What is Tourette Syndrome?

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Tourette Syndrome (TS) is a condition of the nervous system. TS causes people to have “tics”.

Tics are sudden twitches, movements, or sounds that people do repeatedly. People who have tics cannot stop their bodies from doing these things. For example, a person might keep blinking over and over again. Or, a person might make a grunting sound unwillingly.

Tourette’s syndrome is a problem with the nervous system that causes people to make sudden movements or sounds, called tics, that they can’t control. For example, someone with Tourette’s might blink or clear their throat over and over again. Some people may blurt out words they don’t intend to say.

About 100,000 Americans have full-blown Tourette’s syndrome, but more people have a milder form of the disease. It often starts in childhood, and more boys than girls get it. Symptoms often get better as children grow up. For some people, they go away completely.

Although there’s no cure for Tourette syndrome, treatments are available. Many people with Tourette syndrome don’t need treatment when symptoms aren’t troublesome. Tics often lessen or become controlled after the teen years.

Having tics is a little bit like having hiccups. Even though you might not want to hiccup, your body does it anyway. Sometimes people can stop themselves from doing a certain tic for a while, but it’s hard. Eventually, the person has to do the tic.

The most frequent forms of tics involve:

• blinking
• sniffing
• grunting
• throat clearing
• grimacing
• shoulder movements
• head movements

According to the National Institute of Neurological Disorders and Stroke (NINDS), about 200,000 people in the United States exhibit severe symptoms of Tourette syndrome.

As many as 1 in 100 Americans experience milder symptoms. The syndrome affects males nearly four times more than females.

Causes

Tourette’s has been linked to different parts of the brain, including an area called the basal ganglia, which helps control body movements. Differences there may affect nerve cells and the chemicals that carry messages between them. Researchers think the trouble in this brain network may play a role in Tourette’s.

Doctors don’t know exactly what causes these problems in the brain, but genes probably play a role. It’s likely that there is more than one cause.

People who have family members with Tourette’s are more likely to get it themselves. But people in the same family may have different symptoms.

It’s a complex disorder likely caused by a combination of inherited (genetic) and environmental factors. Chemicals in the brain that transmit nerve impulses (neurotransmitters), including dopamine and serotonin, might play a role.

Risk factors

Risk factors for Tourette syndrome include:

• Family history. Having a family history of Tourette syndrome or other tic disorders might increase the risk of developing Tourette syndrome.
• Sex. Males are about three to four times more likely than females to develop Tourette syndrome.

Symptoms

The main symptom is tics. Some are so mild they’re not even noticeable. Others happen often and are obvious. Stress, excitement, or being sick or tired can make them worse. The more severe ones can be embarrassing and can affect your social life or work.

There are two types of tics:

Motor tics involve movement. They include:

• Arm or head jerking
• Blinking
• Making a face
• Mouth twitching
• Shoulder shrugging

Vocal tics include:

• Barking or yelping
• Clearing your throat
• Coughing
• Grunting
• Repeating what someone else says
• Shouting
• Sniffing
• Swearing

Tics can be simple or complex. A simple tic affects one or just a few parts of the body, like blinking the eyes or making a face.

A complex one involves many parts of the body or saying words. Jumping and swearing are examples.

Before a motor tic, you may get a sensation that can feel like a tingle or tension. The movement makes the sensation go away. You might be able to hold your tics back for a little while, but you probably can’t stop them from happening.

Doctors aren’t sure why, but about half of people with Tourette’s also have symptoms of attention deficit hyperactivity disorder (ADHD). You may have trouble paying attention, sitting still, and finishing tasks.

Tourette’s can also cause problems with:

• Anxiety
• Learning disabilities such as dyslexia
• Obsessive-compulsive disorder (OCD) — thoughts and behaviors you can’t control, like washing your hands over and over again
  • Attention-deficit/hyperactivity disorder (ADHD)
  • Obsessive-compulsive disorder (OCD)
  • Autism spectrum disorder
  • Sleep disorders
  • Depression
  • Pain-related to tics, especially headaches
  • Anger-management problems

Diagnosis

There’s no specific test that can diagnose Tourette syndrome. The diagnosis is based on the history of your signs and symptoms.

The criteria used to diagnose Tourette syndrome include:

• Both motor tics and vocal tics are present, although not necessarily at the same time
• Tics occur several times a day, nearly every day or intermittently, for more than a year
• Tics begin before age 18
• Tics aren’t caused by medications, other substances, or another medical condition
• Tics must change over time in location, frequency, type, complexity, or severity

A diagnosis of Tourette syndrome might be overlooked because the signs can mimic other conditions. Eye blinking might be initially associated with vision problems or sniffling attributed to allergies.

Both motor and vocal tics can be caused by conditions other than Tourette syndrome. To rule out other causes of tics, your doctor might recommend:

• Blood tests
• Imaging studies such as an MRI

Getting a Diagnosis

If you or your child has symptoms of Tourette’s, your doctor may want you to see a neurologist, a specialist who treats diseases of the nervous system. There aren’t any tests for the condition, but they’ll ask you questions, like:

• What did you notice that brought you here today?
• Do you often move your body in a way you can’t control? How long has that been happening?
• Do you ever say things or make sounds without meaning to? When did it start?
• Does anything make your symptoms better? What makes them worse?
• Do you feel anxious or have trouble focusing?
• Does anyone else in your family have these kinds of symptoms?

Your doctor may do imaging tests of your brain to rule out other conditions that have symptoms like those of Tourette’s. They might include:

Treatment

There’s no cure for Tourette syndrome. Treatment is aimed at controlling tics that interfere with everyday activities and functioning. When tics aren’t severe, treatment might not be necessary.

Medication

Medications to help control tics or reduce symptoms of related conditions include:

• Medications that block or lessen dopamine. Fluphenazine, haloperidol (Haldol), risperidone (Risperdal) and pimozide (Orap) can help control tics. Possible side effects include weight gain and involuntary repetitive movements. Tetrabenazine (Xenazine) might be recommended, although it may cause severe depression.
• Botulinum (Botox) injections. An injection into the affected muscle might help relieve a simple or vocal tic.
• ADHD medications. Stimulants such as methylphenidate (Metadate CD, Ritalin LA, others) and medications containing dextroamphetamine (Adderall XR, Dexedrine, others) can help increase attention and concentration. However, for some people with Tourette syndrome, medications for ADHD can exacerbate tics.
• Central adrenergic inhibitors. Medications such as clonidine (Catapres, Kapvay) and guanfacine (Intuniv) — typically prescribed for high blood pressure — might help control behavioral symptoms such as impulse control problems and rage attacks. Side effects may include sleepiness.
• Antidepressants. Fluoxetine (Prozac, Sarafem, and others) might help control symptoms of sadness, anxiety, and OCD.
• Antiseizure medications. Recent studies suggest that some people with Tourette syndrome respond to topiramate (Topamax), which is used to treat epilepsy.

Therapy

• Behavior therapy. Cognitive Behavioral Interventions for Tics, including habit-reversal training, can help you monitor tics, identify premonitory urges, and learn to voluntarily move in a way that’s incompatible with the tic.
• Psychotherapy. In addition to helping you cope with Tourette syndrome, psychotherapy can help with accompanying problems, such as ADHD, obsessions, depression, or anxiety.
• Deep brain stimulation (DBS). For severe tics that don’t respond to other treatments, DBS might help. DBS involves implanting a battery-operated medical device in the brain to deliver electrical stimulation to targeted areas that control movement. However, this treatment is still in the early research stages and needs more research to determine if it’s a safe and effective treatment for Tourette syndrome.

Children with Tourette syndrome

If your child has Tourette’s, you may also want to ask how long their tics might last or what you can do to help them deal with their symptoms at home and at school.

School may pose special challenges for children with Tourette syndrome.

To help your child:

• Be your child’s advocate. Help educate teachers, school bus drivers, and others with whom your child interacts regularly. An educational setting that meets your child’s needs — such as tutoring, untimed testing to reduce stress, and smaller classes — can help.
• Nurture your child’s self-esteem. Support your child’s personal interests and friendships — both can help build self-esteem.
• Find a support group. To help you cope, seek out a local Tourette syndrome support group. If there aren’t any, consider starting one.

In most cases, kids grow out of their tics by their late teens or early 20s. A few will have them for the rest of their lives, but their symptoms may get better as they get older.

Foods to Avoid in Tourette’s Syndrome

Avoiding food items one is allergic to can be of great help. Avoiding dairy products, especially if there is a sensitivity towards milk and dairy products can help reduce the recurrence of tics. The protein ‘casein’ found in milk and dairy products is found to be the main culprit for an increase in the occurrence of these tics. A casein-free diet can help control the tics.

Similarly, a gluten-free diet has also been shown to reduce the motor tics and behavior issues associated with Tourette’s syndrome.

Natural Tourette Syndrome Treatments

Always consult with your doctor before trying alternative remedies

Magnesium

Magnesium supports the central nervous system, promoting proper muscle action and reaction. In 2008, researchers in Spain found that oral solutions of magnesium and vitamin B6 decreased total tic scores in children with Tourette Syndrome. Researchers did not see any side effects and the treatment was deemed safe and effective. Further studies are needed. In addition to the evidence of helping reduce the tics associated with Tourette’s, those with a magnesium deficiency can suffer from anxiety, depression, and chronic fatigue, many of the same co-occurring conditions that affect those with Tic Disorders.

Try incorporating more magnesium-rich foods and brain-boosting foods into your diets, such as avocados, bone broth, and dark chocolate.

Video Living with Tourette Syndrome. Click for the video.

Passion Flower 

Is known to help with these conditions. There are teas and supplements available; follow the recommended dosing for best results.

Passionflower a double-blind, randomized controlled trial that pitted Passiflora extract vs. Oxazepam, researchers found that Passiflora extract is effective for the management of anxiety, and has a low incidence of impairment of performance when compared to oxazepam. Individuals with Tourette’s often have trouble sleeping, anxiety, and depression, and often have co-occurring ADHD.

Vitamins

B vitamins

B vitamins support the nervous system, promote healthy skin and hair, combat stress and depression, fight free radicals, boost HDL cholesterol, regulate mood and sleep, and reduce inflammation. As stress is a common trigger for Tourette’s, it is important to support the body’s ability to fight stress.

Vitamin B12 

In particular, can support those with Tourette’s by fighting depression and anxiety and improving concentration and cognitive function. For best results, be sure to follow the National Institutes of Health recommended dosing.

Vitamin D

It’s believed that nearly 90% of the population has a vitamin D deficiency. Often overlooked as an essential nutrient, vitamin D plays a critical role in the nervous system, muscle health, and depression. In fact, researchers from the Department of Psychiatry and Behavioral Neurosciences at St. Joseph’s Hospital in Ontario, Canada found that there is a strong relationship between vitamin D and depression.

The single best way to get the vitamin D you need is through sunlight; during the winter months, or if you don’t get outside for at least 20 minutes each day, it is important to boost your intake of vitamin D-rich foods.

Chamomile

For over 5,000 years, chamomile has been used for insomnia, wounds, allergies, arthritis, to fight anxiety and depression, and for muscle spasms. As a matter of fact, a randomized, double-blind, placebo-controlled trial published in the Journal of Clinical Psychopharmacology found that chamomile reduced anxiety in patients with mild to moderate generalized anxiety disorder. Luckily, organic chamomile teas, tinctures, and essential oils are readily available at health food stores, which makes it easy to incorporate into your daily routine.

To help relieve tension and promote sleep, try diffusing chamomile essential oil. You can also enjoy a cup of tea (or iced tea) any time of the day to gain the benefits of this powerful flower.

Whole Body Relaxation

A study published in the Journal of Affective Disorders found that body-mind relaxation meditations can help modulate brain activity in multiple areas where emotion processing is found. To induce a whole-body relaxation response, guide your child through tensing and releasing various muscle groups. Starting at the feet, and moving upwards, squeeze muscles hard to the count of 5, and then release to the count of 15. Then, go to the next muscle group, and repeat until you reach the top of the head. Some individuals with Tourette’s may find that tensing and releasing the lower body is enough. However, others may find the same to be true with the upper body.

Omega-3 Fatty Acids

A double-blind, placebo-controlled trial conducted by researchers at the New York University Child Study Center at NYU School of Medicine found that omega-3 fatty acids may benefit individuals by reducing tic-related impairment. Long acknowledged for supporting heart health, brain health, and cancer prevention, foods naturally high in Omega 3 Fatty Acids should be incorporated into the diet of anyone suffering from TS.

Acupuncture

In a small study, Chinese researchers found acupuncture to have an effective rate of 97.1% in the treatment of Tourette’s Syndrome.  Their conclusion was that acupuncture is a “very effective therapy for TS.” While parents and children alike may hesitate to try acupuncture, it is a safe procedure that is proven to help with insomnia, pain, stress, and now Tourette’s.

Exercise

Aerobic exercise has been shown to significantly reduce tics during exercise and post-exercise. The study published in Behavior Modification Journal found that in addition to tic reduction, aerobic exercise also had a beneficial impact on anxiety and mood levels.

While the study did not identify the intensity or length of time for the exercise sessions observed, incorporate regular aerobic activity daily for best results. Try to find ways to make exercise fun. Dance, tennis, basketball, and playing tag can all get the heart pumping, resulting in healthier and happier kids.

Precautions

Tourette Syndrome is a challenging disorder for both the family and the child who has been diagnosed. Depending on the severity and frequency of tics, significant behavioral and social challenges are likely.

Children and teens with Tourette Syndrome often suffer from poor self-image, loneliness, and isolation. Also, with so many serious co-occurring disorders, including ADHD, OCD, depression, anxiety, anger, and autism-spectrum disorders, effective treatment must focus on overall wellness and support.

Things To Keep In Mind

• People with Tourette Syndrome cannot control their physical and verbal tics.
• Tic Disorder is a neurodevelopmental condition that does not have a cure, but treatments are available to ease the symptoms and co-occurring disorders.
• Genetics, environment, and allergens may all play a role in Tourette Syndrome.
• Depression, loneliness, and poor self-esteem are common.
• Many of the prescription medications commonly prescribed have frightening side effects, particularly for young children and teens.
• Natural treatments can help with tic severity and the symptoms of co-occurring disorders.

If you see someone having uncontrollable movements please try not to judge as they may be suffering from a disease.

Thank you for reading

Michael

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