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WHAT IS TOURETTE’S SYNDROME Neurological disorder Involving uncontrolled movements or sounds known as tics Scientists believe that tics may result from changes in brain chemicals (neurotransmitters) that are responsible for producing and controlling voluntary movements. WHAT ARE TICS Motor and Vocal Tics • Simple motor tics • Clonic tics : sudden muscle or limb jerks, like a spasm. • Tonic tics : tensing of the muscles • Dystonic : twisting pulling or squeezing movements resulting in a briefly maintained abnormal posture • Simple vocal tics are wordless sounds WHAT ARE TICS CONT’D • Complex Motor tics • Involves slower, longer, and more purposeful movements • Complex Vocal tics • Include uttering syllables, words, phrases, • Palilalia: repeating one’s self • Echolalia: repeating others • Coprolalia: uttering of socially inappropriate language, swearing • Common motor tics seen in Tourette syndrome Common vocal tics seen in Tourette syndrome Simple tics Complex tics Simple tics Complex tics Eye blinking Touching the nose Hiccupping Using different tones of voice Head jerking Touching other people Yelling Repeating one's own words or phrases Shoulder shrugging Smelling objects Throat clearing Repeating others' words or phrases Eye darting Obscene gesturing Barking Using vulgar, obscene or swear words Finger flexing Flapping the arms DSM-IV • have two or more motor tics • have had tics for at least a year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on. • have tics that begin before he or she is 18 years of age. • have symptoms that are not due to taking medicine or other drugs or due to having another medical condition (for example, seizures, Huntington disease, or postviral encephalitis). SOME STATISTICS • It is not known exactly how many people have Tourette Syndrome (TS). Some studies have found that 1 of every 360 children between 6 and 17. Other studies using different methods have estimated the rate of TS at 1-10 per 1000 children. • 27% have been reported as having moderate or severe forms of the condition. • TS affects people of all racial and ethnic groups. • Boys are affected three to five times more often than girls. • A TS diagnosis is twice as likely among non-Hispanic White people than among Hispanic and non-Hispanic Black people. • A diagnosis of TS is twice as common among children 12 through 17 years of age as among those 6 through 11 years of age. CO-MORBID CONDITIONS • Attention-deficit/hyperactivity disorder (ADHD) • Obsessive-compulsive disorder (OCD) • Learning disabilities • Sleep disorders • Depression MEDICAL TREATMENT • Drugs that block or deplete the neurotransmitter dopamine in the brain: Used to control tics. Side effects: weight gain and a dulling of the mind. (fluphenazine, Haldol) • Botulinum toxin type A (Botox) injections.: For simple or vocal tics, an injection into the affected muscle may help relieve the tic. • Stimulant medications: Used to help increase attention and concentration for people with ADHD. (methylphenidate (Concerta, Ritalin, others) (dextroamphetamine (Adderall XR, Dexedrine, others). MEDICAL TREATMENT CONT’D Central adrenergic inhibitors:. Typically prescribed for high blood pressure, these drugs may help control behavioral symptoms, such as impulse control problems and rage attacks. Side effects may include sleepiness. • Antidepressants:. These may help control symptoms of sadness, anxiety and OCD. (clonidine (Catapres) or guanfacine (Tenex) fluoxetine (Prozac, Sarafem, others) • THERAPY TREATMENT • Psychotherapy.: May help individual cope with Tourette syndrome, may help with additional conditions ADHD, obsessions, depression or anxiety. • Behavior therapy: Habit Reversal Training: monitor tics and identify premonitory urges —respond to urges voluntarily; move incompatibly with the tic, hopefully suppressing the tic. IMPACT Individual with Tourette’s Syndrome may experience difficulties with: problems concentrating in class Homework Examinations, Writing, Anxiety Depression Shame teasing and bullying by other students Unhelpful responses by school staff Irritability Antisocial behavior Self-harming behavior (less commonly) Inappropriate behavior to others REFERENCES • Mayo Clinic http://www.mayoclinic.org/diseases-conditions/cerebral-palsy/basics/definition/con20030502 • Movement Disorder Society http://www.movementdisorders.org/MDS/About/Movement-Disorder-Overviews/Tics-Tourette-Syndrome.htm • Tourette Canada http://www.tourette.ca • CDC http://www.cdc.gov/ncbddd/tourette/data.html National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm • Web MD http://www.webmd.com/brain/tourettes-syndrome?page=2