Understanding the misunderstood

What is Tourettes Syndrome? Inherited neurological condition 1/100 School children 300,000+ children and adults in the UK 1:4 girls to boys Complex condition with a wide spectrum

Symptoms

Relative likelihood of lifetime sensory tics in a given region as based on a self-report of patients with TS 7 10-12 18

Causes The Basal Ganglia Dopamine theory Genetics Childhood infection -specialised brain cells involved in helping regulate the physical movements of the body -higher brain functions such as motivation and decision-making -temporary disruption scrambling decision making - sudden development unconscious motivation to perform an action (the tic) that the conscious mind regards as both unwanted and unexplained -MRI and PET scans show different structure Dopamine theory -excessive levels for a person with TS effecting Basal Ganglia -alternatively normal dopamine level but TS more sensitive to its effects Genetics -inherited - 50% -in twins if one has TS other ½ chance Childhood infection -streptococcal throat infections, antibodies causing abnormal immune reaction Other possible environmental factors contributing to onset or severity: -pregnancy and birth related problems -complications during pregnancy, smoking during pregnancy, severe nausea and/or vomiting during the first trimester premature low birth weight children

MRI

Diagnosis Other possibilities to rule out: Allergies – sniffing, coughing Vision problems - blinking Autistic spectrum disorder Dystonia – condition causing involuntary muscle spasms Huntington's disease – genetic condition that can cause a range of symptoms including muscle twitching Referral Neurologist – a doctor who specialises in treating conditions that affect the brain and nervous system Psychiatrist – a doctor who specialises in treating mental health conditions Educational psychologist - a health professional who works with children who have learning, developmental or behavioural difficulties computerised tomography (CT) scan –  where a series of X-Rays are taken to build up a detailed 3D image of the brain magnetic resonance imaging (MRI) scan – where strong fluctuating magnetic fields are used to produce a detailed image of the inside of the brain Confirming the diagnosis Not caused by other medical conditions or medication Tics started before the age of 18. Several physical tics and at least one phonic tic. Tics occur many times during the day, nearly every day Tics have been present for at least a year.

Research and Treatment No cure at present Medication: alpha2-adrenergic agonists (release noradrenaline, stabilize norepinephrine, clonidine), muscle relaxants and neuroleptics (risperidone, benzimides) Therapy: behavioural, psychotherapy, muscle relaxation Surgery : Limbic leucotomy, Deep Brain Stimulation

Obsessive compulsive disorder Anxiety Disorder chronic (long-term) mental health condition associated with obsessive thoughts and compulsive behaviour OCD is one of the most common mental health conditions. It is estimated that up to 3 in 100 adults and up to 5 in 100 children and teenagers have OCD

Symptoms Intrusive thoughts -intentionally causing harm -unintentionally causing harm -fear of contamination -need for symmetry or orderliness -committing offensive acts Common Compulsions cleaning hand washing checking – such as checking that doors are locked, or that the gas or a tap is off  counting ordering and arranging hoarding  asking for reassurance needing to confess repeating words silently prolonged thoughts about the same subject

Causes Genetic Brain abnormalities -No specific gene isolated -But 4 times likely to inherit OCD if a family member has it Brain abnormalities -Increased blood flow and activity -Increased level of neurotransmitter serotonin -Streptococcal throat infections, antibodies causing abnormal immune reaction Life events, coping mechanisms and stress

PET scan showing increased brain activity due to hyper-vigilance

Diagnosis GP questionnaire Psychiatrist Educational psychologist

Research and Treatment Based on severity mild functional impairment – obsessive thinking and compulsive behaviour occupy less than one hour of your day moderate functional impairment – obsessive thinking and compulsive behaviour occupy one to three hours of your day severe functional impairment – obsessive thinking and compulsive behaviour occupy more than three hours of your day CBT, psychotherapy Anti-anxiety medication Surgery : Limbic leucotomy, Deep Brain Stimulation

Comorbidities Over 85 percent of people with TS have more than just tics. 60% have OCD 70% have attention deficit hyperactivity disorder (ADHD). More susceptible to fits of rage, depression and sleep disturbances Co-morbidities often present more problems than the tics and can be less visible.