Syndrome, Tourette

A tic disorder characterized by the presence of chronic vocal and motor tics, probably based on differences in or damage to the basal ganglia of the brain. Tourette syndrome usually emerges between the ages of 6 and 18 and is somewhat more common in people with ADHD (attention deficit hyperactivity disorder), obsessive-compulsive disorder, or an autistic spectrum disorder than in the general population. Tics may be minor and trifling or be major and debilitating. The frequency of the tics, minor and major, typically tends to wax and wane. Infections, particularly those with streptococcus ("strep") can sometimes initiate or exacerbate Tourette syndrome. Emotional distress and stress also appear to influence the frequency of tics. People with this disorder tend to have an impulsive, quick, and frequently humorous disposition. Some, particularly those with co-morbid disorders, experience episodes of rage that are difficult to control. The diagnosis of Tourette syndrome is by clinical observation. There is no laboratory test for the disorder. Treatment with medication may not be recommended unless the tics are self-injurious or embarrassing to the patient or rage is a problem. When treatment is desired, medication choices include the blood-pressure drugs guanfacine (brand name: Tenex) and clonidine (brand name: Catapres), or one of the atypical or older neuroleptics. Some patients have also found the nicotine patch to be useful. Two medicines were reported (in the journal Neurology in 2001) to produce results that are almost mirror images: one drug suppresses individual tics but not the overall level of disability; the other has no effect on frequency of tics but leaves patients feeling less impaired. Botulinum toxin, a chemical that acts to paralyze muscles, drops the tic frequency by about 40% but there is no reduction in the level of the syndrome's overall severity. The other drug, baclofen (brand name: Lioresal), yields no significant reduction in the number of tics but patients appear to be less tense and report feeling better. Therapy can help a patient develop social coping strategies and maintain a positive self-image.