By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

TOURETTE SYNDROME IS LIFELONG, BUT USUALLY GETS BETTER WITH AGE

Question: My 7-year-old son, who has been treated for ADHD for a couple of years, now has been diagnosed with Tourette Syndrome. Can you tell me more about this? Why didn’t they find it sooner? How did he get this? Will he outgrow it?

Answer: Tourette Syndrome (TS) is believed to occur in about ten in 10,000 school-aged children, with boys having this problem much more frequently than girls. The onset is usually between ages 6 and 8, which is probably why it is just now being diagnosed in your son. TS never develops after the age of 18.

The disorder is named for a 19th Century French neurologist who first described the condition in an 86-year-old French noble woman. The first symptoms of TS are virtually harmless and may go unnoticed –- involuntary blinking of the eyes, a facial grimace or twitch of the nose. As the disorder progresses, these “motor tics,” as they are called, can spread to other parts of the body. These may include head jerking, neck stretching, foot stamping, and body twisting.

Perhaps, the most frustrating part of TS is what is known as vocal tics. Patients with this manifestation may start to utter strange words or sounds. One type of vocal tic -- known as coprolalia -- involves uttering obscenities. Despite common misconceptions, most TS sufferers never develop this symptom.

Let me emphasize that these tics are involuntary. The person, therefore, has no control over them. Sometimes the urge can be suppressed for short periods -- like holding a sneeze -- but a burst of tics usually follow attempts at suppression.

It is not unusual for a child with TS to have another condition like ADHD or obsessive-compulsive disorder. In fact, there is speculation about a genetic link between ADHD and TS.

In most people, the movements and vocalizations subside in adulthood. The condition, however, is considered chronic and will remain throughout life. TS is not a degenerative condition, so there is no neurological impact on normal aging. It is also felt to be an inherited condition, so other family members may have had similar behavior as children, but were never diagnosed with TS. It is not uncommon to “accidentally” diagnose the father when the child is being evaluated.

The diagnosis of TS is based on medical history and the exclusion of any medical condition that could cause the involuntary movements and vocalizations. There are no specific tests that can make this diagnosis at this time. There are studies being done, however, to see if brain imaging can detect certain patterns unique to those with Tourette Syndrome.

In many children with TS, no medication is need to control the involuntary movements and vocalizations, but when these interfere with daily activities, medications can be used. Haldol and Clonidine are often used to treat the tics. As with any problem, your doctor will tailor the medication prescribed to your child’s individual needs.

Some families also benefit from psychotherapy. Therapy can help the patient develop coping skills for this chronic illness and help other family members understand the needs of the TS sufferer. This last point is very important, because providing a nurturing and understanding home environment is tremendously beneficial in the overall management of this disorder. It’s also crucial that the TS child have the same support at school both -- in the classroom and the playground.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.