Tourette Syndrome

Tourette syndrome is a disorder of a nervous system that starts in childhood. It is characterized by repetitive unusual movements or uncontrolled unwanted sounds. For e.g. patient may repeatedly blink eyes, jerk head, clears throat or shrug shoulders.

It is an inherited disorder and named after French Dr. Georges Gilles De La Tourette. Tourette syndrome was first described by Dr. Tourette in 1885. He first described the condition in French noblewoman who is 86 years old.

Genetic studies have suggested that Tourette syndrome occurs with other problems like:
• Obsessive compulsive disorder.
• Anxiety.
• Attention deficit hyperactivity disorder.
The unusual sounds or movements that person with Tourette syndrome make is called tics. The tics are involuntary; people having Tourette syndrome can not control their body from doing such things. Person can stop from doing a tic for a while but eventually he has to do it.

The tics start in childhood and the condition may get worst in teen age. A tic comes and goes over time. They vary in type, location, frequency and severity. The first symptom develops in head and neck and progress to involve muscle of trunk and extremities. Motor tics occur first than vocal and simple tics develop that precede complex tics. 10-15 % affected persons approximately have progressive course that lasts in adulthood.

Tourette syndrome can be a chronic condition. The symptoms last for lifetime. It can be sever or mild. Many people have mild tics and they are not aware of it and do not seek any medical help.
Psychological problems do not cause Tourette syndrome but these problems are may be a result of Tourette syndrome.

Age/Sex prevalence of Tourette Syndrome

Symptoms usually appear between ages 2 and 12.
Tendency of development of Tourette syndrome in males are four times higher as compared to females.

Classification of Tourette Syndrome

• Motor tics:
Movements of the body are called motor tics. This includes shrugging the shoulders, blinking, jerking head or arm, etc.

• Vocal tics:
Unusual sounds made by a person are called vocal tics. This includes throat clearing, humming, yelling out words, etc.

• Simple tics:
Few parts of body are involved in simple tics, e.g. sniffing or squinting.

• Complex tics:
In this tic different parts of body are involved and have a pattern. For e.g. patient bobs the head while jerking an arm and then jumps up.

Causes of Tourette Syndrome

The exact cause of Tourette syndrome is unknown. Various researches have suggested abnormalities in some regions of brain, the circuit that connect these regions and the neurotransmitters.

Tourette Syndrome Signs and Symptoms

The symptoms of Tourette syndrome are involuntary. Sometimes people can suppress or manage the tics in order to minimize the impact.

Simple tics:
• There are sudden brief and repetitive movements.
• Limited number of muscle is involved.
• It includes eye blinking, shoulder shrugging, jerking of head and arm, facial grimacing, throat clearing, sniffing, grunting sounds, etc.

Complex tics:
• Several muscle groups are involved.
• There are distinct co-coordinated movement pattern.
• It includes facial grimacing with jerking of head and shoulder shrugging.
• In more complex vocal tics person utters swear words (coprolalia) or they may repeat words or phrases of other person (echolalia).
• Some tics precede an urge in affected muscle called premonitory urge.

Differential diagnosis

• Chorea in Adults
• Huntington Disease
• Movement Disorders in Individuals with Developmental Disabilities
Wilson Disease
• Hemifacial Spasm
• Periodic Limb Movement Disorder

Investigations of Tourette Syndrome

If the person has both vocal and motor tics for at least one year then a person is said to be affected with Tourette syndrome.
Neuro-imaging studies may be needed to exclude other conditions that may be confused with Tourette syndrome.

Neuro-imaging studies include:
• CT

To confirm the diagnosis, a person must:
• Show many motor tics and vocal tics,
• Have both these tics for at least one year,
• Develop tics before 18 years of age, and
• Have no other neurological problem.

Treatment of Tourette Syndrome

In majority of persons no medicines are required to suppress tics in Tourette syndrome.
If the tics are troublesome then neuroleptic medicines e.g. haloperidol, pimozide, etc. are used to suppress the tics.

These medicines are not able to eliminate the symptoms completely and unfortunately there are side effects of these medicines.

Side-effects of neuroleptic drugs are weight gain, sedation, tremor, dystonia, parkinsonian like symptoms. But these symptoms can be managed with the reduction of dose.
If neuroleptic drugs are being used for ling time, it must be reduced slowly to avoid withdrawal symptoms and increase in tics.

Some medicines are effectively used in patients to treat neuro-behavioral disorders that are associated with Tourette syndrome.

In people having ADHD with Tourette syndrome medicines such as methylephenidate and dextroamphitemine is helpful in reducing the symptoms.

Serotonin reuptake inhibitors are helpful in associated symptoms of obsessive compulsive disorder.
Psychotherapy may prove helpful.

Prognosis of Tourette Syndrome

Tourette syndrome is chronic and lifelong but the person has a normal life expectancy.
There is no cure for Tourette syndrome. There is improvement of symptoms in late teen-age.
If there is development of neurobehavioral disorders such as depression, mood swings, then it can cause impairment in adult life.

Complications of Tourette Syndrome

• Impulsive behavior
• Attention deficit hyperactivity disorder (ADHD)
• Obsessive-compulsive disorder
• Poor social skills

Homeopathic treatment for Tourette Syndrome

Every branch of science has its own scope and limitations, so does Homeopathy. Although Homeopathy has a lot of very good remedies for curing & controlling auto-immune disorders, male & female disorders, children and elderly people.

In cases of any emergency situation such as poisoning, serious abdominal complaints (such as acute appendicitis /pancreatitis), fractures, injury, and accidents should be treated first taken to emergency. However a patient can consult his homeopathic physician after recovering from his initial phase. Please note Homeopathy plays no role in treating any nutritional disorders.

The scope of Homeopathy is limited; it is the sole responsibility of the physician to decide upon the cure – by looking into the complete nature of the disease, onset and stage of the disease and then act accordingly.

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