Tourette Syndrome

What Is Tourette Syndrome?

Tourette syndrome, or simply Tourette’s, is a complex nerve disorder that causes a person to make sudden, uncontrollable, repeated movements or vocal sounds called tics.

Causes of Tourette Syndrome

Scientists believe that chemical messengers (neurotransmitters) in the brain, such as dopamine, norepinephrine, and serotonin, are not able to properly communicate between nerve cells in people with Tourette’s.

Experts don’t know exactly why this happens. The condition does run in some families, and researchers have found associations between Tourette syndrome and changes (mutations) in specific genes in a very small number of people. But most people with Tourette syndrome have no relatives with the condition.

Tourette Syndrome Symptoms

The main symptoms of Tourette’s are tics, usually repeated, rapid body movements or vocalizations (sounds). Tics come and go and most are mild. They often change in location, type, frequency, and intensity that ranges from mild to severe.

Tics usually begin between the ages of 5 and 10. Tic symptoms usually peak in intensity during early adolescence. Symptoms then typically become more easily controlled during late adolescence and early adulthood.

Tics may improve during periods of calm or focused activity and even go away completely during deep sleep. Tics can occur during light sleep.

Symptoms may worsen during periods of excitement, illness, stress, fatigue, or anxiety. Physical discomfort or hearing similar sounds to vocal tics may provoke tic symptoms.

Some people with Tourette syndrome can control tics to a certain extent. But tension often builds up to where a tic must be expressed involuntarily.

Types of Tics that Occur with Tourette’s

Tics are classified based on whether they involve muscles (motor tics) or sounds (vocal tics).

They are then further classified into simple or complex tics.

• Simple tics are sudden, quick, repetitive movements in just a few muscles. Simple tics occur more frequently than complex tics and may happen right before a complex tic.
• Complex tics involve several muscle groups that perform distinct, coordinated movement patterns.

Simple motor tics may include:

• Eye blinking
• Eye darting
• Facial grimacing/nose scrunching
• Head or shoulder twitching
• Jaw or mouth movements
• Nose twitching
• Shoulder shrugging

Simple vocal tics may include:

• Barking
• Coughing
• Grunting
• Shouting
• Sniffing
• Throat clearing

Complex motor tics may include:

• Bending
• Gesturing
• Hopping
• Jumping
• Sniffing or touching an object
• Stepping in a certain pattern
• Twisting

Complex vocal tics may include:

• Repeating words or phrases
• Repeating another person’s words or phrases (echolalia)
• Using vulgar, obscene, or swear words (coprolalia)

Tourette Syndrome Diagnosis

There is no specific test for Tourette syndrome. Diagnosing this condition can be challenging because some tics may overlap with symptoms of other conditions. For example, sniffling may be a symptom of allergies or eye blinking may result from an eye or vision problem.

Doctors use a list of criteria to diagnose Tourette’s:

• Presence of both motor and verbal tics
• Onset of tic symptoms before the age of 18
• Tics happen multiple times a day, every day or on and off for more than one year
• There is no other explanations for the tics, such as medications or other conditions or substances

Blood tests and certain imaging studies, such as computed tomography (CT) scans, electroencephalography (EEG), or magnetic resonance imaging (MRI), can rule out other conditions that may cause symptoms that mimic Tourette syndrome.

Tourette Syndrome Treatment

There is no cure for Tourette syndrome, but treatments may help control tics. Mild tics may not require treatment, while more severe tics or tics that cause accidental self-harm may need to be controlled with medication.

Medications

Medications can help manage tics or reduce symptoms of other conditions that often occur with Tourette’s. Medications may include:

• Alpha-adrenergic blockers (clonidine or guanfacine): These first-line treatments for tics inhibit the release of noradrenaline, a hormone that helps send messages from nerve-to-nerve and nerve-to-muscle.
• Botulinum toxin: These injections are inserted into a muscle to temporarily weaken or paralyze it. This treatment may relieve simple or vocal tics.
• Fluphenazine: This medication works to control tics by blocking or lessening the effects of dopamine in the brain to change mood, thinking, or behavior.
• Haloperidol: This medication helps to control motor and verbal tics by blocking the activity of dopamine in the brain.
• Pimozide: This medication controls severe motor or verbal tics by blocking the activity of dopamine.
• Risperidone: This medication helps rebalance levels of dopamine and serotonin. This reduces the uncontrollable urges to move or vocalize in Tourette syndrome.
• Tetrabenazine: This medication decreases the amount of dopamine stored in the brain to reduce unwanted motor and verbal tics.
• Topiramate: This anti-seizure medication helps manage symptoms in some people with Tourette’s.

Your doctor may also prescribe medication to help manage symptoms of other behavioral or mental conditions that may occur with Tourette syndrome, such as:

• Anxiety
• Attention deficit hyperactivity disorder (ADHD)
• Autism
• Depression
• Obsessive-compulsive disorder (OCD)

Therapies

People living with Tourette’s may benefit from a combination of medication and specific therapies to help control tics.

Comprehensive behavioral intervention for tics (CBIT) is a form of psychotherapy that teaches you ways to monitor tics and identify the beginnings of an urge for a tic. You then learn to do voluntary movements that compete with the tic to prevent the tic from happening. CBIT also teaches stress reduction techniques and ways to reduce tic triggers, such as stress or anxiety.

Surgery

A procedure called deep brain stimulation (DBS) involves the surgical placement of a medical device in the chest (similar to a pacemaker) that sends an electrical impulse through wires to specific areas of the brain that are responsible for the tics. These electrical signals can help to block the abnormal brain signals causing tics.

DBS may help reduce severe tics that re not controlled with medications or behavioral therapy. Researchers are studying DBS as a treatment for people with Tourette syndrome and people who have Tourette’s and obsessive-compulsive disorder.

Care for Tourette Syndrome at Penn Medicine

As the leading movement disorders center in the Philadelphia region, Penn Medicine’s Movement Disorders Center has decades of experience caring for adults with Tourette syndrome. Our involvement in research and clinical trials puts us at the leading edge of Tourette syndrome treatment, so we are able to offer every available therapy. We work with you to understand your symptoms and needs and create a treatment plan that brings you the most relief.

Make an Appointment

Please call 800-789-7366 or make an appointment.

Penn Programs & Services for Tourette Syndrome