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What is Tourettes Syndrome? • Inherited neurological condition • 1/100 School children • 300,000+ children and adults in the UK • 1:4 girls to boys • Complex condition with a wide spectrum Symptoms Relative likelihood of lifetime sensory tics in a given region as based on a self-report of patients with TS Causes •The Basal Ganglia -specialised brain cells involved in helping regulate the physical movements of the body -higher brain functions such as motivation and decision-making -temporary disruption scrambling decision making - sudden development unconscious motivation to perform an action (the tic) that the conscious mind regards as both unwanted and unexplained -MRI and PET scans show different structure •Dopamine theory -excessive levels for a person with TS effecting Basal Ganglia -alternatively normal dopamine level but TS more sensitive to its effects •Genetics -inherited - 50% -in twins if one has TS other ½ chance •Childhood infection -streptococcal throat infections, antibodies causing abnormal immune reaction •Other possible environmental factors contributing to onset or severity: -pregnancy and birth related problems -complications during pregnancy, -smoking during pregnancy, -severe nausea and/or vomiting during the first trimester -premature low birth weight children MRI Diagnosis Other possibilities to rule out: • Allergies – sniffing, coughing • Vision problems - blinking • Autistic spectrum disorder • Dystonia – condition causing involuntary muscle spasms • Huntington's disease – genetic condition that can cause a range of symptoms including muscle twitching Referral • Neurologist – a doctor who specialises in treating conditions that affect the brain and nervous system • Psychiatrist – a doctor who specialises in treating mental health conditions • Educational psychologist - a health professional who works with children who have learning, developmental or behavioural difficulties • • computerised tomography (CT) scan – where a series of X-Rays are taken to build up a detailed 3D image of the brain magnetic resonance imaging (MRI) scan – where strong fluctuating magnetic fields are used to produce a detailed image of the inside of the brain Confirming the diagnosis • Not caused by other medical conditions or medication • Tics started before the age of 18. • Several physical tics and at least one phonic tic. • Tics occur many times during the day, nearly every day • Tics have been present for at least a year. Research and Treatment • No cure at present • Medication: alpha2-adrenergic agonists (release noradrenaline, stabilize norepinephrine, clonidine), muscle relaxants and neuroleptics (risperidone, benzimides) • Therapy: behavioural, psychotherapy, muscle relaxation • Surgery : Limbic leucotomy, Deep Brain Stimulation Obsessive compulsive disorder • Anxiety Disorder • chronic (long-term) mental health condition associated with obsessive thoughts and compulsive behaviour • OCD is one of the most common mental health conditions. It is estimated that up to 3 in 100 adults and up to 5 in 100 children and teenagers have OCD Symptoms Intrusive thoughts -intentionally causing harm -unintentionally causing harm -fear of contamination -need for symmetry or orderliness -committing offensive acts Common Compulsions • cleaning • hand washing • checking – such as checking that doors are locked, or that the gas or a tap is off • counting • ordering and arranging • hoarding • asking for reassurance • needing to confess • repeating words silently • prolonged thoughts about the same subject Causes • Genetic -No specific gene isolated -But 4 times likely to inherit OCD if a family member has it • Brain abnormalities -Increased blood flow and activity -Increased level of neurotransmitter serotonin -Streptococcal throat infections, antibodies causing abnormal immune reaction • Life events, coping mechanisms and stress PET scan showing increased brain activity due to hyper-vigilance Diagnosis • GP questionnaire • Psychiatrist • Educational psychologist Research and Treatment • Based on severity • • • mild functional impairment – obsessive thinking and compulsive behaviour occupy less than one hour of your day moderate functional impairment – obsessive thinking and compulsive behaviour occupy one to three hours of your day severe functional impairment – obsessive thinking and compulsive behaviour occupy more than three hours of your day • CBT, psychotherapy • Anti-anxiety medication • Surgery : Limbic leucotomy, Deep Brain Stimulation Comorbidities • Over 85 percent of people with TS have more than just tics. • 60% have OCD • 70% have attention deficit hyperactivity disorder (ADHD). • More susceptible to fits of rage, depression and sleep disturbances • Co-morbidities often present more problems than the tics and can be less visible.