Behaviors May Stablize In Adulthood

Q. What is Tourette’s syndrome? My 10-year-old grandson has it, causing him to sometimes make noises like a pigeon. He also makes facial twitches. Will he outgrow this as he gets older? He’s otherwise a healthy and very smart child. What can be done for it? - M.E., Scottsdale, Ariz.

A. In 1883, French neurologist/psychiatrist Georges Gilles de la Tourette described a rare disorder whose symptoms included involuntary tics of many parts of the body. He also described uncontrollable vocalizations, including outbursts of foul language. His impression was that this was some sort of rare psychological disorder.

We now know that it’s a neurological disorder that’s nearly always inherited. It’s believed to be caused by an abnormal breakdown of the brain chemical transmitters dopamine and serotonin. We don’t understand the precise defect that triggers uncontrollable tics, movements, or outbursts of words or phrases. There are no blood tests to measure brain chemicals, and no brain imaging scans can diagnose Tourette’s.

Tourette’s syndrome typically appears in childhood, between the ages of 2 and 15.

The estimated number of Americans with Tourette’s syndrome is 200,000. It affects males 3-4 times as often as females. Usually, as the child enters adulthood, the tics and uncontrollable behaviors stabilize or subside.

There’s a great deal of misunderstanding about Tourette’s syndrome, which I’d like to address:

First, although the example of the child with uncontrollable outbursts of foul language might come to mind when thinking of Tourette’s, only a small percentage of folks actually do that sort of thing. For those who do, most are able to mask their compulsion for outbursts of foul language with alternate words.

Second, those with Tourette’s do not necessarily suffer from mental illness. However, there does seem to be a fairly common association with other behaviors such as obsessive-compulsive personality disorder or attention-deficit hyperactivity disorder. While children with Tourette’s have the same IQ range as the rest of the child population, many do seem to have some sort of difficulty with reading, writing or math.

Third, those who suffer from Tourette’s can’t simply will themselves to control their movements and sounds. Their physical and vocal tics can only be controlled for very short periods of time. After that, they must be released. For them, it’s like trying to hold back a sneeze.

Last, most folks with Tourette’s have only mild symptoms - such as rapidly blinking eyes, mouth twitching, a grimace or involuntary throat clearing or sniffing.

How is Tourette’s treated? Nonmedical treatments focus on relaxation strategies.

Stress, inadequate sleep and too much caffeine can make the symptoms worse. Exercise, relaxing music, meditation, and individual/group therapy may be helpful.

As far as drug treatments, there are several. The uncontrollable tics may be controlled with Clonidine; dopamine-regulating drugs such as Haldol, Prolixin or Orap; or responsible use of tranquilizers.

Obsessive-compulsive personality behaviors may be helped with antidepressants such as Zoloft or Paxil. Attention deficit disorder is usually helped greatly by stimulants such as Ritalin, Dexedrine or Cylert; however, they have the potential to exacerbate the symptoms of Tourette’s syndrome.

Researchers at the University of South Florida are testing low doses of an old and seldom-used blood-pressure drug, Mecamylamine, in Tourette’s syndrome. It’s safer long term than Haldol and seems to be well-tolerated at low doses. It’s under FDA review.

For more information on Tourette’s syndrome, contact the Tourette Syndrome Association online at http:/ /tsa.mgh.harvard.edu/ or call (718) 224-2999.