Tourette Syndrome
Understanding Tourette Syndrome
By: Dr Pieter Fourie
Introduction: Tourette syndrome is considered to be neither a psychological nor a psychiatric problem. In layman’s terms it is defined as a highly talented and intelligent brain that is held captive by a body that it has not yet come to terms with. It is possibly one of the most common neurological disorders known, although no genetic test is readily available. Most research indicates that the genetic transmission is autosomal dominant, however, it is probably more complex.
There is no cure for Tourette syndrome and therefore it is a lifelong condition. Treating Tourette syndrome symptoms effectively leads to a dramatic improvement of the manner in which the patient will manage the problems he/she experiences and the syndrome will “burn out”. Boys are more affected than girls. These children often slept poorly as infants, refused specific foods, and often do not tolerate loud sounds or rough clothing materials.
1. Clinical presentation
Tics and involuntary movement of body parts, are the most common symptoms that will occur around the ages 7 to 11. These will include the following:
Blinking of eyes
Throat clearing
Feet tapping
Shoulders pulling
Facial grimacing
Sniffing
Hands clapping
Biting nails, clothes and licking of lips
Shouting
Profanity
Lying: primarily to avoid punishment
Stealing: trying to impress friends or purely on the spur of the moment
Inappropriate sexual touching
Low self esteem due to poor performance at school
Poor interpersonal relationships
Argumentative: always trying to win the argument
Does not demonstrate remorse
Poor response to punishment
Has a high sense of what is right or wrong and will expect others to comply, although often fails to comply themselves
Manipulative: will especially try and set up parents against each other
Likes to tease others but does not tolerate to be ridiculed
A strong association with obsessive compulsion has been demonstrated
2. Management
Understanding the underlying pathology is essential for effective management. Parents need to be educated and know that there is hope and if the syndrome is treated well, the outcome will often be very good. Children with Tourette syndrome are more comfortable operating in an environment where they have well structured guidelines and expectations. Rather than punishment, negotiations concerning expectations are often more effective. Attention must be paid to the specific educational requirements that will support the patient’s specific needs and capabilities.
3. Therapeutic support:
Because the brain is highly neuroplastic up to the age of twenty, the sooner medication is instituted, the more effective it can support the central nervous system to optimize neural pruning as well as neural integration. Never commence with stimulants such as methylphenidate first and only add them once the patient is more receptive. Because these patients suffer from a high level of anxiety, an SSRI should be prescribed as early as possible. Poor neural communication should be supported with an antipsychotic such as risperidone, aripiprazole or equivalent. Clonidine will often control mood swings and improve concentration. Psychological support, especially to educate the parents/caregiver is often very helpful with specific focus and supplying them with management tools to cope with all the aspects mentioned above.
4. Future outcome
Although the underlying pathology is poorly understood and the symptomatology extremely complex and difficult to manage, the outcome will often be surprisingly positive provided:
Therapeutic interventions are commenced as early as possible.
Parents are psychologically supported to cope with these children.
Educational support is specifically structured around the needs of the individual patient.
Teachers and caregivers are educated to identify children with Tourette syndrome as early as possible.
Always be reminded that these patients are often very talented and highly intelligent and with the right support the final outcome will improve dramatically.