Tourette Syndrome

Introduction

-Gilles de la Tourette syndrome is a chronic neuropsychiatric disorder characterized by multiple motor and phonic tics. 

-Tics are sudden, involuntary, rapid, uncontrollable, repetitive, nonrhythmic, stereotyped movements with no purpose. 

-Symptoms begin before 21 years of age, most often by the age of 11

-the course is one of remission and relapse.

-the disorder is more common in males than females 

Symptoms & Signs 

Tics typically start early, at 3–5 years of age, and peak around 9–12 years

Phonic Tics: Throat-clearing,gruting, barking, sniffing, hissing

Coprolalia: Vulgar or obscene speech 

Echolalia: Parroting the speech of others 

Echopraxia: Imitation of others’ movements 

Palilalia: Repetition of words or phrases 

Motor tics: Eye Blinking, facial grimacing, sniffing, hopping, jumping, and kicking, body gyrations, complex obscene gestures, neck jerking, shoulder shrugging 

Sensory tics: Tics consisting of pressure, tickling, and warm or cold sensations 

Behavioral disorders: Anxiety, obsessive-compulsive disorder, attention deficit disorder, depression 

Diagnosis 

Diagnosis is made based on history and physical examination

Laboratory tests are normal 

Treatment 

Behavioral therapy: Cognitive behavioral therapy, Habit reversal training 

Pharmacotherapy: 

α-Adrenergic agonists: the first-line therapies

Clonidine: Most frequent side-effects are sedation, orthostatic hypotension, constipation 

Guanfacine 

Antipsychotics: Risperidone, Aripiprazole,olanzapine, ziprasidone, Haloperidol, Pimozide 

Botulinum toxin A injections 

Tetrabenazine 

Prognosis 

-the disorder is chronic, with waxing and waning

-Majority will experience significant improvement by the end of adolescence (80%).

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