100 cases in the United States, and a 1973 registry reported only 485 cases worldwide.
However, multiple studies published since 2000 have consistently shown that the prevalence is much higher than previously thought.
The discrepancies between current and previous prevalence estimates come from determination bias in previous samples taken from clinically referred cases, evaluation methods that may not detect milder cases, and differences in diagnostic criteria and thresholds.
There were few broad-based community studies published before 2000. Until the 1980s, most of the epidemiological studies of Tourette syndrome were based on individuals referred to tertiary care or specialized clinics.
People with mild symptoms may not seek treatment, and doctors can not confer an official diagnosis of Tourette syndrome on children for fear of stigmatization.
Children with milder symptoms are unlikely to be referred to specialized clinics, so prevalence studies have an inherent bias towards more severe cases.
Studies of Tourette syndrome are vulnerable to error because tics vary in intensity and expression, are often intermittent, and are not consistently recognized by doctors, patients, family members, friends, or teachers; Approximately 20% of people with Tourette syndrome do not recognize that they have tics.
The most recent studies (which recognize that tics are often undiagnosed and difficult to detect) use direct observation in the classroom and multiple informants (parents, teachers, and trained observers).
Moreover, therefore, they register more cases than previous studies that depend on references. As the diagnostic threshold and the evaluation methodology have moved towards recognizing milder cases, the result is an increase in the estimated prevalence.
Tourette syndrome is associated with several comorbid conditions or concurrent diagnoses, often the primary source of impairment for an affected child.
Most people with tics do not seek medical attention, so epidemiological studies of Tourette syndrome “reflect a strong determination bias.”
However, among those who deserve medical attention, most have other conditions, and up to 50% have attention deficit hyperactivity disorder or obsessive-compulsive disorder.
History
It is believed that the first presentation of Tourette syndrome is in the book Malleus Maleficarum (“Witch’s Hammer”) by Jakob Sprenger and Heinrich Kraemer, published at the end of the 15th century and which describes a priest whose tics “are thought to be related with possession by the devil. “
A French physician, Jean-Marc Gaspard Itard, reported the first case of Tourette’s syndrome in 1825, describing Marquise de Dampierre, an important woman of the nobility.
Jean-Martin Charcot, an influential French doctor, assigned his resident Georges Albert Édouard Brutus Gilles de la Tourette, a French physician and neurologist, to study patients at the Salpêtrière Hospital to define a disease other than hysteria and Korea.
In 1885, Gilles de la Tourette published an account in the Study of a Nervous Affliction that describes nine people with “tic convulsive disorder,” concluding that a new clinical category should be defined.
The eponymous was later bestowed by Charcot after and on behalf of Gilles de la Tourette.
During the last century, there was little progress in the explanation or treatment of tics, and a psychogenic vision prevailed well into the twentieth century.
The possibility that stroke disorders, including Tourette’s syndrome, may have an organic origin was raised when an epidemic of encephalitis between 1918 and 1926 led to a subsequent epidemic of tic disorders.
During the 1960s and 1970s, when the beneficial effects of haloperidol (Haldol) on tics were known, the psychoanalytic approach to Tourette’s syndrome was questioned.
The turning point came in 1965, when Arthur K. Shapiro, described as “the father of modern tic research,” treated a Tourette patient with haloperidol and published an article that criticized the psychoanalytic approach.
Since the 1990s, a more neutral view of Tourette’s has emerged, in which biological vulnerability and adverse environmental events interact.
In 2000, the American Psychiatric Association published the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), revising the DSM-IV text to no longer require that symptoms of tic disorders cause distress or impair functioning and recognize that doctors often see patients who meet all other criteria for Tourette but who do not have distress or deterioration.
The findings since 1999 have advanced the science of Tourette syndrome in the areas of genetics, neuroimaging, neurophysiology, and neuropathology.
There are still questions regarding the best way to classify Tourette syndrome and how closely it relates to other movement disorders or psychiatric disorders.
Good epidemiological data are still lacking, and the treatments available are not free from risks and are not always well-tolerated.
High-profile media coverage focuses on treatments that do not have established safety or efficacy, such as deep brain stimulation. Many parents pursue alternative therapies that involve unstudied efficacy and side effects.
Society and culture
Not everyone who has Tourette’s wants treatment or a “cure,” especially if it means they can “lose” something else.
Researchers Leckman and Cohen, and former member of the national board of the American Tourette Syndrome Association (TSA), Kathryn Taubert, believe that there may be latent advantages associated with an individual’s genetic vulnerability to the development of Tourette syndrome.
Greater awareness and greater attention to that may have an adaptive value.
There is evidence to support the clinical understanding that children with “TS only” (Tourette in the absence of comorbid conditions) are unusually gifted: neuropsychological studies have identified advantages in children with Tourette in the absence of comorbid conditions.
Children with Tourette’s in the absence of comorbid conditions are faster than the average for their age group in timed motor coordination tests.
Notable individuals with Tourette syndrome are found in all walks of life, including musicians, athletes, media figures, teachers, doctors, and authors.
The best-known example of a person who may have used obsessive-compulsive traits to benefit is Samuel Johnson, the eighteenth-century English man of letters, who probably had Tourette’s syndrome, as evidenced by the writings of James Boswell.
Johnson wrote A Dictionary of the English Language in 1747 and was a prolific writer, poet, and critic.
Tim Howard, described by the Chicago Tribune as “the rarest of creatures, a hero of American football” and by the Tourette Syndrome Association as the “most notable individual with Tourette syndrome worldwide,” says that its composition Neurological gave him a better perception and a hyper-focus ability that contributed to his success in the field.
Although it has been speculated that Mozart had Tourette’s, no expert or organization of Tourette has presented credible evidence to support such a conclusion, and there are problems with the arguments that support the diagnosis: the tics are not transferred to the written form, as is supposed with the of Mozart.
Eschatological writings; the medical history in retrospect is not thorough; Side effects due to other conditions can be misinterpreted; “It is not proven whether written documents can explain the existence of a vocal tic” and “the evidence of motor tics in Mozart’s life is doubtful.”
Before the publication of Gilles de la Tourette in 1885, the probable representations of Tourette’s syndrome or the tic disorders in fictional literature are Mr. Pancks in Little Dorrit by Charles Dickens and Nikolai Levin in Anna Karenina by Leo Tolstoy.
The entertainment industry has been criticized for representing those with Tourette syndrome as social misfits whose only tic is coprolalia, which has fostered the stigmatization and misunderstanding of the public of those with Tourette’s.
