Research Paper on Tourette Syndrome

Definition and Historical Background

The Tourette syndrome abbreviated as TS is a neurological disorder associated with involuntary movements (tics), compulsive rituals or behaviors, or involuntary sounds that are repetitive (Tabers Medical Dictionary, 2018). According to studies, Tourette syndrome is characterized by multiple involuntary motor movements and the minimum of one vocal tic (Williams, 2013). In other words, the condition is defined as a spectrum of tic neural disorders with chronic and transient tics. The disorder was named after Dr. Georges Gilles de la Tourette, a French neurologist, who first identified the condition in 1885 (Tabers Medical Dictionary, 2018). In medical literature, the first reported case of the condition was in 1825, when a French doctor Jean Marc Gaspard illustrated the case of a woman named Marquise de Dampierre. She was a noblewoman with vocalization tics where she uttered swear words and regularly yelled out obscenities while conversing with her high society friends. Dr. Georges Gilles de la Tourette was working with nine patients at l'Hopital de la Salpetriere who had "maladie des tics." He used Marquise de Dampierre as his case example to describe the neural disorder. His findings were published in the landmark medical journal Archives de Neurologie on January 1885 (Williams, 2013). In the article, Dr. Tourette observed that the nine patients had stereotyped movements, waning and waxing, premonitory sensation and the disorder was onset during childhood. Therefore, he speculated that the condition was hereditary and that the nervous system was weakened by immoral past behaviors. However, Dr. Tourette succumbed to death when he was shot by a derailed woman who was his patients. In honor of his name, Dr. Charcot who trained him named the disorder Gilles de la Tourette. Currently, the condition is widely renowned as Tourette disorder (TD) or Tourette syndrome (TS) (Wyborny, 2011).

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Save 25%

Diagnostic Tests

According to the DSM-5 psychological classification of mental disorders, TS may be diagnosed when the onset occurred before an individual attained 18 years of age and exhibits multiple motor tics and at least one vocal tic in a one year period (Williams, 2013). However, the vocal and motor tics should be concurrent. Therefore, a diagnosis can only be made by an experienced physician based on the historical symptoms of the neural disorder. However, there are no biological tests to confirm the TS diagnosis. Furthermore, there are no specific screening tests leading the frequent underdiagnosis or misdiagnosis of the disorder. Due to a broad array of severity expressions, a range of severe or moderate tics like eye blinking and coughing that mimic unrelated medical conditions such asthma, the risk of wrong diagnosis increases. In case a family history entails reported tics and compulsive or obsessive disorder, a basic neurological and physical examination would be sufficient for a physician to diagnose TS. Moreover, to rule out the secondary causes of tics, physicians may order Magnetic Reasoning Imaging (MRI) and Electroencephalography (EEG) to check for brain abnormalities and clear the confusion between seizures and tics respectively. According to Wyborny (2011) medical studies indicate that even though not all Tourette affected people possess comorbid conditions, most patients with the condition may exhibit symptoms derived from other conditions like ADHD.

Signs and Symptoms

The tics in TS fall in either the simple or complex category. The simple tics are repetitive, sudden movements confined to a small group of muscles. For instance, the eye movements shoulder shrugging, and facial grimacing (Wyborny, 2011). The simple vocal tics include grunting sounds, sniffling or throat-clearing. On the other hand, complex tics are quite distinct because they involve coordinated motor movements. Complex motor tics appear as though a patient purposely engages them. They involve head twist combined with shoulder shrugging and facial grimacing (Williams, 2013). Apart from that, they also involve jumping, hopping or touching objects. Likewise, complex vocalization tics include grunting, sniffing, throat-clearing or even barking. In most severe cases, patients may utter words or phrases repetitively medically known as echolalia. However, severe tics could be more dramatic and lead to self-harm like pinching or punching oneself. Besides, complex vocal tics could lead to coprolalia, a situation involving the uttering of words inappropriate for social interactions. Only 10-15% of Tourette's patients have coprolalia (Ninds.nih.gov, 2018). It is important to note that some of the tics enhance sensation of the affected group of muscles or present a preceded urge known as premonitory urge. Some people with the condition may experience the urge to complete a tic in a particular manner or countless times to decreases the sensation or relieve the premonitory urge. Most importantly, anxiety or excitement leads to aggressive tics that are better during focused or calm activities. Likewise, certain physical experiences such as wearing a tight collar could trigger neck tics (Scahill, Dalsgaard & Bradbury, 2013).

Causes

The causes of Tourette syndrome together with other tic disorders remain unknown over a century since the disease was discovered. The condition seems hereditary because most patients are born with the disorder; hence research indicates that genetics plays a role in some of the TS cases (Fernandez & State, 2013). People with a family history of TS are more likely to develop the neural condition. However, developmental, environmental and other factors may contribute to the disorders, but medical scientists and physicians have not identified a specific agent. Therefore, Tourette syndrome may likely to be caused by complex interaction between external factors and genetics, which varies among afflicted individuals. Nonetheless, TS has been linked with the basal ganglia and other brain parts that control body movements (Fernandez & State, 2013).

Prevalence and Typically Afflicted

TS has been reported in all parts of the globe. The disorder is found in all social groups (both racial and ethnic). According to a study by the CDC, one in every 360 children aged 6-17 in the US is diagnosed with Tourette syndrome based on the parents' reports. The CDC acknowledges that it does not have the actual number of people affected by TS. However, the CDC estimates that 138,000 children have been diagnosed with TS in the US (CDC.gov, 2018). Other studies indicate that 1% of the population is affected by tic disorders and that chronic and moderate tics affect 5% and 20% of children respectively (Scahill, Dalsgaard & Bradbury, 2013). Boys are thrice as likely to develop TS as compared to girls according to the CDC. According to the US National Institutes of Health (NIH), there has been an increase in TS cases since the 2000s. In the 1970s, the NIH reported that there were less than 100 Tourette syndrome cases in the US (Ninds.nih.gov, 2018).

Treatment

Tic disorders do not cause impairments. Therefore, some people do not require medication to curb tics. However, there exists effective medical treatment for people with symptoms that affect their functioning. For example, the neuroleptic drugs used in the treatment of psychotic disorders are effective for tic suppression (Ninds.nih.gov, 2018). However, there are no effective medical options or treatments that help in the elimination of symptoms. As such, the neuroleptics have side effects that could be reduced by minimizing the intake of the drugs. Some of the common side effects include cognitive dulling, weight gain, and sedation. Alternative medications such as alpha-adrenergic agonists like the clonidine have demonstrated efficacy in reducing the efficacy of tics. Some of the risk-free alternative treatments include behavioral therapy. Awareness training and competing response therapy sessions help TS patients learn how to reduce tics. The NIH has instituted the Cognitive Behavioral Intervention for Tics (CBIT) to handle or counter premonitory urge. However, supportive and biofeedback therapy has not been effective in reducing the efficacy of tics (Ninds.nih.gov, 2018).

Prognosis

The NIH states that even though there is no cure for Tourette syndrome, the condition improves with age (Williams, 2013). Some individuals overcome tics and live a normal life without the need for medication to suppress tics. However, people with other conditions such as ADHD together with TS may experience behavioral changes such as mood swings later in life even though the symptoms of TS decrease with age. Furthermore, research studies indicate the disorder is not degenerative even though it is lifelong and chronic (Ninds.nih.gov, 2018).

Research and Development

Clinical trials are currently underway. For example the NIH and the National Institute of Neurological Disorders and Stroke (NINDS), federal government initiatives have been working on clinical trials involving the treatment of ADHD in Tourette syndrome to reduce the severity of symptoms, especially in affected children. Since TS cuts across different medical fields, current research is ongoing in genetic, neuroimaging, neuropathology and epidemiology and clinical studies to understand and treat the disorder (Ninds.nih.gov, 2018).

Economic Implications

The Tourette syndrome is an economic burden to affected individuals. The costs of treatment and therapy are exhaustive because there are onl7y a few professionals and clinical facilities that handle the condition. Besides, some people lose income because the symptoms affect their ability to handle tasks. Individuals with tics that limit their functioning are discriminated from jobs leading to loss of wages. For those with severe symptoms, they increase the dependency level of their families (Williams, 2013).

References

CDC.gov. (2018). Data and Statistics | Tourette Syndrome | NCBDDD | CDC. Centers for Disease Control and Prevention. Retrieved 9 April 2018, from https://www.cdc.gov/ncbddd/tourette/data.html

Fernandez, T. V., & State, M. W. (2013). Genetic Susceptibility in Tourette Syndrome. Tourette Syndrome, 137-155. Doi:10.1093/med/9780199796267.003.0007

Ninds.nih.gov. (2018). Tourette Syndrome Fact Sheet | National Institute of Neurological Disorders and Stroke. Retrieved 9 April 2018, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tourette-Syndrome-Fact-Sheet

Scahill, L., Dalsgaard, S., & Bradbury, K. (2013). The Prevalence of Tourette Syndrome and its Relationship to Clinical Features. Tourette Syndrome, 121-134. Doi:10.1093/med/9780199796267.003.0006

Tabers.com. (2018). Tourette syndrome | Taber's Online. Retrieved 9 April 2018, from https://www.tabers.com/tabersonline/view/Tabers-Dictionary/756306/all/tourettesyndrome

Williams, M. (2013). Tourette syndrome. Detroit [Mich.]: Greenhaven Press.

Wyborny, S. (2011). Tourette syndrome. Detroit, MI: Lucent Books.