Tourette syndrome (TS) is a neurobehavioral disorder characterized by involuntary motor and vocal tics that typically begin before age 18. Common motor tics include eye blinking, head jerking, and body twisting, while vocal tics can include sounds like grunting, snorting, or repeating words. The cause is unknown but may involve abnormalities in neurotransmitter levels in the brain. Treatment involves psychotherapy to help manage symptoms and develop coping strategies, as well as medication in some severe cases.

1. MR. JAYESH PATIDAR
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2.  It is also called tic disorder.
 TS is a neurobehavioral disorder characterized by
sudden, involuntary muscle movements (motor
tics) & vocalization (vocal tics).
 In some cases, the tics may include inappropriate
words. Symptoms, which may range from mild to
severe, usually appear before age 18.
 Motor tics tend to affect the head, trunk, or
limbs. They sometimes change in severity,
frequency, & location. Verbal tics may involve a
wide variety of sounds, such as clients, yelps,
barks, & snorts.
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3.  Most TS sufferers gradually develop a
combination of different motor & vocal tics.
The tics may occur a few times or many
times during the day.
 Tics may grow less frequent & severe during
adolescence or adulthood. In a few causes,
they disappear completely after
adolescence.
 TS usually becomes apparent between ages
2 & 15. Roughly one-half of patient
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4.  The disorder is more common in males than
females. It affects from 0.1% to 1.0% of the
general population.
 Many people with TS have associated
behavioral problems, such as obsessions &
compulsions, inattention, hyperactivity, &
impulsivity. Because of their odd behavior,
they tend to experience distress &
difficulties in social situations, in school, &
on the job.
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5.  The cause of TS is unknown. Many researchers
suspect the disorder is linked to abnormalities in
neurotransmitters, because abnormal levels of
dopamine, serotonin, GABA, norepinephrine, &
acetylcholine have been found in TS patients.
Also, the basal ganglia & other brain regions show
decreased metabolic activity.
Predisposing factors for TS may include:
 Genetic factors (in a few cases, TS may be
inherited from both parents)
 Pregnancy & prenatal problems, such as
emotional problems, stress during pregnancy, &
severe nausea & vomiting during the first
trimester of pregnancy.
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6.  Facial tics, such as eye blinking, typically are the
first sign of TS. The tics commonly begin around
age 7, although some children as young as age 2
have them. Over time, facial grimacing, neck or
head jerking, neck stretching, or body twisting &
bending may occur.
 Tics tend to worsen during stress, excitement,
boredom, or fatigue & to ease during relaxation,
sleep, & when the person is absorbed in an
activity. although some people can suppress the
tics for a short time, tension eventually builds &
the tic escapes.
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7.  Some people with TS periodically clear their
throat, cough, sniff, grunt, snort, yelp, bark, or
shout. They may touch other people excessively
or repeat actions obsessively & unnecessarily. A
few engages in self-harming behaviors, such as lip
& cheek biting & head banging.
 Other signs & symptoms may include:
 Coprolalia (swearing or using obscene language)
 Copropraxia (making obscene gestures)
 Low self-esteem
 Feeling of shame
 Obsessive thinking
 Compulsive behaviors.
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8.  TS is diagnosed clinically from patient
observation & evaluation of the family
history, which may reveal a familial
predisposition to TS.
 For diagnosis of TS, tics must be present for
at least 1 year.
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9.  Treatment of TS may involve child & family
psychotherapy & possibly, medications.
 Psychotherapy promotes & maintains the child’s
self-esteem & helps the patient & family learn
about:
 The nature of the disorder & how to mange
symptoms
 Stress management strategies, with focus on
how to best handle distress or crisis.
 Strategies for coping with the stigma of the
illness, especially peer teasing.
 Social skills & ways to mange disagreements,
anger, & conflict at school, at home, & in the
community.
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10.  Most TS patients don’t require medication.
However, some may take it when symptoms
interfere with their functioning.
 Specific drug therapy may involve one of three
types of drugs:
 Low-dose antipsychotic agents, such as pimozide
(orap), risperidone, & (for severe tics)
haloperidol.
 SSRIs, such as fluoxetine, for patients who also
have obsessive-compulsive disorder
 Clonidine, an antihypertensive drug.
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11.  Develop a relationships may be appropriate with
the child that fosters trust & acceptance.
 Teach him about the disorder & ways to mange
symptoms.
 Help him address behaviors that contribute to
irritability & frustration.
 Explain to the child & family that stress tends to
increase tic frequency, whereas quiet activities
(such as reading) can diminish the intensity of
tics. If appropriate, recommend relaxation &
biofeedback therapy.
 Encourage the child to express feelings about
the illness & the problems he experiences.
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12.  Help him learn to cope with impulses, negativity,
& unacceptable behaviors.
 Promote the child’s strengths & self-esteem.
 Address ways for him to stay positive about
himself.
 Work with family members to decrease their
focus on the child’s symptoms & to reduce
critical comments.
 If he has difficulty in regular classes, help the
family obtain information about special
education options as appropriate,
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