The initial symptoms of this disorder is noticed first in childhood between the age of 7 and 10 years though this ailment occurs in people from all groups and males are affected around 3 to 4 times more often than females. Tourette syndrome can be a chronic disease having symptoms that could last for a lifetime and the victim experiences the worst symptoms in early teens which gradually improve as they grow to adulthood.
Environmental and genetic factors do play an important role in this ailment though the real cause is unknown and in most of the cases, medication may not be needed. Moreover for every case of tics, there is no effective treatment but certain therapies and medication can be of some help besides bringing about an awareness together with explanation and reassurance which can do wonders in a treatment plan. Earlier, Tourette was not considered as a rare ailment though it is not often accurately identified due to several cases that turn out to be mild and the severity of tics goes on decreasing in most children as they reach adolescence.
Extreme Tourette in adulthood is very rare and this disorder does not adversely affect life expectancy or intelligence. Often people with TS do not realize that they have tics since tics are commonly expressed in private and may go undetected or unrecognized. This disorder tends to subside as they mature and since milder cases of tourette are now more likely to be recognized and the realization that parents had tics while they were young may not come until their kids are diagnosed of this ailment. The symptoms of Tourette syndrome in the form of tics are classified either as simple or complex wherein simple tics are sudden, repetitive or brief movements involving limited number of muscle groups which include eye blinking with other vision irregularities, shoulder shrugging, facial grimacing and head or shoulder jerking.
Besides this, simple vocalization could also include sniffing or grunting sounds or repetitive throat clearing. In the case of complex, the tics are distinct with coordinated patterns of movements with several muscle groups including facial grimacing, accompanied with head twist and shoulder shrug. Various other complex tics may occur purposeful with sniffing or touching objects, jumping, hopping, bending or even twisting. More complex vocal tics may also include phrases or words.
A dramatic and disabling tic may include motor movement leading to self harm like hurting oneself in the face or vocal tics like coprolalia, utterance of swear words or echolalia, repeating of words or phrases of others, while some tics preceded by a sensation or urge in affected muscle group are called premonitory urge. Unfortunately there is no particular medication which is helpful for all people with Tourette disorder or any medication which can completely eliminate the symptoms since most of the medications have side effects. Neuroleptic side effects can be handled by initiating slow treatment and gradually reducing the dose when side effects are envisaged like tremor, twisting movements or postures or dystonic reactions, Parkinson like symptoms with other dyskinetic or involuntary movements which are less common can be managed on reducing the dose.
Other common side effects of neuroleptics include weight gain, sedation and cognitive dulling. After a long term use, neuroleptics should be discontinued gradually to avoid a rebound increase of tics and withdrawal dyskinesia where one form of withdrawal known as tardive dyskinesia, a movement disorder may result from chronic use of neuroleptics. While the risk of this side effect can be reduced with smaller doses for a shorter span of time, there are other medications also which could be useful in reducing the severity of tics disorder. Some medications with demonstrated results include alpha adrenergic agonist like clonidine and guanfacine, where these medications are used for hypertension as well as the treatment of tics and the most common side effects from these medications is sedation.
Recent study indicates that some stimulant medications like methylphenidate and dextroamphetamine lessens ADHD symptoms with tourette without causing much severe tics. Psychotherapy could prove to be helpful for Tourette syndrome victims to cope up with this disorder and deal with secondary social and emotional problems which may occur sometimes. Recent study indicating specific behavioral treatments including awareness training together with competing response training like voluntarily moving in response to premonitory urge have been effective to some extent.