1. Tourette’s syndrome

2. What is Tourette’s syndrome
Neurological disorder Involving uncontrolled movements or sounds known as tics
More reseach needs to be done. The casue is not exactly known, but many theories exists. Most experts agree that abnormal processes with the neurotransmiiters is the likely cause.

3. Scientists believe that tics may result from changes in brain chemicals (neurotransmitters) that are responsible for producing and controlling voluntary movements.
One belief is that the problem occurs in an abnormal processed between the basal ganglia and the frontal cortex. The frontal lobes plan and execute movement and It is believed that the Basal Ganglia facilitates desired action while stopping undesired or inappropriate ones., for individuals with Tourette’s something happens when the frontal cortex tells the basal ganglia to stop a particular movement resulting in undesired sounds or movements.

4. What are tics Motor and Vocal Tics Simple motor tics
Clonic tics : sudden muscle or limb jerks, like a spasm.
Tonic tics : tensing of the muscles
Dystonic : twisting pulling or squeezing movements resulting in a briefly maintained abnormal posture
Simple vocal tics are wordless sounds
People with Tourette’s syndrome often describe the tics as a sensation, urge or impulse to perform a specific movement, this urge is known as a premonitory sensation, The Promonitory urge can be brief, a second or two, or prolonged, 30 second and is usually followed by sensation of relief once performed. Motor tics which are associated with movement and vocal tics which are associated with sound. Tics can also be Simple or complex. Simple tics involve a limited number of muscle groups and are sudden brief and repetitive. Complex tics on the other hand are distinct, coordinated patterns of movements that involve several muscle groups

5. What are tics Cont’d Complex Motor tics
Involves slower, longer, and more purposeful movements
Complex Vocal tics
Include uttering syllables, words, phrases,
Palilalia: repeating one’s self
Echolalia: repeating others
Coprolalia: uttering of socially inappropriate language, swearing
Most people are aware of the tics that cuase socially inappropriate language, however this type of tic only affect less than 10% of people diagnosed with torettes

6. Common motor tics seen in Tourette syndrome
Simple tics
Complex tics
Eye blinking
Touching the nose
Head jerking
Touching other people
Shoulder shrugging
Smelling objects
Eye darting
Obscene gesturing
Finger flexing
Flapping the arms
Common vocal tics seen in Tourette syndrome
Simple tics
Complex tics
Hiccupping
Using different tones of voice
Yelling
Repeating one's own words or phrases
Throat clearing
Repeating others' words or phrases
Barking
Using vulgar, obscene or swear words
I have a video that might help to show some of the more severe tics. Her toruettes seems to be severe enough that she requires a wheelchair for her own saftey

7. DSM-IV
• have two or more motor tics
• have had tics for at least a year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on.
• have tics that begin before he or she is 18 years of age.
• have symptoms that are not due to taking medicine or other drugs or due to having another medical condition (for example, seizures, Huntington disease, or postviral encephalitis).

8. Some statistics
• It is not known exactly how many people have Tourette Syndrome (TS). Some studies have found that 1 of every 360 children between 6 and 17. Other studies using different methods have estimated the rate of TS at 1-10 per 1000 children. • 27% have been reported as having moderate or severe forms of the condition. • TS affects people of all racial and ethnic groups. • Boys are affected three to five times more often than girls. • A TS diagnosis is twice as likely among non-Hispanic White people than among Hispanic and non-Hispanic Black people. • A diagnosis of TS is twice as common among children 12 through 17 years of age as among those 6 through 11 years of age.
Prevemnce of this disorder affects all ethnic groups however non-Hispanic white people are more likely to be diagnosed than Hispanic and non Hispanic black people

9. Co-morbid conditions
• Attention-deficit/hyperactivity disorder (ADHD) • Obsessive-compulsive disorder (OCD) • Learning disabilities • Sleep disorders • Depression
Many if not most individuals diagnosed with this disorder will also present with ADHD, OCD, Learning disabilities and Sleep disorders, and depression

10. Medical treatment
• Drugs that block or deplete the neurotransmitter dopamine in the brain: Used to control tics. Side effects: weight gain and a dulling of the mind. (fluphenazine, Haldol) • Botulinum toxin type A (Botox) injections.: For simple or vocal tics, an injection into the affected muscle may help relieve the tic. • Stimulant medications: Used to help increase attention and concentration for people with ADHD. (methylphenidate (Concerta, Ritalin, others) (dextroamphetamine (Adderall XR, Dexedrine, others).

11. Medical Treatment Cont’d
• Central adrenergic inhibitors:. Typically prescribed for high blood pressure, these drugs may help control behavioral symptoms, such as impulse control problems and rage attacks. Side effects may include sleepiness.
• Antidepressants:. These may help control symptoms of sadness, anxiety and OCD. (clonidine (Catapres) or guanfacine (Tenex) fluoxetine (Prozac, Sarafem, others)

12. Therapy treatment
• Psychotherapy.: May help individual cope with Tourette syndrome, may help with additional conditions ADHD, obsessions, depression or anxiety. • Behavior therapy: Habit Reversal Training: monitor tics and identify premonitory urges —respond to urges voluntarily; move incompatibly with the tic, hopefully suppressing the tic.

13. Impact
Individual with Tourette’s Syndrome may experience difficulties with: problems concentrating in class Homework Examinations, Writing, Anxiety Depression Shame teasing and bullying by other students Unhelpful responses by school staff Irritability Antisocial behavior Self-harming behavior (less commonly) Inappropriate behavior to others
Although many areas of life may be affect, most of the severe symptoms decrease with age. Most people will be able to live a relatively normal life.

14. References Mayo Clinic Movement Disorder Society Tourette Canada CDC
Movement Disorder Society
Tourette Canada
CDC
National Institute of Neurological Disorders and Stroke
Web MD