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Tourettes research
Anyone reading my journal please disregard the following unless you are interested in learning more about TS, commonly known as Tourettes Syndrome. My computer at home is not working and this is the only way i have to save my information on the library's computer. Thanks!:)
Glossary of Terms Related to Tourette Syndrome
Akathisia - Inability to be still; a feeling of inner restlessness. A possible side effect of neuroleptic medications
Antidepressant - A prescription drug that relieves or minimizes depression
Arithmomania - Compulsive mental counting
Associated behaviors - The spectrum of behaviors sometimes seen in association with Tourette Syndrome; include OCD, ADHD, and poor impulse control
Attention deficit hyperactivity disorder (ADHD) - A neurobiological disorder causing distractibility and inability to focus attention
Basal ganglia - Structures deep in brainstem that relay messages between the prefrontal cortex and the lower motor and sensory areas
Behavior therapy - Used with OCD and other conditions such as phobias; a person is exposed to anxiety-provoking stimuli while being prevented from performing the ritual or behavior previously used to reduce that anxiety
Bi-polar disorder - Another name for manic-depression, a disorder involving extreme ups and downs in mood
CAT scan - (also known as CT scan) Computerized axial. tomography, a series of computerized X-rays of the brain
Catapres - See clonidine
Central nervous system (CNS) - Refers to voluntary activity of the brain and spinal cord
Chorea - Abrupt, quick, jerky movements of the head, neck, arms, or legs
Chromosomes - Microscopic, rod-shaped bodies in cells which contain genetic material
Clomipramine - An antidepressant medication used in Tourette Syndrome to treat symptoms of OCD
Clonidine (Catapres) - A high blood pressure medication used in treatment of TS. It can be helpful in controlling tics and ADHD symptoms.
Cognitive dulling - A common side effect of neuroleptic drugs; involves short-term memory loss and slowed thinking
Co-morbid condition - Medical term meaning a medical condition that occurs along with another medical condition, although one condition does not directly cause the other
Compulsion - The feeling of being compelled or forced to do a behavior, even though the person experiencing the compulsion does not want to do it. For example, evening things up, washing hands, cleaning
Coprolalia - Involuntary utterances of obscene or inappropriate statements or words
Depression - Disorder producing depressed mood, appetite changes, sleep changes, and sometimes suicidal thinking. Can often be treated with medication
Desipramine - A tricyclic antidepressant used in the treatment of ADHD associated with TS
Developmental disability - A handicap or impairment originating before the age of eighteen which may be expected to continue indefinitely and which constitutes a substantial disability
Diagnostic and Statistical Manual of Mental Disorders (DSM IV) - A manual published by the American Psychiatric Association (APA) which describes all of the diagnostic criteria and the systematic descriptions of various mental disorders
Dopamine - One of the neurotransmitters (brain chemicals) involved in motor and vocal tics
Dyskinesia - A general term for involuntary movements
Dyslexia - One type of learning disability that affects reading ability
Echolalia - Involuntary repetition of words or phrases of others
Echopraxia - Copying the gestures of others
Etiology - The study of the cause of a disease or condition
Extrapyramidal effects - Side effects of medications
Fluoxetine (Prozac ) - An antidepressant used in TS to treat OCD and depression
Genes - Material within the chromosomes that determines specific traits, such as hair and eye color and stature
Haloperidol (Haldol) - A neuroleptic medication used to treat TS
Involuntary movements - Actions beyond one's control
Magnetic Resonance Imaging (MRI) - A scan of the brain or other part of the body that employs magnetic and low-energy radiowaves. No radioactive materials or dyes are needed
Methylphenidate - A stimulant drug often prescribed for ADHD; can cause increase in tics of TS
Monozygotic twins - Identical twins
Neuroleptic - A class of medications, e.g. haloperidol, pimozide
Neurotransmitter - Any of the chemicals carrying nerve impulses across the synapse (gap) between adjacent neurons (nerve cells)
Norepinephrine - One of the brain's neurotransmitters involved in the formation and function of dopamine and serotonin.
Obsession - An unwanted recurring thought or impulse that is without purpose
Obsessive-compulsive disorder (OCD) - When a person has uncontrollable thoughts and compulsive behaviors to an extent that impairs functioning
Orap - See pimozide
Palilalia - Repeating one's own words or phrases
Pimozide - A neuroleptic drug used to help reduce tics of TS
Positron Emission Tomography (PET) - An imaging technique using small amounts of radioactive material that produces a cross-sectional view of specific chemical activities in the brain
Premonitory urges - Sensations immediately preceding an involuntary movement or vocalization
Prozac - See fluoxetine
Remission - A complete absence of symptoms for a period of months to years . . . Sometimes occurs with TS
Ritalin - See methylphenidate
Serotonin - One of the brain's neurotransmitters, believed to be involved in depression and OCD
Side effects - Secondary, unwanted effects of using a medication
Single Photon Emission Computed Tomography (SPECT) - Device which measures brain function through blood flow and glucose metabolism
Stimulant - A psychotrophic drug such as Ritalin and dexedrine often used to control hyperactivity in children
Synapse - The gap between neurons, across which messages are carried by neurotransmitters
Tardive dyskinesia - Involuntary movements of the mouth, tongue, and lips. Some medications prescribed for Tourette Syndrome can contribute to the development of this condition
Tic - An involuntary movement (motor tic) or involuntary vocalization (vocal tic)
Titration - Process of determining how much of a medication is required to produce a desired reaction
Tourette Syndrome - A chronic, physical disorder of the brain which causes both motor tics and vocal tics, and begins before the age of eighteen
Trichotillomania - A compulsion to pull out one's own hair in order to relieve anxiety
Waxing and waning - A naturally occurring increase and decrease in severity and frequency of TS symptoms
Frequently Asked Questions and Answers about Tourette Syndrome
Q. What is Tourette Syndrome?
A. Tourette Syndrome (TS) is a neurological disorder characterized by tics -- involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way.
The symptoms include:
1.Both multiple motor and one or more vocal tics present at some time during the illness - although not necessarily simultaneously;
2.The occurrence of tics many times a day (usually in bouts) nearly every day or intermittently throughout a span of more than one year;
3.Periodic changes in the number, frequency, type and location of the tics, and in the waxing and waning of their severity. Symptoms can sometimes disappear for weeks or months at a time.
4.Onset before the age of 18.
The term, "involuntary," used to describe TS tics is sometimes confusing since it is known that most people with TS do have some control over their symptoms. What is not recognized is that the control, which can be exercised anywhere from seconds to hours at a time, may merely postpone more severe outbursts of symptoms. Tics are experienced as irresistible and (as the urge to sneeze) eventually must be expressed. People with TS often seek a secluded spot to release their symptoms after delaying them in school or at work. Typically, tics increase as a result of tension or stress, and decrease with relaxation or concentration on an absorbing task.
Q. How would a typical case of TS be described?
A. The term typical cannot be applied to TS. The expression of symptoms covers a spectrum from very mild to quite severe. However, the majority of cases are in the mild category.
Q. What causes the symptoms?
A. The cause has not been established, although current research presents considerable evidence that the disorder stems from the abnormal metabolism of several brain chemicals (neurotransmitters) such as dopamine and serotonin.
Q. How is TS diagnosed?
A. A diagnosis is made by observing symptoms and by evaluating the history of their onset. No blood analysis or other types of neurological tests exist to diagnose TS. However, some physicians may wish to order an EEG, MRI, CAT scan, or certain blood tests to rule out other ailments that might be confused with TS.
Q. What are the first symptoms?
A. The most common first symptom is a facial tic such as rapidly blinking eyes or twitches of the mouth. However, involuntary sounds such as throat clearing and sniffing, or tics of the limbs may be initial signs.
Q. How are tics classified?
A. There are two categories of tics: motor and vocal. Both of these are then subdivided into simple and complex.
Simple:
Motor-- Eye blinking, head jerking, shoulder shrugging and facial grimacing.
Vocal-- Throat clearing, yelping and other noises, sniffing and tongue clicking.
Complex:
Motor-- Jumping, touching other people or things, smelling, twirling about, and only rarely self-injurious actions including hitting or biting oneself.
Vocal-- Uttering words or phrases out of context and coprolalia (vocalizing socially unacceptable words).
The range of tics is very broad. Some symptoms are often so complex that family members, friends, teachers and employers may find it hard to believe that the movements and vocalizations are involuntary.
Q. How is TS treated?
A. The majority of people with TS are not significantly disabled by their tics or behavioral symptoms, and therefore do not require medication. However, there are medications available to help control the symptoms when they interfere with functioning. The drugs include haloperidol (Haldol), clonidine (Catapres), pimozide (Orap), fluphenazine (Prolixin, Permitil), and clonazepam (Klonopin). Stimulants such as Ritalin, Cylert, and Dexedrine that are prescribed for ADHD may increase tics. Their use is controversial. For obsessive compulsive traits that interfere significantly with daily functioning, fluoxetine (Prozac), clomipramine (Anafranil), sertraline (Zoloft), fluvoxamine (Luvox) and paroxetine (Paxil) are prescribed. Risperidone (Risperdal) is a newer medication that is also being prescribed.
Dosages which achieve maximum control of symptoms vary for each patient and must be gauged carefully by a doctor. The medicine is administered in small doses with gradual increases to the point where there is maximum alleviation of symptoms with minimal side effects. Some of the undesirable reactions to medications are weight gain, muscular rigidity, fatigue, motor restlessness and social withdrawal, most of which can be reduced with specific medications. Side effects such as depression and cognitive impairment can be alleviated with dosage reduction or a change of medication.
Other types of therapy may also be helpful. Psychotherapy can assist a person with TS and help his/her family cope, and some behavior therapies can teach the substitution of one tic for another that is more acceptable. The use of relaxation techniques, biofeedback and exercise can reduce the stress that often exacerbates tic symptoms.
Q. Is it important to receive a TS diagnosis early in life?
A. Yes, especially in those instances when the symptoms are viewed by some people as bizarre, disruptive and frightening. Sometimes TS symptoms provoke ridicule and rejection by peers, neighbors, teachers and even casual observers. Parents may be overwhelmed by the strangeness of their child's behavior. The child may be threatened, excluded from activities and prevented from enjoying normal interpersonal relationships. These difficulties may become greater during adolescence -- an especially trying period for young people and even more so for a person coping with a neurological problem. To avoid psychological harm, early diagnosis and treatment are crucial. Moreover, in more serious cases, it is possible to control the symptoms with medication.
Q. Do all people with TS have associated behaviors in addition to tics?
A. No, but many do have one or more additional problems which may include:
- Obsessions which consist of repetitive unwanted or bothersome thoughts.
- Compulsions and Ritualistic Behaviors are when a person feels that something must be done over and over and/or in a certain way. Examples include touching an object with one hand after touching it with the other hand to "even things up" or repeatedly checking to see that the flame on the stove is turned off. Children sometimes beg their parents to repeat a sentence many times until it "sounds right."
- Attention Deficit Disorder with or without Hyperactivity (ADD or ADHD) occurs in many people with TS. Children may show signs of hyperactivity before TS symptoms appear. Indications of ADHD may include: difficulty with concentration; failing to finish what is started; not listening; being easily distracted; often acting before thinking; shifting constantly from one activity to another; needing a great deal of supervision; and general fidgeting. Adults too may exhibit signs of ADHD such as overly impulsive behavior and concentration difficulties and the need to move constantly. ADD without hyperactivity includes all of the above symptoms except for the high level of activity. As children with ADHD mature, the need to move is more likely to be expressed by restless, fidgety behavior. Difficulties with concentration and poor impulse control persist.
- Learning Disabilities may include reading and writing difficulties, arithmetic disorders and perceptual problems.
- Difficulties with impulse control which may result, in rare instances, in overly aggressive behaviors or socially inappropriate acts. Also, defiant and angry behaviors can occur.
- Sleep Disorders are fairly common among people with TS. These include frequent awakenings or walking or talking in one's sleep.
Q. Do students with TS have special educational needs?
A. While school children with TS as a group have the same IQ range as the population at large, many have special educational needs. It is estimated that many may have some kind of learning problem. That condition, combined with attention deficits and the problems inherent in dealing with frequent tics, often call for special educational assistance. The use of tape recorders, typewriters, or computers for reading and writing problems, untimed exams (in a private room if vocal tics are a problem), and permission to leave the classroom when tics become overwhelming are often helpful. Some children need extra help such as access to tutoring in a resource room.
When difficulties in school cannot be resolved, an educational evaluation may be indicated. A resulting identification as "other health impaired" under federal law will entitle the student to an Individual Education Plan (IEP) which addresses specific educational problems in school. Such an approach can significantly reduce the learning difficulties that prevent the young person from performing at his/her potential. The child who cannot be adequately educated in a public school with special services geared to his/her individual needs may be best served by a special school.
Q. Is TS inherited?
A. Genetic studies indicate that TS is inherited as a dominant gene (or genes) causing different symptoms in different family members. A person with TS has about a 50% chance of passing the gene to one of his/her children with each separate pregnancy. However, that genetic predisposition may express itself as TS, as a milder tic disorder or as obsessive compulsive symptoms with no tics at all. It is known that a higher than normal incidence of milder tic disorders and obsessive compulsive behaviors occurs in the families of TS patients.
The sex of the child also influences the genetic expression of the condition. The chance that the gene-carrying child of a person with TS will have symptoms is at least three to four times higher for a son than for a daughter. Yet only about 10% of the children who inherit the genetic predisposition will have symptoms severe enough to ever require medical attention. In some cases TS may not be inherited, and is identified. Those cases are called sporadic TS and the cause is unknown.
Q. Is there a cure?
A. Not yet.
Q. Is there ever a remission?
A. Many people experience marked improvement in their late teens or early twenties. Most people with TS get better, not worse, as they mature, and those diagnosed with TS have a normal life span. As many as 1/3 of patients experience remission of tic symptoms in adulthood.
Q. How many people in the U.S. have TS?
A. Since many people with TS have yet to be diagnosed, there are no absolute figures. The official estimate by the National Institutes of Health is that 100,000 Americans have full-blown TS. Some genetic studies suggest that the figure may be as high as one in two hundred if those with chronic multiple tics and/or transient childhood tics are included in the count.
The Tourette Syndrome Association has an extensive Catalog of Publications and Videos that details many of the topics touched upon in these FAQs.
SIMPLIFIED CHART FOR IDENTIFICATION OF TICS
SIMPLE COMPLEX
MOTOR Eye blinking Jumping
Head Shaking Touching
Head jerking Smelling
Neck jerking Stamping
Shoulder shrugging Twirling about
Facial Echopraxia
Copropraxia
VOCAL Throat clearing Palilalia
Coughing Coprolalia
Snorting Echolalia
Barking
Yelping
Sniffing
Tongue Clicking
DIAGNOSTIC CRITERIA FOR TIC DISORDERS
Transient Tic Disorders
- most common of the tic disorders
- onset during early school years
- affects 5% to 24% of all children
- single or multiple motor and/or vocal tics occurring daily for at least two weeks but for no longer than one year
- three to four times more common in males than females
- more common in the first-degree relatives of people who have transient tic disorders
Chronic Motor/Vocal Tic Disorder
- onset before age 21
- usually persist unchanged throughout a period of more than one year ยท involves either motor or vocal tics
- generally related to Tourette's syndrome
Tourette Syndrome
- Symptoms begin before age 21.
- Tics occur for more than one year.
- Tics are highly variable, changing over time in anatomic location, number, complexity, and frequency.
- Associated problems may include obsessive compulsive disorder.
- Associated behavioral difficulties may include problems in attention, hyperactivity, and emotional liability.
- Symptoms can be suppressed at school, then emerge abruptly upon arrival in the safety of the home.
- Fifty to sixty percent of children with TS have attention deficit hyperactive disorder.
http://www.angelfire.com/ok/onedayatatime/diag.html
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