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Tourette's Syndrome

Tourette’s Syndrome has been in the limelight recently with celebrities admitting they have the illness.  Louisiana State University basketball star, Chris Jackson, has been diagnosed with TS, as has Jim Eisenreich, a major league baseball player .  It is estimated that up to 20% of children will have at least a transient tic disorder at some point.  Tourette’s represents the more severe tic disorders.  Tics are defined as, “sudden, rapid, purposeless, repetitive, nonrhythmic, stereotyped movements or vocalizations”.  Tics can be chronic or transient, and can include eye blinking, shoulder jerking, picking movements, grunting, sniffing, and barking.  More complex tics can include facial grimacing, arm flapping, use of obscene words, and repeating one’s own or someone else’s words .  Teachers and parents usually recognize tics in the early school years.  Multiple tics are often present at once.  Patients can teach themselves to suppress the tics, but this causes them to build up in a sense, and upon ceasing to consciously suppress the tics, they can occur in flurries of one to two hours.  In addition, anxiety, stress and fatigue can intensify tics.  They usually decrease during sleep or while the patient is focused on an activity.

Tourette's Syndrome

The DSM VI gives the following criteria for Tourette’ Syndrome :

  • A: Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently.
  • B: The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.
  • C: The disturbance causes marked distress or significant impairment in social, occupational, or other important areas of functioning.
  • D: The onset is before age 18.
  • E: The disturbance is not due to the direct physiological effects of a substance (e.g. stimulants) or a general medical condition (e.g. Huntington's disease or postviral encephalitis).

Scientists who believe there is one neurological cause of TS have made the following conclusions.  First, tics are thought to result from a dysfunction in the central nervous system.  Also, there may be an inappropriate regulation of neurotransmitters, such as dopamine, that cause the disorder.  Thirdly, as noted by authors , “a neurophysiologic deficit secondary to neurotransmitter abnormalities, resulting in failure of inhibition of the frontal-subcortical motor circuits” (2263+) could be the source of the dysfunction.

The other approach in the etiology of TS is known as “splitting.”  Researchers who prefer this approach organize the problems of TS patients categorically and evaluate and treat them independently.  They do not assume one underlying neurobiologic mechanism causes all symptoms.  This may create artificial distinctions, but also allows each TS patient to be treated separately based on their symptoms.

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