Written & Medically reviewed by

Dr.Sanjana.V.B. Bhms. Dbrm.Cdn

 Tourette’s Syndrome (TS)

Overview

Tourette’s syndrome is a neurological condition characterized by sudden twitches, movements, or sounds that people do repeatedly; for instance, blinking the eyes over and over or a person might make a grunting sound involuntarily in this condition. Symptoms usually begin when a child is 5 to 10 years of age. Most people with TS experience the severe tic symptoms in their early teens, but it may lessen and become controlled by the late teens to early 20s.

The first symptoms often are motor tics that occur in the head and neck area. Tics usually are worsened by stress or excitement. They tend to improve when a person is calm or focused on an activity. The type and frequency of tics change over time.

 Symptoms of tics might appear, disappear, and reappear and now it is considered as chronic condition. However, in most cases, symptoms of tics decrease during adolescence and early adulthood, and sometimes disappear entirely. Only in a few people with TS tics progress into adulthood and get worsened.

 There are two types of tics—motor and vocal tics.

·        Motor Tics

Motor tics are movements of the body. Examples of motor tics include blinking, shrugging the shoulders, or jerking an arm.

·        Vocal Tics

Vocal tics include sounds that are a person making unwillingly such as humming, clearing the throat, or yelling out a word or phrase.

Tics can be either simple or complex:

·        Simple Tics

Simple tics are sudden, brief, repetitive movements that involve a few muscle groups. Simple tics involve just a few parts of the body. Examples of simple tics include squinting the eyes or sniffing.

·        Complex Tics

 Complex tics are distinct, coordinated patterns of movement involving several muscle groups in different parts of the body. Complex tics usually involve various parts of the body with a definite pattern.

Examples of complex tics include bobbing the head while jerking an arm and then jumping up, Girl with her hands on her head, facial grimacing combined with a head twist and a shoulder shrug etc.

Complex vocal tics may include: 

Repeating one's own words or phrases

Repeating others' words or phrases (echolalia)

Using vulgar, obscene, or swear words (coprolalia) 

Causes:

The exact cause of TS is unknown, current research points to abnormalities in some part of brain in people having this syndrome. The basal ganglia, frontal lobes, and cortex shows some changes as well as some neuronal circuits that connect these regions.

Neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication between nerve cells (neurons) are also having some role in this syndrome especially in tics with behavioral disorders like ADHD, OCD etc.

TS genetic information of Inheritance pattern: 

Changes (mutations) in one or more genes have been shown to be involved with Tourette’s syndrome.

A small number of people with TS have mutations involving the SLITRK1 gene, which affects how neurons grow and connect with one another. Abnormalities in the NRXN1 and CNTN6 genes, which also regulate the normal formation of these nerve connections, also may play a role in TS.

Diagnosis of Tourette’s syndrome

There is no single test to diagnose TS. Clinical history of the person affected with, is important for diagnosing TS. Doctors look at the person’s symptoms to diagnose TS and other tic disorders. The clinical examination of the patient gives an idea about the type and frequency of tics.

Tics may coexist with other behavioral and conduct disorders in TS. The major conditions are listed below.

Attention Deficit Hyperactivity Disorder (ADHD)—People with TS may have problems with concentration, hyperactivity, and impulsivity. It is a behavioral disorder of neurodevelopmental origin seen in children as well as adults with or without tics. ADHD is characterized by inattention or reduced focus alone or in combination with impulsive, hyperactive behavior.

Obsessive Compulsive Disorder or Behaviors (OCD/OCB)—it is the constant inflow of unwanted thoughts, ideas, or sensations (obsessions) may compel someone to perform some behaviors repeatedly or in a certain way (compulsions). Repetitive behaviors can include handwashing, checking things, and cleaning, and can significantly interfere with daily life. Tics are seen with OCD in Tourette’s syndrome. 

Anxiety—People with TS may have an increased fear, uneasiness, or apprehension about a situation or event that may have an uncertain ending. 

Learning disabilities—Problems with reading, writing, and arithmetic calculations that are not related to intelligence are seen in some individuals with TS.

Behavioral or conduct problems—aggressive behavior, anger and emotional control in a social context is difficult in some people with tics. People may have trouble with social skills and with maintaining social relationships also.

Treatment for Tourette syndrome

Although there is no permanent cure for TS, there are treatments available to help manage the tics. Tics not affecting the daily life do not require any treatment. However, medication and behavioral treatments are available if tics affect the everyday life, causing pain, stress, poor performance in school etc.

Conventional medical treatment

Medications that block dopamine (drugs that may be used to treat psychotic and non-psychotic disorders) are the most consistently useful medications to suppress tics (for example, haloperidol and pimozide)

TS may coexist with other disorders like attention-deficit/hyperactivity disorder (ADHD), anxiety, or obsessive-compulsive disorder (OCD). It is very important to detect the other coexisting clinical conditions like these and manage accordingly.

Behavioral treatments such as awareness training and competing response training can be used to reduce tics. Recent researches show that Cognitive Behavioral Intervention for Tics (CBIT) showed that training to voluntarily move in response to a premonitory urge can reduce tic symptoms.

Alternative and complementary medicine

Homeopathy for Tourette’s syndrome

Drugs- agaricus, argentum nitricum,arsenicum album,bufo,carcinosin,hyoscyamus,ignatia,lycopodium,palladium,tarantula.

All these drugs may address other co- existing conditions like ADHD, OCD, learning disabilities, anxiety, Conduct disorders etc. Medicines are to be chosen based on the individual symptoms presented.

Extra notes for homeopathic physicians:

The criteria for diagnosing Tourette’s syndrome are:

 Presence  of motor and vocal tics, and history of occurrence of tic symptoms for at least a year, onset of tics before age 18and tics that are not caused by medications, other substances, or medical conditions.

TS may coexist with other disorders like attention-deficit/hyperactivity disorder (ADHD), anxiety, or obsessive-compulsive disorder (OCD). It is very important to detect the other coexisting clinical conditions like these and manage accordingly. Manage these co-morbidities with a well-chosen constitutional remedy.

Tourette’s syndrome has a strong genetic component and chances of inheritance to off springs . It is important to understand that the genetic tendency may not necessarily result in TS; instead, it may express itself as a milder tic disorder or as obsessive-compulsive behaviors. It is also possible that children who inherit the gene abnormality will not develop any TS symptoms. So diagnose the case as TS only after meticulous evaluation of severity and based on the criteria cited above.

Males are more likely to have tics and at-risk females are more likely to have obsessive-compulsive symptoms. 

Genetic counseling of people with TS should include a full review of all potentially hereditary conditions in the family.

A miasmatic evaluation is also recommended while choosing the constitutional remedy in homeopathy even if the symptoms are mild.

[Disclaimer- Please take homeopathic medicines only under the guidance of a qualified homeopathic doctor in appropriate dosage. Over the counter medications may have adverse effects and we do not recommend it as homeopathy requires proper case taking, clinical examination, lab investigations , evaluation and analysis of each case in an individualized manner and selection of most appropriate remedy with proper strength &dosage for curing any clinical condition.] 

References

1.       https://www.cdc.gov/ncbddd/tourette/facts.html#:~:text=Tourette%20Syndrome%20(TS)%20is%20a,keep%20blinking%20over%20and%20over

2.       https://www.ninds.nih.gov/health-information/disorders/tourette-syndrome

3.        Pocket Manual Of Homoeopathic Materia Medica & Repertory

4.         A Concise Repertory Of Homeopathic Medicines

5.         Homoeopathic Medical Repertory