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Tourette’s Syndrome

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What is the truth about Tourette’s Syndrome?
Jake Walter
Herzing University

Abstract
Though out this paper, we will discuss the truth and myths behind Tourette’s syndrome and insure we have a good understanding of what the disorder really is. We will try to break the Hollywood stereotype of this disorder and who are really the worst hit from Tourette’s syndrome. We will also discuss what the patient’s symptoms will be and what they may go through and classified the types of symptoms known as tics into motor and vocal. Finally, we will discuss what treatment options they may have and what hope someone may have who is suffering from this disorder; furthermore, what organizations are out there to help with the disease. I hope this gives you some more details on Tourette’s syndrome and what a person or their family may go through when suffering from this disorder. I know that researching it and find out all the information I could really open my eyes to what people go through and how challenging life can be.

What is Tourette’s syndrome? Tourette's syndrome has the misnomer of being a disease where you use profanity and yell inappropriate words in a public environment. However, it can be much more serious and challenging to deal with that is only a symptom of the disease. The disorder was first documented in 1885 by a French Doctor named Georges Gilles de la Tourette; he would be considering a Neurologist in today standards. The Doctor Georges Gilles de la Tourette Name the disorder "maladie des tics" and he diagnosed nine patients in1885 with the disorder who all demonstrated the normal symptoms of Turrets. (NIND, 2012) The symptoms can have a vast array of different characteristics and can be different for each person. It involves unusual repetitive movements or unwanted sounds that can't be controlled, these are categorized as tics. (PubMed Health, 2012) The disorder was later renamed in his honor by Jean-Martin Charcot, the director at the hospital. (NIND, 2012)

Someone stricken with Tourette can have deferent severity of the disease. There are over 200,000 people diagnosed in the United States with the more severe form and 100,000 with the less severe form. The disorder normally manifest in early child hood around the ages of three to nine and symptoms normally become more challenging through early teenage years and lessen as the inflicted reach young adulthood. (NIND, 2012)The tics can range from simple motor tics such as eye blinking, facial grimace, kicking, and shoulder shrugging, sniffing, or even grunting. The much more elaborate tics include several Motor reactions at once such as grunting shoulder shrug and a grimace.

Tourette’s syndrome is also known for the use of inappropriate word such as profanity at inappropriate places, this is known as Coprolalia, and repeating the words or phrases of others similar to a parrot is called echolalia. Coprolalia is a very challenging part of the disorder for patients suffering with it and is an involuntary action that the patient has no control over. There is a misconception that this is what Tourette’s is however this is just a possible symptom of the disorder. This actually happens in less than ten to fifteen percent of people suffering from Tourette. (NIND, 2012)This misconception was created by the movies and television. An example of this is in Deuce Bigalow, where Amy Poehler plays a woman stricken with a severe case of Turrets. This disorder makes a much bigger impact on the lives of the people then what was demonstrated in this movie. They can have the issue of how to deal with the public with the disorder and the challenges of dealing with everyday life. Furthermore, there can be other complications such as anger control issue which can steam from dealing with this disorder and asking the question why me. ADHD, Attention Deficit Hyperactive Disorder, is also very closely connected to the disorder and OCD, Obsessive-Compulsive Disorder. The patient can also suffer from impulsive behavior and poor social skills. (TSA, 2012)

The severity can be the major aspect of this disorder in that it can be very minimal or relentless depending on the person suffering from it. They can have a very subtle tic or what that can go on for several hours. The tics are broking up into categories, motor tics and vocal tics. The motor tics are broken up into simple and complex. The simple motor tics are brief and sudden movements. An example would be an eye blink or clearing of the throat. If the tic goes unnoticed or not recognized it could be confused with a mannerism and never diagnosed as Tourrets. The complex motor tic would include several simple tics group together. (PubMed Health, 2012)

The vocal tic is defined as unconsciously producing sounds by moving air through the nose, mouth, or throat. This could be anything from grunting, sniffing, Clearing of the throat, or even verbalization of words. (CDC, 2012)As stated by the National Tourette Syndrome Association “Like motor tics, vocal tics frequently change and vary in severity over time, and both remissions and exacerbations are common. “ The major connection is that these are involuntary action and not a choice the person suffering from the disorder can make. The additional problem people with Tourrets are faced with is the tics may vary in type and severity. Then it can also be trigger by anxiety, stress, and being tired or excited. There is even a claim that the tics can occur when asleep. (PubMed Health, 2012) This unfortunately means that the patient’s anxiety is going to increase due to lack of sleep. I think one of the most challenge aspects of the disease is that it mainly occurs worse in teenage years and improve during the transition into adulthood. The teenage years are hard enough for most of us without the extra added stress of this disorder. The patient will normally feel premonitory urge before the onset of the disease. Premonitory urge is when the body gives you the feeling you want to complete the action of the tic. This is in the form of an itch or tingle. The tics begin because it relieves the urge. (PubMed Health, 2012)This urge that they feel prior to tic actually give some people the ability to suppress the tic to later time. However, this normally makes the tics more severe.

They are some people that have learned how to suppress and camouflage the disorder to help in everyday life however there appears to be a build up if the symptoms are suppress too much and the anxiety builds up and this will cause a much more severe outburst of the disorder. (NIND, 2012) Furthermore, Tourette can be triggered by other stressor, anxiety or excitement and can have co-occurring conditions such as ADHD, OCD, Anxiety, Depression, and developmental delays, 64% of children diagnosed with Tourette’s syndrome also have the disorder ADHD. (TSA, 2012)

Thus, what causes Tourette syndrome to occur? There appears to be a genetic connection and may be an inherited disorder; however, this has not been proven. Most studies suggest that Tourette syndrome is an autosomal dominant disorder with decreased penetrance, although this hypothesis has not been proven and may not be true in all families.(NIND, 2012) Therefore, further studies are needed to come to a conclusion.

They are not sure what the actual cause of Tourette syndrome is; however, some studies show it is caused by a raised level of a neurotransmitter called dopamine. A neurotransmitter is a chemical found in the brain that allows the transmission of information from one brain cell to next. Other research shows that the deficiency in Tourette syndrome involves a different neurotransmitter called serotonin; or involves other chemicals necessary for normal function of the brain. (NIND, 2012) The more I learned about the disorder the more I would imagine that there could be several factors contributing to this disorder weather you look at it genetically or environmentally. This makes it extremely difficult to diagnose the disorder in the early stage and requires that the patient have both motor and verbal tics documented for a minimum of one year and no interruption of the tics for a three month period. The patient must have showed tics prior to the age of 18 and have no other brain troubles that could cause the symptoms. (Mayo, 2012) There are no other test that can be used to verify that the issue at hand it Tourette’s. However, the use of CT, EEG and certain blood test can assist to rule out other conditions. (NIND, 2012)

The treatment for Tourette’s syndrome is normally not to treat with medication because the majorities of cases the tics don’t cause any type of handicap and are manageable. When the tics are interfering with the patient ability to function they may utilize anti-seizure medication such as Neuroleptics to suppress the tics. This medication does not completely remove all the symptoms and Neuroleptics have some serious side effects. Some of the most common side effects of Neuroleptics include sedation, weight gain, cognitive dulling, and could have Parkin’s like tremors. They have also used blood pressure medication and Botulinum toxin injections to control some motor tics. Finally, Dopamine blockers are also used to control the tics but they also have side effects. (Mayo, 2012) There is even research into deep brain stimulation where doctors implant pacemaker into the brain to help eliminate and reduce the tics in people dealing with Tourette syndrome. (Crane, 2012) The prognosis for someone who is diagnosed with Tourette’s syndrome is normally good. Most people diagnosed with the disorder show improvement in their early twenties and may even become symptom free. There is no cure for the disorder at this time and even though it may clear up and symptoms may fade the other behavioral issue may continue. (NIND, 2012)The disorder should not hinder the life expectancy of someone suffering from it and has no impact to their intelligence. Therefore, someone should be able to live a long and healthy life and in most cases the tics will subside and lessen. However, the impact can be quite challenging and there some wonderful organization out There for people dealing with this disorder. One of them that I found to be a great organization was The National Tourette Syndrome Association. They really do a lot to help answer the question anyone has in regards to Tourette’s Syndrome. (TSA, 2012)
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ReferencesCDC (2012, November 20). CDC - Tourette Syndrome, Other Concerns & Conditions - NCBDDD. Centers for Disease Control and Prevention. Retrieved November 25, 2012, from http://www.cdc.gov/ncbddd/tourette/otherconcerns.htmlCrane, K. (2012, October 17). UF: Deep-brain stimulation helping with OCD, Tourette?s, along with Parkinson?s ? Department of Neurology ? College of Medicine ? University of Florida. Department of Neurology ? College of Medicine ? University of Florida. Retrieved November 22, 2012, from http://neurology.ufl.edu/2012/11/12/uf-deep-brain-stimulation-helping-with-ocd-tourettes-along-with-parkinsons/Gilles de la Tourette syndrome - PubMed Health. (2012, February 16). National Center for Biotechnology Information. Retrieved November 21, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001744/Mayo Clinic (2012, April 19). Tourette syndrome - MayoClinic.com. Mayo Clinic. Retrieved November 17, 2012, from http://www.mayoclinic.com/health/tourette-syndrome/DS00541 National Institute of Neurological Disorders and Stroke (2012, October 19). Tourette Syndrome Fact Sheet. NINDS. Retrieved November 19, 2012, from http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm#220453231Tic Disorders Definitions Classification. (2012, March 12). TSA Home Page. Retrieved November 24, 2012, from http://tsa-usa.org/aMedical/definitions.html |

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