Understanding Tourette Syndrome and Its Symptoms

Many of us have met someone who had a tic – maybe the person blinked a little more frequently or cleared their throat more often – but when is a tic more than just a tic? ProMedica HealthConnect asked Selena Nicholas-Bublick MD, MHS with ProMedica Physicians Neurology some questions to about Tourette Syndrome and its symptoms.

What is Tourette Syndrome?
Tourette Syndrome is a neurobehavioral disorder that involves involuntary motor and vocal tics. Many people have tics, but a patient with Tourette’s has both motor and vocal tics.

In diagnosing Tourette Syndrome, the main criteria is tics – the timing, whether there are motor and vocal tics, how long they have they been going on. Non-Tourette’s tics are quite common. Between 20-30% of students in a school system may have some sort of tic, but the prevalence of actual Tourette Syndrome would be closer to only 3 out 1,000 school-age children. True Tourette syndrome includes sudden, repetitive movements or sounds. People with Tourette’s  have both motor and vocal tics, are less than 18 years of age at the onset, and have experienced disruption for school or home-life for more than a year. Observations from parents and teachers become very important to an accurate diagnosis.

What causes Tourette Syndrome?
The cause of Tourette Syndrome has not been defined. There may be a genetic component to tics. There is also a hereditary component to it. Patients with parents that have tics or a prior diagnosis of Tourette’s are more likely to develop tics or a diagnosis of Tourette’s themselves.

What are tics like?
Tics are divided between motor tics – tics that involve motion – and vocal tics – tics that include sound. From there you can have both simple and complex tics in either category.

Simple motor tics could include blinking, mouth opening, toe curling, fist clenching and eye rolling.  More complex motor tics would include shaking or jumping, or what we call echopraxiaEchopraxia is an imitating gesture. For example, if you wipe your eye brow, someone with Tourette’s may mimic that gesture by wiping their own eyebrow.

Simple vocal tics could include throat clearing or even growling or barking. Complex vocal tics include echolalia, when someone with Tourette’s repeats words or phrases heard around them and coprolalia, or involuntary use of obscene language. While it is widely associated with Tourette Syndrome, the number of people who actually count coprolalia among their tics is quite small.

Can people with Tourette Syndrome control their tics?
Patients may be able to suppress their tics for a period of time, but many patients report an uncomfortable sensation from suppressing them, and when they’re released, the tics come with a flurry.

Tics tend to peak in adolescence, and can be more intense with stress or anxiety, but tend to improve with age. There are medications for Tourette’s, but medication should be prescribed in consultation with the patient if the tics are severely inhibiting social, school or work interactions. We encourage patients to pursue other behavioral therapies first.

How else are people with Tourette’s affected?
Around 80% of patients with Tourette Syndrome will have behavioral co-morbidities. Obsessive Compulsive behavior is most common among these patients. Attention Deficit Disorder is also frequently seen in patients with Tourette’s. These are more behavioral aspects of the disorder and so we work with patients to make sure they are also seeing a behavioral therapist to address these issues.

How can people be more aware of tics and Tourette Syndrome?
Being informed is very important. Understand that this isn’t attention-seeking behavior. The more stressed the person is, the worse the tics may be, so try to be understanding and help them feel at ease. Also, many patients may not yet have a diagnosis. It’s important to see your doctor and be informed about what is causing them. The Tourette Syndrome Association is a good resource for people who are newly diagnosed and want to learn more.