Tourette Syndrome

Najah Johnson

Tourette syndrome is an inherited severe neurological disorder usually occurring before the age of eighteen and is associated with a degree of facial and body tics sometimes accompanied by random declarations of phrases or obscenities (2,3). The facial and body tics associated with the disorder can be painful and even embarrassing. Involuntary body movements such as jaw snapping, gyrating, hopping, and obscene gesturing are to name a few (1). Tourette Syndrome was named after a French neuropsychiatrist named Gilles de la Tourette who successfully assessed the disorder in the late 1800’s(3). Tourette Syndrome claims no specific race or ethnicity. The disorder generally can affect any ethnic group yet it does affect three to four times more males than it does females (3).

Although just a mere decade ago Tourette Syndrome was frequently misdiagnosed as schizophrenia, Sydenham’s chorea, epilepsy, or nervous habits, its symptoms are now differentiated and specific case related. Tourette Syndrome is a case sensitive genetic disorder that varies from generation to generation. However, not everyone that carries the genetic make up of Tourette Syndrome will express those symptoms (1). Coined as the term autosomal dominate, when one parent is a carrier or expresses symptoms of having Tourette syndrome, there is a 50/50 chance the child will receive the gene from the parent (1,4).

There are several behavioral and cognitive difficulties associated with the tics that many with Tourette Syndrome experience. Although Tourette Syndrome may present itself as a disorder of motor and vocal tics, it is much more complex. Commonly linked with Tourette Syndrome is attention deficit disorder with hyperactivity(ADHD) as well as obsessive compulsive behavior (1,3). There are other behavioral disorders that Tourette Syndrome patients display such as depression, anxiety, irritability, argumentativeness, stubbornness, and impulsivity, that may not be directly linked to Tourette Syndrome itself, but may be contributed to the patient’s reaction to having to live with such a chronic illness (3). Associated with the motor tics experienced by the patient are sometimes more self-destructive behavior such as head banging, eye poking, and lip biting (1). There have also been cases of various learning disabilities connected with Tourette Syndrome such as dyslexia (4).

Vocal tic behavior in patients diagnosed with Tourette Syndrome include outbursts of meaningless words or phrases. The vocal tics disrupt the regular flow of speech and cause the patient to stammer or stutter (1). Inappropriate outbursts called coprolalia are considered involuntary. Coprolalia may also take place in this display of vocal tic disorder. However, coprolalia only takes place in a small number of Tourette Syndrome sufferer’s (1).

Each individual suffering from Tourette Syndrome should be evaluated as such. Certain manifestations of Tourette Syndrome may disable one in certain parts of their life such as in their school performance, while it may affect another’s personality or psyche (3). It may affect a totally different behavioral dimension in one’s life than that of another diagnosed with Tourette Syndrome.

Although research on Tourette Syndrome is ongoing, it is believed that the disorder is related to an abnormal metabolism of the neurotransmitters; dopamine and serotonin (4). Evidence for the involvement of dopamine stems from the response haloperidol and other neuroleptics generate(1). There is currently no cure for each symptom associated with Tourette Syndrome, but these drugs can offer the patient a much less aggravated lifestyle. Haloperidol along with pimozide, flupenazine, and penfluridol have shown reduced levels of dopamine and have therefore led investigators to believe that Tourette Syndrome results from a hypersensitivity of postsynaptic dopamine receptors (1).

The presence of an abnormality in the serotonergic mechanisms in Tourette Syndrome patients have been suggested due a reduced serotonin metabolites after medications. Neurotransmitters seem effective for that part of the brain after medical induction and show to be effective for the obsessive behavior experienced by patients with Tourette Syndrome (1).

As was stated earlier there is no definite cure for Tourette Syndrome as a whole, but only relief for some symptoms of it in some cases. Many that suffer from Tourette Syndrome may not require drug therapy (3). These are those that have a great deal of support and are able to effectively cope with their illness. Drug therapy should be dispensed if Tourette Syndrome is impairing one’s ability to grow and develop socially, and emotionally (1). It is also very important that each case be measured on an individual based scale. In one patient the major problem may be to suppress tic movement and not obsessive compulsive disorders (3). Not every patient with Tourette Syndrome takes a medication, but those that do are usually started off on the smallest dosage possible so that it can be known what movements are being suppressed (1,3). A low dosage also helps to pay attention to the side effects that a patient may develop as a result of the medication.

Tourette Syndrome has raised some interesting questions about the relationship between the brain and behavior. In the specific case of Tourette Syndrome, how meaningful are the tics in determining one’s behavior? If Tourette Syndrome patients brains are undergoing an imbalance that is constant, shouldn’t they have tics or outbursts all of the time? When my body jerks does that classify me as having a chemical imbalance? Or can my behavior be altered without my brain being altered? How does coprolalia play a role in the behavior of someone with Tourette Syndrome? Why do many patients shout profanities instead of saying ‘the flowers smell nice?' My thoughts are that brain and behavior are interrelated, but it could be the case that Tourette Syndrome patient is frustrated with their disorder and is showing a behavior that is perfectly normal. Instead of a scientific name ‘coprolalia’ I think it is just frustration and a normal human reaction. Many of us sometimes say obscenities when we are not satisfied or aggravated with a circumstance.

Behavior is a result of the brain, but in a much more complex fashion than we sometimes tend to realize. Chemical imbalances in the brain can sometimes cause a whole systematic reaction that our bodies just can’t control. While we think of behavior as a voluntary physical action, Tourette Syndrome reminds us that it is not. Without proper brain function our behavior can become totally involuntary and have a ‘mind’ of its own. Behavior is not a result of a physical bodily movement. Behavior may start in the brain and the type of behavior emitted is thus a result of the manner by which that brain functions. However it is also important to be opened minded and realize that sometimes our bodies can react without direct causation of the brain.

WWW Sources

1)htttp://www.mentalhealth.com/book/p40-gtor.html; Guide to the Diagnosis and Treatment of Tourette Syndrome

2)Dictionary.com/tourette syndrome

3)http://www.tsa-usa.org/; Tourette Syndrome Association, Inc.

4)http://members.tripod.com/~tourette13/; The Facts About Tourette Syndrome