Tourette Syndrome Health Article

Symptoms

Motor tics in TS can be classified as simple or complex. Simple tics are sudden brief movements involving a single group of muscles or a few groups that 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 TS 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 TS may get much better for weeks or months at a time, only to worsen later.

The following examples show why TS can be such a strange and dramatic disorder:

• Simple motor tics. These may include 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. Rapid finger movements are common, as are snapping the jaws and clicking the teeth.
• Complex motor tics. These may include jumping, touching parts of the body or certain objects, smelling things over and over, stamping the feet, and twirling about. Some TS patients throw objects, others arrange things in a certain way. Biting, head-banging, writhing movements, rolling the eyes up or from side to side, and sticking out the tongue may all 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 intend to be offensive, TS patients may make obscene gestures like "giving the finger," or they may imitate any movements or gestures made by others.
• Simple vocal tics. These include clearing the throat, coughing, snorting, barking, grunting, yelping, and 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 TS 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 suggestive or hostile phrases) is probably the best known feature of TS, but fewer than one-third of all patients display this symptom.

Behavioral abnormalities that may be associated with TS 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 in TS patients.

Diagnosis

There are no specific tests for TS. TS is diagnosed by observing the symptoms and asking whether relatives have had a similar condition. To qualify as TS, both motor and vocal tics should be present for at least a year and should begin before age 18 (or, some believe, age 21). Often, the diagnosis is delayed because the patient is misunderstood not only at home and at school, but in the doctor's office as well. It may take some time for the patient to trust the doctor enough not to suppress the strangest or most alarming tics. Blood tests may be done in some cases to rule out other movement disorders. A test of the brain's electrical activity (electroencephalograph or EEG) is often abnormal in TS, but not specific. A thorough medication history is very important in making the diagnosis as well, because stimulant drugs may provoke tics or aggravate the symptoms of TS.