Tourette’s Disorder Overview

As a neurodevelopmental disorder characterized by motor and vocal tics that begin in childhood typically, Tourette’s involves repetitive movements or unwanted sounds (tics) that can't be easily controlled. This condition is primarily characterized by its tics, which are sudden, brief, repetitive movements or sounds. These tics are classified into various categories based on their complexity and nature; for instance, some people may experience simple vocal tics, while others may experience multiple movement (motor) tics. Below is a breakdown of common signs and symptoms, though they can vary between individuals. 

Simple Tourette's motor tics

Simple motor tics might include the following: 

• Blinking rapidly or squinting
• Facial twitching, especially around the nose and mouth
• Shrugging the shoulders
• Jerking or thrusting the head
• Snapping fingers
• Jumping or hopping
• Flapping the hands

Complex motor tics

Complex motor tics can include the following: 

• Touching or smelling objects repeatedly
• Twisting or bending the body into unusual postures
• Hopping repeatedly
• Echopraxia, or echoing someone else’s actions
• Copropraxia, or making obscene gestures

Simple vocal tics

People with Tourette’s syndrome or another tic disorder may experience simple vocal tics, which are sudden, involuntary vocalizations. Some simple vocal tics include:

• Throat clearing or grunting
• Coughing
• Sniffing or snorting
• Whistling or hissing

Complex vocal tics

Complex vocal tics might present like the following: 

• Palilalia (repeating one’s own words or sounds) 
• Echolalia (repeating words or phrases that were just heard) 
• Coprolalia (using swear words or making inappropriate remarks) 
• Speaking in a different tone or pitch
• Yelling 

Premonitory sensations

Some individuals with Tourette’s experience what are called premonitory sensations or premonitory urges before the onset of a tic, including:

• A sense of tension or discomfort in a particular body part
• An urgent sensation that can only be relieved by performing the tic
• Sensations that may be described as itchy, tingly, or pressure

Coexisting conditions

Five in six children diagnosed with Tourette’s have a co-existing mental, behavioral, or developmental condition. Though not directly a part of Tourette’s, these conditions can compound its impact:

• Attention-deficit hyperactivity disorder (ADHD)
• Obsessive-compulsive disorder (OCD)²
• Anxiety disorders
• Learning disabilities
• Sleep disorders

While this condition causes a person to make involuntary sounds and movements called tics, not all individuals with Tourette’s display all these signs and symptoms, and their severity can vary significantly based on individual factors. Recognizing the signs and symptoms can lead to an earlier diagnosis, which may support those affected.

Tourette’s origins are not fully understood. However, there are several theories related to causes and risk factors.³ 

Genetics

While the exact genes that impact Tourette’s are still being studied, some research shows a familial component, and relatives of those with the condition have a higher likelihood of having tics or related conditions.

Brain abnormalities

Some research indicates that differences in some brain regions, the circuits that interconnect them, and the neurotransmitters responsible for communications between nerve cells might play a part in the development of Tourette’s.

Environmental factors

Factors during and after pregnancy like smoking, stress, infections, or childbirth complications might contribute to the disorder, though they are not confirmed direct causes.

Risk factors

Specific risk factors for developing Tourette’s may include the following: 

• Family history: Individuals with family members who have Tourette’s or other tic disorders may be at a higher risk of developing a similar condition.
• Gender: Men are about three times more likely than women to develop Tourette’s.
• Other mental health disorders: The presence of conditions like ADHD or OCD could increase the risk of coexisting Tourette’s.

While these causes and risk factors can increase the likelihood of developing Tourette’s, they do not guarantee its onset. Some individuals with several risk factors never develop the disorder, and others with the disorder might not have any known risk factors. Continued research can be beneficial to better understand the complex factors leading to this condition. 

Though it lacks a definitive cure, Tourette’s can be managed through various treatments. The primary goal of treatment is to help clients manage symptoms, especially if they interfere with daily activities and functioning.

Medication

While no medication is approved explicitly for Tourette’s, several can be prescribed off-label, including:

• Dopamine antagonists: These medications can be prescribed for tics. Some have FDA approval for treating tics, though like any other medication they can have side effects. These include medications like neuropeltics, benzamides, and atypical antipsychotics.
• Antidepressants: Antidepressant medications could be helpful in treating symptoms of anxiety and OCD, which can be seen in individuals with Tourette’s disorder. 
• Central adrenergic inhibitors: These medications, such as clonidine, are sometimes used to treat tics due to their potential to modulate neurotransmitter activity in the brain.

Other treatment options

Other treatment options for coping with or managing this condition include the following: Deep brain stimulation (DBS): DBS involves implanting a battery-operated medical device to deliver electrical impulses into the brain. It is usually reserved for severe cases that do not respond to other treatments. Botox injections: Injections can treat some motor tics, like excessive blinking, by potentially weakening the mechanism in the body that causes the tics.

Self-care

Self-care can be a way to reduce stress, as stress may sometimes lead to worsening in tics. Below are a few options: 

• Education: The more one knows about Tourette’s, the better-equipped one may be to deal with its challenges. 
• Stay organized: Keeping a structured routine may reduce stress.
• Relaxation techniques: Methods like meditation, deep breathing exercises, and yoga may manage stress and reduce tics.
• Stay connected: Keeping in touch with friends and family can offer emotional support and understanding.
• Regular physical activity: Regular exercise can act as an outlet for energy and stress, potentially reducing the frequency or severity of tics.

While Tourette’s can be challenging, a combination of therapies, medications, and self-care practices may help individuals manage their symptoms effectively. Regular consultations with healthcare professionals can aid in tailoring treatment plans to individual needs.

Therapy can be a foundational step in managing the complexities of Tourette’s. Therapy can provide strategies to cope with tics, improve self-esteem, and address coexisting conditions. For those interested in online counseling, an online platform like BetterHelp can allow clients to connect with a licensed therapist from their homes.

Additional Tourette's resources

Other resources include:

• National Institute of Neurological Disorders and Stroke (NINDS): As a branch of the US government’s National Institutes of Health, NINDS provides comprehensive information on neurological disorders, including Tourette’s, along with other relevant information and research updates.
• Tourette Association of America: Dedicated to advocating for individuals with Tourette’s and tic disorders, this organization offers resources, research, and support for individuals who experience Tourette’s disorder, as well as their families.
• Tourette Syndrome Online Support Group: This organization offers online communities where individuals with Tourette’s disorder and their loved ones can share experiences, seek advice, and find peer support. 

These resources can offer invaluable support, information, and community connection for individuals with Tourette’s and their loved ones while helping them navigate the challenges of the condition.

Some individuals with Tourette’s also experience accompanying anxiety. A recent study in Nutrients explored the impact of nutritional supplements, specifically L-Theanine and Vitamin B6, on reducing tics and associated anxiety symptoms in youth with Tourette’s. The study involved 34 children aged four to 17 and compared the benefits of these supplements to psychoeducation. Results showed that both methods reduced tic and anxiety severity, but L-Theanine and Vitamin B6 had a notably more substantial effect, especially for tics.

Additional research seeks effective treatments for people with severe Tourette’s syndrome and related mental health conditions. The Journal of Neurosurgery tested a combination of deep brain stimulation and bilateral anterior capsulotomy on ten patients, primarily with obsessive-compulsive and affective disorders. Post-surgery evaluations showed notable tic and symptom relief. There was a 64% decrease at 12 months and 77% at final check-ins on a tic severity scale. Participants also experienced improved quality of life and adaptive functioning, with minimal side effects. This combined approach may benefit people with severe Tourette’s and co-existing psychiatric conditions or symptoms. 

Below are several statistics on Tourette’s:

• According to the Centers for Disease Control’s 2020 data estimates, 350,000 to 450,000 children and adults in the United States are diagnosed with Tourette’s disorder.  
• The ADHD Foundation says about 85% of individuals with Tourette’s syndrome also have co-occurring disorders like ADHD, obsessive-compulsive disorder, and anxiety.
• Research from the Journal of Psychosomatic Research says that by early adulthood, roughly three out of four individuals with Tourette’s experience a significant reduction in tic severity, and over one-third become entirely tic-free.
• A trial in the Journal of Advanced Nursing showed that behavioral therapy effectively reduced Tourette’s symptoms by 46.4% in three months, compared to minimal change in non-therapy groups.