Tourette Syndrome

What is Tourette syndrome?

Tourette syndrome (TS) is a neurological disorder (a condition that affects your nervous system). People with Tourette syndrome make repetitive movements or sounds. These behaviors, called tics, are unwanted and repeated. The person can’t easily control them.

There are two types of tics: simple and complex. Simple tics usually start first, followed by complex tics:

• Simple tics: Short, sudden movements or sounds, such as blinking (simple motor tic) or throat clearing (simple vocal tic).
• Complex tics: Sequences of movements or phrases that use different muscles or parts of the body, such as jumping or repeating words. Someone with complex tics may seem like they are doing them on purpose.

Tourette syndrome usually starts between ages 5 and 10 and may get worse in the preteen and teen years before improving and being controlled in adulthood. However, some people have symptoms that last into adulthood. Symptoms can range from mild to severe.

Causes and risk factors for Tourette syndrome

Experts don’t know exactly what causes Tourette syndrome. These factors may play a role:

• Genetics: TS often runs in families, so there may be a genetic link. Having a family history of tic disorders, obsessive compulsive disorder (OCD) or attention deficit hyperactivity disorder (ADHD) is a known risk factor.
• Brain structure and function: Abnormalities in brain regions like the basal ganglia, frontal lobes and cortex – and in neurotransmitters such as dopamine and serotonin – may play a role in TS.
• Gender: Boys are three to four times more likely than girls to develop Tourette syndrome.
• Prenatal and birth factors: Complications during pregnancy (such as low birth weight, smoking or stress) might increase the risk of TS, although more research is needed.

Signs and symptoms of Tourette syndrome

Motor and vocal tics are the main symptoms of Tourette syndrome. Tics that involve movement are called motor tics, while tics that involve sound are called vocal tics. Over time, these symptoms could change in how severe they are, how often they happen, and what part of the body they affect.

Motor tics

Motor tics often start in the head and neck and reach the body, arms and legs over time. They usually begin before vocal tics. Motor tics include movements you can’t stop such as:

• Eye blinking
• Face grimacing
• Head jerking
• Shoulder shrugging
• Arm or leg movements

Extreme motor tics could cause self-harm.

Vocal tics

Vocal tics are sounds or phrases made without control. Vocal tics include:

• Throat clearing
• Grunting
• Sniffing
• Repeating words or phrases
• Repeating other people’s words (echolalia)
• Using swears or vulgar language (coprolalia)

Although the swearing and vulgar language tics get attention in the media, most people with TS don’t have them.

You may feel a tingle or tension as a sign a tic is about to begin and you may feel as though the tic needs to happen a number of times or in a certain way before it can stop. 

You might be able to suppress tics with a lot of effort, but you may feel as though they then build up until they have to come out.

Being stressed, excited or tired may make tics worse. Being calm or busy with an activity can make them better. Light sleep reduces tics and they don’t happen during deep sleep.

Related conditions and challenges

Many people with Tourette syndrome often have other conditions. That can make it harder to manage symptoms:

• ADHD: Difficulty focusing, hyperactivity and impulsiveness
• OCD: Repetitive thoughts and behaviors
• Anxiety disorders: Excessive worry that may make tics worse
• Learning difficulties: Trouble focusing and processing information in school
• Behavioral issues: Acting aggressively, struggling to control anger or trouble in social situations
• Sleep disorders: Trouble falling asleep and staying asleep
• Sensory processing issues: Difficulty processing information from sight, sound, touch, taste or smell

These conditions can make a big impact on a person’s daily life. So it’s important to find a treatment plan that includes all the conditions they may have. 

Conditions that Tourette syndrome may be mistaken for

Some other conditions have symptoms similar to those of TS include:

• Functional Neurological Disorder: Rapid onset tic-like movements and sounds that are not considered to be a developmental disorder but can still respond to behavioral therapies like those that are helpful for tics and Tourette’s.
• Transient tic disorder: Temporary tics that last less than a year
• Persistent (chronic) motor or vocal tic disorder: Tics lasting a year or more that are either motor or vocal but not both
• Autism spectrum disorder: Repeated movements and speech patterns can seem like tics
• Seizure disorders: Involuntary movements that may look like tics
• Habit disorders: Behaviors like hair twirling or nail biting may be confused with tics

Diagnosis of Tourette syndrome and related disorders

To diagnose TS, your health care provider will evaluate your symptoms and review your medical history. They may:

• Observe the type of tics and how often they occur
• Make sure that you’ve had both motor and vocal tics for at least one year and that they started before age 18
• Rule out other causes of tics

There are no specific tests that diagnose tics. Your provider may perform tests, such as a blood test, neurological exam or brain imaging, to rule out other conditions.

Treatment options for Tourette syndrome

There is no cure for Tourette syndrome. Mild symptoms may not need treatment. Behavioral therapies, medication and other treatments may help manage symptoms that interfere with your daily life. Your health care provider can work with you to come up with a treatment plan that helps with your symptoms and meets your needs.

Behavioral therapies

• Comprehensive behavioral intervention for tics (CBIT) can help you learn techniques to manage and reduce tics.
• Cognitive behavioral therapy (CBT) can help you cope with TS and can address anxiety, depression, ADHD and OCD symptoms.

Medications

For severe symptoms, medications may help, including:

• Drugs that reduce or block dopamine, a brain chemical, to help control tics
• Clonidine or guanfacine (blood pressure medications that can also help tics)
• Topiramate
• Botulinum toxin injections
• Medications for anxiety, depression, OCD or ADHD

Other treatment options

• Deep brain stimulation (DBS) may be an option in severe cases when other treatments don’t work.
• Lifestyle adjustments like stress management and structured routines may be helpful.

Living with Tourette syndrome

Managing TS involves more than just reducing tics. These strategies can help you have a better quality of life:

• Mindfulness and relaxation exercises can help you cope with the condition.
• School support, like extra time on tests, tutoring, smaller classes and other accommodations can help, especially in cases where a student has TS and other conditions such as ADHD or OCD.
• Flexible work arrangements can help you succeed in your job.
• Community support groups can connect you with others who understand your experience and can share strategies that have helped them.

When to seek help

It’s important to talk to a health care provider if:

• Tics are having a big impact on your daily life
• Symptoms become painful or get worse
• You need care for other conditions like OCD or ADHD

Early diagnosis and treatment of Tourette syndrome can make it easier to manage symptoms and improve your quality of life.

Getting care

At Banner Health, our team of neurologists, therapists and specialists experienced in tic disorders provides thorough, compassionate care for people with Tourette syndrome. Our personalized treatment plans and access to the latest therapies are aimed at improving your outcome and your well-being.