Research shows that, in Tourette Syndrome, something is
wrong with the way in which the brain produces or uses important
substances called neurotransmitters, which control how signals are
sent along the nerve cells. The neurotransmitters dopamine and
serotonin have been implicated in Tourette Syndrome; noradrenaline is thought to be
the most important stimulant. (Medications that mimic noradrenaline
may cause tics in susceptible patients.) Whatever the exact defect,
it is handed down through the genes from parents to children. If one
parent has Tourette Syndrome, each child has a 50% chance of getting the abnormal
gene. Seven of every ten girls who inherit the gene, and nearly all
boys who inherit it, will develop symptoms of Tourette Syndrome. Overall, about one
in every 2,500 persons has full-blown Tourette Syndrome. Three times as many will
have some features, usually chronic motor tics or obsessive thoughts.
Patients with Tourette Syndrome are more likely to have trouble controlling their
impulses, to have dyslexia (or other learning problems), and to talk
during sleep or wake frequently. Compulsive behavior, such as
constantly washing the hands or repeatedly checking that a door is
locked, is a common feature of Tourette Syndrome, seen in 30-90% of all patients.
Simple tics are sudden, brief movements involving a single group of
muscles or a few groups, which may be repeated several times.
Complex tics consist of a repeated pattern of movements that can
involve several muscle groups and usually occur in the same order.
For instance, a boy with Tourette Syndrome may repeatedly move his head from side
to side, blink his eyes, open his mouth, and stretch his neck. Vocal
tics may be sounds or noises that lack all meaning, or repeated
words and phrases that can be understood. Tics tend to get worse and
better in cycles, and patients can develop new tics as they grow
older. The symptoms of Tourette Syndrome may get much better for weeks or months at
a time, only to worsen later.
A number of examples will show why Tourette Syndrome can be such a strange and
dramatic disorder:
Simple motor tics (blinking the eyes, pouting the lips, shaking or
jerking the head, shrugging the shoulders, and grimacing or "making
faces"). Any part of the body may be tensed up or rapidly jerked, or
a patient may suddenly kick out. Rapid finger movements are common,
as are snapping the jaws and clicking the teeth.
Complex motor tics (jumping, touching part of the body or certain
objects, smelling things over and over, stamping the feet, and
twirling about). Some Tourette Syndrome patients throw objects, others arrange
things in a certain way. Biting, head-banging, writhing (snake-like)
movements, rolling the eyes up or from side to side, and sticking
out the tongue all may be seen. A child may write the same letter or
word over and over, or may tear apart papers and books. Though they
do not mean to, Tourette Syndrome patients may make obscene gestures like "giving
the finger," or they may imitate any movements or gestures made by
others.
Simple vocal tics (clearing the throat, coughing, snorting, barking,
grunting, yelping, clicking the tongue). Patients may screech or
make whistling, hissing, or sucking sounds. They may repeat sounds
such as "uh, uh," or "eee."
Complex vocal tics and patterns. Older children with Tourette Syndrome may repeat a
phrase such as "Oh boy," "all right," or "what's that?" Or they may
repeat everything they, or others, say a certain number of times.
Some patients speak very rapidly or loudly, or in a strange tone or
accent. Coprolalia (saying "dirty words" or phrases that are sexual
or aggressive) is probably the best known feature of Tourette Syndrome, but fewer
than one-third of all patients actually do this.
Behavioral abnormalities that may be associated with Tourette Syndrome include
attention-deficit/hyperactivity disorder (ADHD) and disruptive
behaviors, including conduct disorder and oppositional defiant
disorder, with aggressive, destructive, antisocial, or negativistic
behavior. Academic disorders, learning disorders, and sleep
abnormalities (such as sleepwalking and nightmares) are also seen. |