Tourette's syndrome

Published by Bupa's Health Information Team, May 2010.

This factsheet is for people who have Tourette's syndrome, or who would like information about it.

Tourette's syndrome is a condition that affects the brain, causing involuntary movements and sounds called tics. It usually starts in childhood, and affects about one in 100 children. Many of these children have mild symptoms and aren't diagnosed. Some people with Tourette's syndrome take medicines to relieve the symptoms, but many people don't need to.

About Tourette's syndrome

The full name for Tourette's syndrome is Gilles de la Tourette's syndrome; it's named after the doctor who first described its symptoms. People with the condition make movements and noises that they can't control. These are called tics, and they vary from person to person.

The first signs of Tourette's syndrome usually begin between the ages of five and seven years. Boys are three to four times more likely to have it than girls. If you have Tourette's, you will probably have the condition throughout your life, but it's likely that the symptoms will decrease as you get older.

Symptoms of Tourette's syndrome

There are many different types of both movement (motor) and sound (vocal) tic. They may be either simple or complex.

Simple tics

Examples of simple motor tics include:

• blinking
  
• head jerking
  
• shoulder shrugging
  
• facial twitches

Simple vocal tics include:

• sniffing
  
• throat clearing
  
• grunting
  
• tongue clicking

Complex tics

Complex tics involve larger movements or sounds. Examples of complex motor tics include:

• jumping
  
• touching other people or things
  
• twirling
  
• hitting or biting yourself
  
• making obscene gestures (copropraxia)

Complex vocal tics include:

• swearing or saying obscene words (coprolalia)
  
• repeating words/phrases
  
• saying things out of context

The symptoms of Tourette's syndrome tend to come and go, often with one tic going and being replaced by a different one. You may find that your tics change as you get older. Your tics may become worse when you are stressed and better when you are concentrating on a task. Tics are unpredictable, but you may be able to control them with relaxation techniques, or you may find that you can suppress them or hide them.

You may have other conditions such as attention deficit hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD). Some people also have trouble sleeping and feel anxious or depressed.

Causes of Tourette's syndrome

It's thought that Tourette's syndrome happens because something goes wrong with the development of your brain. Chemicals called neurotransmitters help to process messages in your brain and spinal cord, and these may be disrupted.

The exact reasons why you may develop Tourette's syndrome aren't fully understood. The condition appears to be inherited - if you have Tourette's syndrome, there is a 50 percent chance that each of your children will inherit the gene or genes that cause the condition. However, your children won't necessarily develop Tourette's syndrome even if they inherit the gene. If your child does develop Tourette's syndrome, he or she may not have the same tics as you.

For some people, doctors can't find a family link and the cause of Tourette's syndrome is unknown.

Some research has shown that Tourette's syndrome might be set off by an infection caused by a Group A Streptococcus bacterium. When your body's immune system attacks harmful substances such as bacteria, it produces antibodies. If this happens during a Group A Streptococcus infection, it's possible that the antibodies damage nerve cells, so tics develop.

Diagnosis of Tourette's syndrome

If you think you have Tourette's syndrome, you should visit your GP. He or she will talk to you about your symptoms. Your GP may diagnose you with the condition if you're under 18 and you have had several movement tics and at least one noise tic for at least a year. During that time you must not have had a period of more than three months without tics.

If you have mild symptoms, it can be difficult to diagnose Tourette's syndrome. Some children who have Tourette's syndrome may be misdiagnosed with other conditions, such as ADHD.

Your GP may refer you for further tests to check that your symptoms aren't being caused by another condition. Children may also be referred to a paediatric neurologist (a doctor specialising in identifying and medically treating conditions that affect the nervous system, including the brain, in children) or a child psychologist.

Treatment of Tourette's syndrome

You may be able to cope with the symptoms of Tourette's syndrome and not need any specific treatment. But if your tics cause you serious problems, there are treatments available.

Medicines

Your doctor may prescribe medicines called neuroleptics, such as haloperidol. Another medicine useful for reducing tics is clonidine. These medicines reduce your tics. They are usually used to treat conditions such as schizophrenia because they have a tranquilising effect. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

It's important to remember that, as with all medicines, you may have side-effects as a result of taking neuroleptics. These may include jerky or unusual face and body movements, which can make your symptoms seem worse at first.

Talking therapies

Talking to a counsellor or therapist may help reduce your symptoms. For example, if stress is a problem and causes your symptoms to get worse, psychotherapy may help you to relax and overcome this.

Behavioural psychotherapy aims to change the way you behave - this may be particularly useful if you have problems with obsessive-compulsive behaviour.

Behavioural therapies

New behaviour therapies are also becoming available. These include habit retraining therapy, or habit reversal training, in which you counter the tic with an opposing movement. Exposure and response prevention (ERP) is another option in which you learn to suppress tics. Your doctor can tell you more about the treatment options available for you.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.