Tourette syndrome is a neurological disorder. It causes repeated, involuntary physical movements and vocal outbursts. The exact cause is unknown.
Tourette syndrome is a tic syndrome. Tics are involuntary muscle spasms. They consist of abrupt intermittent twitches of a group of muscles.
The most frequent forms of tics involve:
- throat clearing
- shoulder movements
- head movements
According to the National Institute of Neurological Disorders and Stroke (NINDS), about 200,000 people in the United States exhibit severe symptoms of Tourette syndrome.
As many as 1 in 100 Americans experience milder symptoms. The syndrome affects males nearly four times more than females.
Symptoms can vary from one person to another. They usually appear between the ages of 3 and 9 years old, starting with small muscle tics of your head and in your neck. Eventually, other tics may appear in your trunk and limbs.
People diagnosed with Tourette syndrome often have both a motor tic and a vocal tic.
The symptoms tend to worsen during periods of:
They’re generally most severe during your early teen years.
Tics are classified by type, as in motor or vocal. Further classification includes simple or complex tics.
Simple tics usually involve only one muscle group and are brief. Complex tics are coordinated patterns of movements or vocalizations that involve several muscle groups.
|Simple motor tics||Complex motor tics|
|eye blinking||smelling or touching objects|
|eye darting||making obscene gestures|
|sticking the tongue out||bending or twisting your body|
|nose twitching||stepping in certain patterns|
|Simple vocal tics||Complex vocal tics|
|hiccupping||repeating your own words or phrases|
|grunting||repeating other people’s words or phrases|
|coughing||using vulgar or obscene words|
Tourette is a highly complex syndrome. It involves abnormalities in various parts of your brain and the electrical circuits that connect them. An abnormality may exist in your basal ganglia, the part of your brain that contributes to controlling motor movements.
Chemicals in your brain that transmit nerve impulses may also be involved. These chemicals are known as neurotransmitters.
Currently, the cause of Tourette is unknown, and there’s no way to prevent it. Researchers believe that an inherited genetic defect may be the cause. They’re working to identify the specific genes directly related to Tourette.
However, family clusters have been identified. These clusters lead researchers to believe that genetics play a role in some people developing Tourette.
Your healthcare provider will ask you about your symptoms. The diagnosis requires both one motor and one vocal tic for at least 1 year.
People with Tourette often have other conditions, as well, including:
- attention deficit hyperactivity disorder (ADHD)
- obsessive-compulsive disorder (OCD)
- a learning disability
- a sleep disorder
- an anxiety disorder
- mood disorders
If your tics aren’t severe, you may not need treatment. If they’re severe or cause thoughts of self-harm, several treatments are available. Your healthcare provider may also recommend treatments if your tics worsen during adulthood.
Your healthcare provider may recommend behavioral therapy or psychotherapy. This involves one-on-one counseling with a licensed mental health professional.
Behavioral therapy includes:
- awareness training
- competing response training
- cognitive behavioral intervention for tics
This type of therapy can help ease symptoms of:
Your therapist may also use the following methods during psychotherapy sessions:
You may find group therapy helpful. You’ll receive counseling with other people in the same age group who also have Tourette syndrome.
There are no medications that can cure Tourette syndrome.
However, your healthcare provider may prescribe one or more of the following drugs to help you manage your symptoms:
- Haloperidol (Haldol), aripiprazole (Abilify), risperidone (Risperdal), or other neuroleptic drugs: These medications can help to block or dampen dopamine receptors in your brain and help manage your tics. Common side effects can include weight gain and mental fogginess.
- Onabotulinum toxin A (Botox): Botox injections may help manage simple motor and vocal tics. This is an off-label use of onabotulinum toxin A.
- Methylphenidate (Ritalin): Stimulate medications, such as Ritalin, can help to reduce the symptoms of ADHD without increasing your tics.
- Clonidine: Clonidine, a blood pressure medication, and other similar drugs, can help reduce tics, manage rage attacks and support impulse control. This is an off-label use of clonidine.
- Topiramate (Topamax): Topiramate can be prescribed to reduce tics. Risks associated with this medication include cognitive and language problems, somnolence, weight loss, and kidney stones.
- Cannabis-based medications: There’s limited evidence cannabinoid delta-9-tetrahydrocannabinol (dronabinol) may stop tics in adults. There is also limited evidence for certain strains of medical marijuana. Cannabis-based medications should not be given to children and adolescents, and pregnant or nursing women.
Off-label Drug Use
Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that hasn’t been approved. However, a doctor can still use the drug for that purpose.
This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.
Deep brain stimulation is another form of treatment that’s available for people with severe tics. For people with Tourette syndrome, the effectiveness of this kind of treatment is still under investigation.
Your healthcare provider may implant a battery-operated device in your brain to stimulate parts that control movement. Alternatively, they may implant electrical wires in your brain to send electrical stimuli to those areas.
This method has been beneficial for people who have tics that have been deemed very difficult to treat. You should talk to your healthcare provider to learn about the potential risks and benefits for you and whether this treatment would work well for your healthcare needs.
Living with Tourette syndrome may cause feelings of being alone and isolated. Not being able manage your outbursts and tics may also cause you to feel reluctant to participate in activities that other people may enjoy.
It’s important to know that there’s support available to help you manage your condition.
Taking advantage of available resources can help you to cope with Tourette syndrome. For example, talk to your healthcare provider about local support groups. You might also want to consider group therapy.
Support groups and group therapy may help you cope with depression and social isolation.
Meeting and establishing a bond with those who have the same condition can help to improve feelings of loneliness. You’ll be able to listen to their personal stories, including their triumphs and struggles, while also receiving advice that you can incorporate in your life.
If you attend a support group, but feel it isn’t a right match, don’t be discouraged. You may have to attend different groups until you find the right one.
If you have a loved one living with Tourette syndrome, you can join a family support group and learn more about the condition. The more you know about Tourette, the more you can help your loved one cope.
The Tourette Association of America (TAA) can help you find local support.
As a parent, it’s important to support and be an advocate for your child, which can include notifying their teachers of their condition.
Some children with Tourette syndrome may be bullied by their peers. Educators can play an important role in helping other students understand your child’s condition, which may stop bullying and teasing.
Tics and involuntary actions may also distract your child from schoolwork. Talk to your child’s school about allowing them extra time to complete tests and examinations.
Like many people with Tourette syndrome, you may find that your tics improve in your late teens and early 20s. Your symptoms may even stop spontaneously and entirely in adulthood.
However, even if your Tourette symptoms decrease with age, you may continue to experience and need treatment for related conditions, such as depression, panic attacks, and anxiety.
It’s important to remember Tourette syndrome is a medical condition that doesn’t affect your intelligence or life expectancy.
With advances in treatment, your healthcare team, as well as access to support and resources, you can manage your symptoms, which can help you to live a fulfilling life.