Some are self-injuring, such as hitting oneself. They can also change in nature over time. Few people understand the intense psychological component of TS. Sutie describes her tics as moderate, but burdensome. In a way, these movements are a physical manifestation of my compulsive nature. Treatment for TS may include medication such as minor and major tranquilizers, among others, but many of these drugs cause drowsiness or sedation. Cognitive-behavioral therapy may also be helpful.
For example, the patient is encouraged to counter the urge to tic by engaging in another activity. Sutie began experimenting artistically with her tics after graduating from Arcadia University, where she studied painting. Some with TS will describe a need to complete a tic in a certain way or a certain number of times to relieve the urge or decrease the sensation.
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. To appreciate what first led Gilles de la Tourette to Tourette syndrome, however, it is necessary to turn to an article that he published a year earlier. In his article, Gilles de la Tourette cited several movement disorders that he thought were similar to each other, yet different from true chorea.
After describing these disorders, namely, "jumping" of Maine, latah of Malaysia, and miryachit of Siberia, he briefly mentioned a boy in Charcot's ward in Paris, France, who seemed to exhibit the same condition.
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