Tic triggers. Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics; for example, tight collars may trigger neck tics. Hearing another person sniff or clear the throat may trigger similar sounds.
Tics do not go away during light sleep but are often significantly diminished; they go away completely in deep sleep. Although the symptoms of TS are unwanted and unintentional called involuntary , some people can suppress or otherwise manage their tics to minimize their impact on functioning. However, people with TS often report a substantial buildup in tension when suppressing their tics to the point where they feel that the tic must be expressed against their will.
Tics in response to an environmental trigger can appear to be voluntary or purposeful but are not. Disorders Associated with TS.
Many individuals with TS experience additional co-occurring neurobehavioral problems how the brain affects emotion, behavior, and learning that often cause more impairment than the tics themselves. Although most individuals with TS experience a significant decline in motor and vocal tics in late adolescence and early adulthood, the associated neurobehavioral conditions may continue into adulthood.
The most common co-occurring conditions include:. Educational Settings. Although students with TS often function well in the regular classroom, ADHD, learning disabilities, obsessive-compulsive symptoms, and frequent tics can greatly interfere with academic performance or social adjustment.
After a comprehensive assessment, students should be placed in an educational setting that meets their individual needs. Students may require tutoring, smaller or special classes, private study areas, exams outside the regular classroom, other individual performance accommodations, and in some cases special schools.
To diagnose TS, a doctor looks for the following:. Common tics are often diagnosed by knowledgeable clinicians. However, atypical symptoms different from classical symptoms or atypical presentations for example, symptoms that begin in adulthood may require specific specialty expertise for diagnosis.
There are no blood, laboratory, or imaging tests needed for diagnosis. In rare cases, neuroimaging studies, such as magnetic resonance imaging MRI or computerized tomography CT , electroencephalogram EEG studies, or certain blood tests may be used to rule out other conditions that might be confused with TS.
It may take some time to receive a formal diagnosis of TS. Families and physicians unfamiliar with the disorder might think mild and even moderate tic symptoms may be negligible or unimportant, a part of a developmental phase, or the result of another condition.
For example, some parents may think that eye blinking is related to vision problems or that sniffing is related to seasonal allergies. Because tic symptoms often are mild and do not cause impairment, some people with TS require no treatment. There are effective medications and other treatments for people whose symptoms interfere with daily functioning. Unfortunately, there is no one medication that is helpful to all people with TS, nor does any medication completely eliminate symptoms.
Other therapies and treatments can include:. Most cases of TS involve the interaction of multiple gene variations and environmental factors. Although the cause of TS is unknown, current research points to abnormalities in certain brain regions including the basal ganglia, frontal lobes, and cortex , the circuits that connect these regions, and the neurotransmitters dopamine, serotonin, and norepinephrine responsible for communication between nerve cells called neurons.
TS Inheritance. Evidence from twin and family studies suggests that TS is an inherited disorder. A small number of people with Tourette syndrome have mutations involving the SLITRK1 gene, which affects how neurons grow and connect with one another, and scientists continue to look for other genes involved with TS. As Gilles de la Tourette noted in his report, the condition manifests largely during childhood, and is now known to affect more boys than girls. Tics typically emerge between the ages of 4 and 6, then increase in severity, and peak between the ages of 10 and Thereafter, tics tend to decline during adolescence and, by early adulthood, most individuals will experience markedly reduced tics or be tic-free The cause of TS remains elusive.
Spearheaded by the Tourette Association, there have been intense, international, efforts aimed at finding the gene defects that cause or contribute to the disorder. These remain unknown, except for findings of very rare mutations in a few families with the condition There are suggestions that other factors, such as environmental agents and infections, might play a role in the development of TS, but these theories remain unproven and require further study There continues to be significant interest in determining the precise changes that occur in the brain of people with TS.
This knowledge will be valuable for the rational development of more effective therapies for tics and associated psychiatric conditions. Imaging of the brain using sophisticated scanning equipment and other kinds of biomedical studies suggest that changes in the basal ganglia, an interconnected group of structures in the brain that control movements, play an important role in TS In particular, there is evidence to suggest that overactivity of nerve cells that release a chemical called dopamine contributes to the expression of tics.
Moreover, there is increasing evidence indicating that alterations in other nerve cells e. Since TS was first described, a variety of therapeutic approaches have been examined. The work by the physician Arthur Shapiro and colleagues in the ss, which showed that the dopamine activity blocker, haloperidol, could reduce tic severity, led to the examination of many other drugs for TS At present, there are a variety of drugs that can interact with dopamine and non-dopamine systems in the brain that can be administered to people with TS However, for some people, several of these mediations have poor benefit and are associated with unpleasant side effects that further limit their usefulness.
Thus, there continues to be a great need for more effective and safer medicines for treating tics and other features of TS. Some patients who have already received this therapy have experienced significant benefit, but many others have failed to show improvement. Thus, deep brain stimulation DBS remains an investigational but potentially effective therapy for otherwise difficult to manage cases of TS.
In recent years, there has been much interest in behavioral therapy as a treatment for TS. In a recent article published in JAMA, it was shown that cognitive behavioral intervention for tics CBIT was as effective as drugs for treating some people with the disorder This promising therapy will undergo further development and testing in the years ahead, and could become a treatment option for people with TS.
While some of these approaches could benefit specific individuals, these interventions have not yet been confirmed in rigorous clinical trials involving many patients.
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