Tourette
Syndrome is best defined in the archives and pages of neurological
conditions, syndromes, and disorders. Initially Tourette Syndrome
was seen as extremely rare and an individual was viewed as having
violent muscle contortions (motor tics) and vocal disruptions
(vocal tics) combined with outburst of swearing and obscenities.
(Tourette history) However Dr. David
E. Comings writes in Tourette Syndrome and Human Behaviour, "...Tourette
Syndrome is one of the most common genetic conditions affecting
humanity and many more carry the trait."
Tourette
Syndrome - Tourette's Disorder is a neurological disorder characterized
by involuntary body movements and vocal outbursts (Tics)
for at least 12 months.
Note:
There are no longer any requirements for severity or impairment.
The
reason for having the tics for at least 12 months is specified
is because transient tics – a brief period or one-off episode
of tics – are really common in children (occurring in around
ten per cent) and these people get better.
Tourette
Syndrome is named after a French physician, Georges
Gilles de la Tourette, who first described Tourette
it in 1885. Tourette Syndrome commonly appears in childhood,
more often in males than females, and may worsen thereafter or
subside. The
absolute cause of Tourette Syndrome is unknown, nonetheless many
theories and advanced information has increased considerably since
1885.
No
cure yet exists, but symptoms are often treatable with
various medications, behavioural therapy and alternative treatments.
It should be noted that there is not any peer reviewed scientific
evidence, yet, of success with "alternative therapies."
Even results of behavioural therapy are unclear long-term, and
are going to be studied on a well-designed TSA grant possibly
starting in 2004.
The
"tics" symptoms involving
Tourette Syndrome are known to temporarily aggravate with increased
stress. Also the tics can wax and wane or come and go through
out the patient's life. It is also normal for the tics to
change and return. Some of the Tourette tics can be suppressed
for small periods of time, however generally return with greater
aggravation. It should also be noted that most persons with Tourette
Syndrome do not require medication for their tics.
Neurodevelopmental
disorders including Tourette Syndrome can have substantial overlap
with other disorders.
There
is a possibility of common co-morbid conditions found in patients
with Tourette Syndrome though they are not required for diagnosis.
("co-morbid"
means the presence of one or more disorders (or diseases) in addition
to a primary disease or disorder.) Examples are Obsessive-Compulsive
Disorder OCD, and Attention Deficit Hyperactivity Disorder ADHD.
All of the available information about co-morbid conditions in
regard to Tourette Syndrome isn't clear and is considered
a complicated subject between clinicians and researchers.
Patients
with Tourette's Syndrome who have other conditions as well, may
be at increased risk for a whole host of other problems, but many
of the problems may not be due to Tourette Syndrome but to other
conditions they may have.
Some
of the other conditions and/or terms you may find discussed in
circles that deal with Tourette Syndrome are: Tourette
Syndrome "Plus", Tourette
Spectrum Disorder, Anxiety Disorders,
Depression Disorders, Paediatric
Autoimmune Neuropsychiatric Disorders Associated with Streptococcal
Infections PANDAS,
Sensory Integrative Dysfunction SID, Rage Attacks - Storms,
Sleep Disorders, Dysinhibition.
There
are people with Tourette Syndrome that have no other co-morbid
conditions, disorders or problem behaviours. They could be referred
to as having "TS-Only." They would meet the minimal
DSM criteria for Tourettes Disorder; which is they have had vocal
and motor tics for at least 12 months.
One
of the less common possible symptoms of Tourettes yet the most
highly publicized would be Coprolalia
(outburst of obscenities and curse words).
Coprolalia is actually very uncommon in Tourette Syndrome and
only effects as low as 5% to 15% of Touretter’s. Coprolalia
is not required for a diagnosis.
Any
medical doctor M.D. knowledgeable about Tourette Syndrome can
diagnose the disorder. This includes paediatricians, psychiatrists,
neurologist, geneticists, etc. Non-physicians can also suggest
the Tourette diagnosis including psychologists and mental health
therapists and even teachers, but only medical doctors M.D.'s
can prescribe medications and most insurance companies require
an "official" diagnosis" by a medical doctor M.D.
How
to Define Tourettes Disorder?
The
definition of Tourette Syndrome has changed over time and is not
fixed from one person or clinician to another. A definition
is intended for clarity among clinicians and researchers. One
patients or clinicians definition may not represent a "thing"
that you have.
Tourette
Syndrome as defined close to the diagnostic criteria (DSM-IV-TR)
for Tourette's Disorder could simply be “Tourette Syndrome
is a neurobiological condition resulting in motor and vocal tics
for at least 12 months.”
Some
recognize Tourette's as a spectrum disorder, “…with
some people having a few tics and others having tics plus features
of other (comorbid) conditions such as obsessions, compulsions,
inattention, impulsivity, mood variability.”
- Leslie Packer PhD
There are those that feel “…Tourette Syndrome
rarely exists in isolation and is part of a global neurological
dysfunction, which includes but is not limited to tics,
and dysinhibition. Where does one draw the line? Is “this”
a symptom of “Tourette Syndrome” or is it part of
“ADHD” or “OCD” or, does it really matter?
Tourette Syndrome is… something more akin to “cross
wiring” and the reality being that daily function requires
one deal with what is thrown at one regardless as to what it is
called."
- Colleen Wang, Tourette Spectrum Association Inc.
Here again is also a great perception and explanation of Tourette
Syndrome. "Tourette Syndrome is not a disease; it is a syndrome,
a cluster of recognizable patterns. There are no tests for it.
The diagnosis is by history and observation only, and the boundary
is fuzzy. No one has decided how many tics a day are necessary
to call it a tic disorder. (Spitting 3 times in school, for example,
will probably result in a phone call, whereas 10,000 eye-blinks
won't!) Although tics are often described as "rapid"
or "sudden," not all are; some tics are "held"
or "tonic" movements involving freezing in a position
for a few seconds. "Purposeless" is another descriptor,
but because many tics are preceded by an uncomfortable feeling
to which the tic is a response, this word also isn't very satisfactory.
The definition is simply a multiple, changing pattern of tics
(not necessarily at the same time) for at least 12 months, including
at least one noise-making tic. (There is no requirement for severity
or impairment.) You can have Tourette Syndrome and function normally."
- Roger D. Freeman, M.D
Reflecting
more than 25 years of research; two of the leading international
authorities on Tourette’s Syndrome and tic-related, obsessive-compulsive
disorders narrate Tourettes this way. "Tourette Syndrome
was considered rare and exotic at one time (however now,)
Tourette's syndrome is a relatively common childhood-onset disorder
defined by persistent motor and vocal tics and frequently associated
with obsessions, compulsions, and attentional difficulties."
- James F. Leckman, Donald J. Cohen of the Yale Child Study Center.
As
you can read all the above opinions and descriptions vary in definition.
Regardless, they will all have similar goals for a Tourette
patient. They want a Tourette patient to have the support and
information they will need to deal with Tourette Syndrome and
or any other disorder they experience. The ultimate goal
would be for patients and families to live happy and productive
lives with joy to the best of their abilities.
Finally
a very important subject to understand is; many people diagnosed
with Tourette’s Disorder may have a variety of other conditions
that they deal with. Nonetheless, Tourette’s Disorder
is by DSM-IV-TR definition listed under
Childhood / Adolescent,Tic Disorders and characterized by involuntary
body movements and vocal, outbursts. Though the DSM categorization
is under Childhood / Adolescent, Tic Disorders, don't misunderstand
this categorization, as it is based on age of onset and diagnosis.
Continue
to an in depth Diagnostic Criteria here
or jump to our Tourette Information pages
here.
Paul
Marshall
editor@tourettes-disorder.com
Top
of page
Tourette
Syndrome "Plus"
Leslie E. Packer, PhD. 1998-2003
http://www.tourettesyndrome.net
Tourette
Syndrome Now What? tsnowwhat, 2000-2003
http://tourettenowwhat.tripod.com/about_ts.htm
Tourette
Spectrum Association Colleen Wang
http://www.tourettesyndrome.org/
Tourette
syndrome: minimizing confusion
Roger D. Freeman, M.D
http://www.tourette-confusion.blogspot.com/
HopePress
- David E. Comings M.D.
http://www.hopepress.com
Tourette's
Syndrome--Tics, Obsessions, Compulsions: Developmental Psychopathology
and Clinical Care
- James
F. Leckman, Donald J. Cohen
mrindianajones
Paul Marshall PhD
2000-2003
http://www.mrindianajones.com
