Tics and Tourette's

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Tourette's syndrome is a condition characterized by repeated sounds or physical movements that are often described as tics. You or your child may have symptoms that lead you to wonder about Tourette's syndrome or a tic disorder.

Rest assured that you are not alone and that this is a more common concern than you probably realize. You might have questions about what is causing the actions, what to expect, and whether they will get better or worse.​

What Are Tics?

Tics are brief sounds or physical movements that usually recur in almost exactly the same way over the course months or years. Common tics include eye blinking, nose or face twitching, shoulder shrugging, neck turning, and throat clearing.

You may have a general sense that you can suppress your tics with great effort, as most people describe a strong urge to make the movement or the sound. The actions can usually be controlled temporarily, but then the urge typically builds up and the tics may occur rapidly in a manner that is described as a ‘burst.’

Tics most commonly begin during childhood, between the ages of 8 and 12. Most of the time, tics do not continue to occur for longer than a year, and they often improve or disappear during adolescence.

There are a number of conditions associated with tics, such as Giles de la Tourette syndrome, but most of the time, tics are not associated with any medical condition.

Experts estimate that approximately 20 percent of school-aged children temporarily experience some form of tics.

What Is Gilles de la Tourette Syndrome? 

A well-known disorder called Giles de la Tourette syndrome, often referred to as Tourette's, is characterized by over 12 months of more than one type of tic.

Most people who have tics do not have Tourette's.

In general, people who have Tourette's are aware of the symptoms and are able to temporary control the tics. Usually, a person who is living with Tourette's can suppress the movements or vocal sounds in limited circumstances, such as in situations that are socially or professionally valued.

The majority of individuals living with Tourette's syndrome experience tics and/or vocal sounds of mild to moderate severity that do not significantly interfere with quality of life and that do not require medical treatment. However, some individuals living with Tourette’s experience severe tics that are embarrassing, awkward or painful and interfere with having a normal social, school or professional life.

Will the Tics Get Better or Worse?

The majority of children who experience tics go on to get better over time. And the majority of children and adults who have Tourette's improve after adolescence or remain stable. Some individuals with tics or Tourette’s worsen with age, although worsening progression is not common.

Some people who have tics or Tourette’s experience episodes of exacerbation that can last for a few months, particularly during times of stress or anxiety.

There is no evidence that early intervention can help prevent the symptoms from worsening. There is some evidence that children who experience shame or excessive attention related to the tics can become anxious.

Treatment for Tics and Tourette's Syndrome

Most of the time, awareness and understanding of the symptoms is the most important aspect when it comes to dealing with tics and Tourette's. Some people can identify triggers and can develop methods to suppress the tics during times when the movements or sounds would be distracting or troublesome.

There are some medications available for the control of tics, including risperidone, pimozide, aripiprazole, clonidine, clonazepam, and tetrabenazine.

The first 3 medications are categorized as antipsychotics because they were developed for psychotic disordders and that is what they are most commonly used for. However, if your doctor prescribes one of these medications for the control of your tics or your child’s tics, rest assured that this does not mean that you have a psychotic disorder. Some of the medications used to control tics may produce side effects that can be more serious than the tics themselves, and thus some patients choose not to take medication.

Another approach to controlling the tics of Tourette’s is a procedure called deep brain stimulation (DBS). DBS involves the surgical placement of a device that electrically stimulates a targeted region of the brain. DBS is a safe technique that requires an intricate and carefully planned surgical procedure. DBS has been used as a treatment for several neurological conditions, including epilepsy and Parkinson’s disease. Not everyone with Tourette’s is expected to benefit from DBS, and it is only recommended for conditions that are severe and that do not improve with the usual treatments.

Are Tics or Tourette's Caused by a Mental Condition?

There are a few other conditions that seem to be more common among those who have tics or Tourette's, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, and depression. Individuals who have tics or Tourette's have the same intelligence level as those who do not have these conditions.

Conditions That Can Be Confused With Tics and Tourette’s

There are other common habits and conditions that may be confused with tics. Fidgeting is a deliberate and habitual type of movement that is more controllable and less repetitive than tics. Tremors, such as those seen in​ ​Parkinson’s disease or benign essential tremor, are not as controllable as tics and usually worsen over time. Seizures are characterized by involuntary movements and/or change in consciousness, while there is no change in awareness or consciousness associated with tics.

Why Do Some People Have Tics or Tourette’s?

So far, it is not completely clear why these conditions develop. There does appear to be a strong genetic component, with most scientific reports consistently pointing to about a 50 percent family history of tics. There may also be other environmental or developmental factors that have not yet been identified.

Overall, tics and Tourette's syndrome have been quite steady as far as prevalence in the general population and do not seem to be increasing or decreasing. These conditions occur throughout the world at a fairly constant rate.

A Word from Verywell

For most people, living with tics or Tourette's turns out to be less stressful than worrying about tics or Tourette's. Many parents become frustrated, anxious and frightened about their child's future when they see their child making unusual movements or sounds. You should discuss the symptoms with your child’s doctor, who can help alleviate the stress you are experiencing and decide if any medical testing or therapeutic treatment is necessary.

Sources:

Smeets AY, Duits AA, Leentjens AF, Schruers K, et al, Thalamic Deep Brain Stimulation for Refractory Tourette Syndrome: Clinical Evidence for Increasing Disbalance of Therapeutic Effects and Side Effects at Long-Term Follow-Up, Neuromodulation. 2017 Jan 19. doi: 10.1111/ner.12556

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