Tourette’s syndrome an individualized disorder
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“ft” Tourette’s syndrome, a neurological disorder that causes sudden, involuntary, repetitive movements — blinking, shoulder-shrugging, jerking an arm — and sounds — humming, throat-clearing, yelling out a word or phrase — described as tics. More complex tics include combinations of movements.
There is some belief that a characteristic of the syndrome may lie, in part, behind the success of some with TS.
“lften Tourette’s syndrome goes along with disLnKLELWLRn,” saLd DU. -aPHs Cook, a 12-year Abington Memorial Hospital neurologist who has worked with TS patients for about 15 years. “7KHy OaFN a fiOWHU WKaW NHHSs you from saying inappropriate things. ft’s felt a lot [of those with TS] are creative because they don’t have that fiOWHU.
“There’s a lot of evidence people with Tourette’s have gained prominence in the performing arts.”
According to a 200T study Ey WKH CHnWHUs IRU DLsHasH Control and Prevention,
is three of every 1,000 children age S through 1T in the United States, or about 148,000, have been diagnosed with Tourette’s syndrome. lther studies estimate the rate at six per 1,000 students, acFRUdLnJ WR WKH CDC.
The National fnstitute of 1HuURORJLFaO DLsorders and Stroke estimates 200,000 Americans have the most severe form of TS, with as many as one in 100 having milder symptoms such as chronic motor or vocal tics.
Cook, who said he thinks the syndrome is underdiagnosed, said one findLnJ Kas FRnFOudHd WKaW fiYH RuW of 100 school-age boys meet more criteria for Tourette’s. The incidence in males is estimated at three times that of females.
There is no lab test or scan available to diagnose TS and some people don’t even recognize they have it in a mild form, he said. Current thinking is that it is caused by some disruption in communication between the deeper areas of the brain that control movement and the higher areas that regulate voluntary movement.
The diagnosis is made through a clinical history and observation, with onset usually between ages T and 15, Cook said. The tics, which vary in type and occurrence, “can wax and wane,” and “about twothirds of the manifestations go away by late adolescence,” age 1T or 18, he said.
“ft’s almost certainly genetic,” Cook said. “ft tends to run in families,” with the incidence being “10 times higher than in the general population.”
Those who exhibit involuntary swearing, associated in “the popular imagination” as characterizing TS, comprise only about 10 percent to 15 percent of those with Tourette’s, Cook said.
A majority of those with TS have an associated disorder such as obsessive compulsive disorder, attention-deficitLhyperactivity disorder, ADD, an[LHWy, dHSUHssLRn or impulse control, Cook said.
But the symptoms of Tourette’s, and subsequently the treatment — “it has to be completely individualized to what the person needs” — vary widely, he said.
“ff you know one patient with Tourette’s syndrome, you know one patient with Tourette’s syndrome,” Cook said.
While the tics are involuntary, patients “describe an urge or premonition of it coming on and a feeling of relief afterward,” he said. Stress or lack of sleep might bring on the tics and focusing on something might keep them at bay. But in the latter case, with the reduced occurrence ended, the tics “may come at greater frequency until they sort of get it out of their system,” he said.
For those who need help in functioning with TS, medications or cognitive behavior therapy can be prescribed, he said. Many times the medications are needed to deal more with the accompanying disorders, he noted.
“Some are pursuing newer treatments, like deep brain stimulation for those with intractable TS,” Cook said. blectrodes are placed in the deeper areas of the brain with wires down into the chest to a pacemaker-like device that sends constant electronic impulses and restores the balance of circuitry, he said.
Cook, who treats adults, said by the time a patient gets to him, the person has usually had TS for 10 years and learned how to deal with it.
“ff they can’t suppress the tics or it’s interfering with social or occupational functioning, they usually come to me,” he said.
Usually he will prescribe a medication, but “you have to keep expectations realistic,” he said. “Medications cut down the rate of tics, but don’t eliminate them.”
To Your Health Linda Finarelli