Tourette's syndrome

Tourette’s syndrome is a neurological condition (affecting the brain and nervous system) that is characterised by a combination of involuntary noises and movements called tics.

The syndrome usually starts during childhood and continues into adulthood. In many cases it runs in families and it is often associated with obsessive compulsive disorder (OCD) or attention deficit hyperactivity disorder (ADHD).

Tourette’s syndrome is named after the French doctor, Georges Gilles de la Tourette, who first described the syndrome and its symptoms in the 19th century.

Tics

Tics can be:

• vocal (sounds) – such as grunting, coughing or shouting out words
• physical (movements) – such as jerking of the head or jumping up and down

They can also be:

• simple – making a small movement or uttering a single sound
• complex – making a series of physical movements or speaking a long phrase

Most people diagnosed with Tourette’s syndrome have a combination of physical and vocal tics, which can be both simple and complex.

The tics do not usually pose a serious threat to a person's overall health, although physical tics, such as jerking of the head, can often be painful. However, children and adults with Tourette’s syndrome may experience associated problems, such as social isolation, embarrassment and low self-esteem.

Read more about the signs and symptoms of Tourette’s syndrome.

What causes Tourette's syndrome?

The cause of Tourette’s syndrome is unknown. However, it is thought to be linked to problems with a part of the brain known as the basal ganglia, which helps regulate body movements.

In people with Tourette’s syndrome, the basal ganglia 'misfire', resulting in the characteristic tics.

Read more about the causes of Tourette's syndrome.

Treating Tourette’s syndrome

There is no cure for Tourette's syndrome, but treatment can help to control the symptoms.

If your child is diagnosed with Tourette's syndrome, their treatment plan may involve a type of psychological therapy, known as behavioural therapy.

Two types of behavioural therapy have been shown to reduce the impact and intensity of tics in some people. These are described below.

• Habit reversal therapy – involves monitoring the pattern and frequency of the tics and identifying any sensations that trigger them. The next stage is to find an alternative, less noticeable method of relieving the sensations that cause a tic (known as premonitory sensations). This is known as a competing response.
• Exposure with response prevention (ERP) – involves increasing exposure to the urge to tic in order to suppress the tic response for longer. This works on the theory that you get used to the feeling of needing to tic until the urge, and any related anxiety, decreases in strength.

When the tics are more frequent or severe, a number of medications can help to improve them, such as alpha2-adrenergic agonists, muscle relaxants and dopamine antagonists.

Surgery may be recommended in very severe cases that do not respond to treatment. However, surgery for Tourette's syndrome is very rare.

Read more about how Tourette’s syndrome is treated.

Associated conditions

Children with Tourette’s syndrome will usually also have one or more other developmental or behavioural conditions.

The two most commonly reported conditions are:

• obsessive compulsive disorder (OCD) – a condition characterised by unwanted persistent obsessive thoughts and useless compulsive behaviour, for example, a compulsion to keep washing your hands due to a fear of catching a serious illness
• attention deficit hyperactivity disorder (ADHD) – a behavioural condition with symptoms such as a short attention span, being easily distracted, a tendency to be impulsive and not being able to sit still because you are constantly fidgeting (hyperactivity)

Children with Tourette’s syndrome may also have other behavioural problems, such as flying into a sudden rage, or behaving inappropriately or anti-socially with other children.

In many cases, these associated conditions and behavioural problems can be more disruptive and troublesome than the tics of Tourette’s syndrome, and are the main focus of treatment.

Read more about the conditions associated with Tourette’s syndrome.

Outlook

In around two-thirds of cases of Tourette's syndrome, a person's symptoms will improve significantly (usually around 10 years after they started).

In many of these cases, medication or therapy will no longer be needed to control the person's tics. Some people's symptoms become less frequent and troublesome, or they disappear completely.

In the remaining third of people with Tourette’s syndrome, the symptoms persist throughout their life. However, they will usually become milder as the person gets older. This means their need for medication and therapy may pass over time.