• Clinical science

Tourette syndrome

Abstract

Tourette syndrome is a severe neurological movement disorder characterized by tics, which are involuntary, repeated, intermittent movements or vocalizations. It is a genetic disorder that commonly presents in boys and is often associated with attention deficit hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD). Diagnosis is based upon multiple motor tics and at least one vocal tic, lasting for longer than a year, and the exclusion of other suspected medical conditions. Treatment is symptomatic and includes behavioral therapy and dopamine antagonists. Approximately 50% of cases resolve by adulthood.

Epidemiology

  • Sex: >
  • Age of onset: usually 2–15 years of age


References:[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[2]

Clinical features

  • Tics
    • Sudden and rapid involuntary, intermittent, nonrhythmic movements or vocalizations without any recognizable purpose
    • Temporarily suppressible
    • An urge or sensation preceding the tic is relieved by its onset.
Simple Complex
Vocal tics
  • Throat clearing
  • Grunting
  • Lip smacking
  • Barking
  • Sniffing
  • Coprolalia: uttering obscene or socially inappropriate words or phrases
  • Echolalia: repeating vocalizations of others
Motor tics
  • Facial grimacing
  • Blinking
  • Shoulder shrugging
  • Head jerking
  • Jumping
  • Twisting the body
  • Echopraxia: repeating movements of others


References:[2]

Diagnostics

  • Clinical diagnosis based on all of the following:

    • Multiple motor tics and at least 1 vocal tic with a variable anatomical location, frequency, number, frequency, complexity, type, or severity over time
    • Onset before 18 years of age
    • Lasting > 1 year
    • Not explained by other medical conditions or substance use (e.g., cocaine)

References:[2][1]

Differential diagnoses

References:[2][1][3][4][5][6]

The differential diagnoses listed here are not exhaustive.

Treatment

Treatment of associated conditions (i.e., ADHD or OCD) can improve symptoms!

References:[2][7]

Prognosis

  • Symptoms peak during adolescence and improve during adulthood.
  • May resolve spontaneously by 18 years of age (50% of cases)

References:[1]

last updated 10/19/2018
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