Tourette syndrome isn’t as rare as you might think. An estimated 1 in 100 people suffers from a mild form of the syndrome. Patients suffering from Tourette syndrome are not constantly twitching. The twitches, referred to as motor tics, actually often occur in intermittent bouts. Some patients experience them throughout the day, every day whilst others less frequently. Tics can include actions like eye-blinking, foot-stomping and grimaces.
Probably the biggest misconception about Tourette syndrome is that those suffering from the condition are frequently belting out obscenities, a symptom known as coprolalia. This symptom actually occurs in less than 15 percent of Tourette’s sufferers. Tourette syndrome can be defined as a tic disorder in which the patient suffers from several motor tics and at least one vocal tic.
It wasn’t until the 20th century that any real progress was made in further defining and treating Tourette syndrome. We now know that Tourette syndrome does have a genetic origin and that it usually first occurs around the age of 6 or 7, although not exclusively. The tics are normally most severe around puberty and can decrease as you move in to early adulthood. The syndrome is a dominant gene and has about a 50 percent chance of passing from parent to child. We also know that boys tend to get Tourette syndrome three to four times more often than girls. However, people who have the gene don’t necessarily suffer from a noticeable form of Tourette syndrome. They might not develop any symptoms, or they could suffer from a mild form that may go undetected.
Scientists are not sure what causes Tourette syndrome and many other brain disorders. We know that it is inherited in the majority of cases. But we don’t know the exact mode of inheritance, and scientists have not yet found a specific Tourette’s gene. What they can seem to agree on is that the tics of Tourette syndrome result from abnormalities in the brain. Specifically, they have pinpointed dysfunctions in the thalamus, basal ganglia and frontal cortex of the brain, as well as dysfunctions in the neurotransmitters between the brain’s nerve cells.
Scientists suspect these parts of the brain because of their roles in brain function. The thalamus works to relay sensory and motor information to the cerebral cortex and the brain stem. The basal ganglia is located at the base of the brain and works in the coordination of motor movements. Therefore, disorders of the basal ganglia usually result in a patient whose movements are unintentional and occur unexpectedly. The frontal cortex is located, as the name suggests, in the front of the brain, directly behind the forehead. This part of the brain is in charge of controlling skilled motor activity, which includes speech.
Abnormalities in the neurotransmitters — specifically, excessive amounts of the neurotransmitter dopamine — may be involved in the syndrome as well, with some suggesting that it could be the underlying mechanism of Tourette’s. Dopamine works in the brain to help regulate normal movement and emotions. Therefore, any disruption can change these factors. Decreased levels of dopamine have been a suggested cause of Parkinson’s disease, an affliction that is characterized by slow movements, facial paralysis and overall weakness. In patients with excessive amounts of dopamine, sudden, spasmodic, involuntary muscular contractions, like those found in Tourette’s, would be expected.
A Syndrome by definition is a group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms. These Symptoms can be attributed to Tourette syndrome. However, some of the most well-known, like bursts of obscenities, are the rarest symptoms. The most common symptoms are usually normal activities, like eye-blinking, and performed in repetition. Some common symptoms may be so slight that many observers would not notice them at all.
A tic is a sudden, spasmodic, involuntary muscular contraction. These tics can be classified by type (motor or vocal) and severity (simple or complex). A motor tic involves involuntary movements, and a vocal tic involves involuntary noises from the mouth. A simple tic is a sudden, spasmodic, involuntary contraction of only a small number of muscle groups. A common example of a simple motor tic is eye-blinking, and a simple vocal tic could be throat-clearing. A complex tic involves distinct and coordinated patterns of many different muscle groups. A common example is eye-blinking coupled with shoulder shrugs and facial grimaces. A complex vocal tic involves spontaneous expression of words or phrases.
The location of a patient’s tics can change, but they usually begin in the face and neck. The most common initial tics are eye-blinking and facial movements. Over time, tics tend to spread in a downward progression. From the face and neck, tics could progress to the arms and hands, with patients shrugging their shoulders or clenching their fists. They can then move on through the body and lower extremities, possibly causing patients to stomp their feet or walk peculiarly. Finally, the tics can progress to the respiratory and alimentary (digestive) system, where they can include hiccupping, whistling, belching and throat-clearing.
The tics can change in frequency, location and severity. Patients describe tic urges as a rising tension that is released by the tic. Some Patients can suppress their tics for a short time period, which usually results in a more severe tic later. Tourette’s tics can increase in times of heightened emotional or if the patient sees someone perform their involuntary action. For example, a patient who suffers from a motor tic like repetitive sniffing may be triggered by hearing someone else sniff.