Tourette Syndrome and other Tic disorders

In the mid-19th century, Jean-Martin Charcot, the premier neurologist of 19th century France, assigned a young medical neurologist to investigate an unusual disorder.

Georges Gilles de la Tourette

In the mid-19th century, Jean-Martin Charcot, the premier neurologist of 19th century France, assigned a young medical neurologist to investigate an unusual disorder. His name was Georges Gilles de la Tourette.

Gilles de la Tourette’s work in hysteria management and hypnotism built his reputation during his lifetime, but today, he is best known for the condition that now bears his name: Tourette Syndrome.

Tasked by Charcot, Tourette got to work. As was common practice, after going over several cases, Tourette presented a paper in which he described what he had seen as well as a hypothesis about potential causes and treatment.

The rare disorder was characterized by motor tics, such as involuntary movements of the face, head, limbs, or trunk, and verbal tics, such as grunting, barking, and even shouting obscene language.

Charcot deemed it to be a specific neurological disease, and he honored his young colleague for his contribution by renaming the illness “la maladie des tics de Gilles de la Tourette.”

Tourette Syndrome

Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by involuntary physical and vocal tics. 

Tics are sudden twitches, movements, or sounds that people do repeatedly. Examples are blinking over and over or repeating the same sound multiple times. Tics are considered to be uncontrollable, meaning that people who have them cannot prevent their bodies from doing these things. They can, however, often feel a premonitory urge coming up – these are the uncomfortable physical sensations preceding tics.

The first signs of TS usually occur in children between the ages of 7 and 10, but they can begin as early as 2 years or as late as 18.

Adult-onset cases are rare. A few potential explanations have been suggested, such as it simply being the reactivation of childhood tics or it stemming from new psychiatric or genetic diseases or central nervous system lesions.

Tic Disorders

Currently, three tic disorders are included in the DSM-5: Tourette syndrome, persistent motor or vocal tic disorder, and provisional tic disorder.

These tic disorders vary based on the duration of symptoms and the type of tic exhibited, namely motor, vocal, or a combination of both.

Tourette syndrome is characterized by the presence of both motor and vocal tics that have persisted for at least a year. 

People with persistent motor or vocal tic disorders have either motor or vocal tics that have lasted for at least a year.

Finally, provisional tic disorders may have motor or vocal tics, or both, but the symptoms have been present for less than a year.

Symptoms of Tic Disorders

Tic disorders can manifest in a variety of ways.

Common physical tics include eye blinking, head jerking, shoulder shrugging, facial grimacing, and twitching.

Symptoms can range from mild to severe, with some individuals experiencing only occasional facial twitches or throat clearing while others may have more frequent and complex motor tics such as jumping or arm flapping.

In contrast to popular belief, people with Tourette syndrome don’t always blurt out swear words. Known as ‘coprolalia’, this only affects about 1 in 10 people with Tourette’s. Coprolalia is a complex tic that involves involuntarily saying swear words or socially inappropriate phrases. Similarly, ‘copropraxia’, which involves showing obscene gestures such as putting up your middle finger, is also relatively rare.

Tic Disorders and OCD

Tic disorders and obsessive-compulsive disorder (OCD) are both neurodevelopmental conditions that can greatly affect someone’s daily life. However, they differ in several ways.

Tic disorders are characterized by involuntary, repetitive movements or vocalizations, whereas OCD is defined by the presence of intrusive, unwanted, and repetitive thoughts called obsessions. These obsessions are generally followed by compulsions aimed at reducing anxiety or preventing a feared event. Examples would be washing one’s hands over and over or repeatedly checking the stove to make sure it is off.

Nonetheless, there is evidence that OCD and TS share a lot of overlap. One strong indication is the frequent occurrence of symptoms from both disorders in the same individual. Up to 60% of people with TS show symptoms of OCD, while 50% of children with OCD are reported to have had tics, and 15% met the criteria for TS.

Research into family history and genetics also indicates a potential link between the two conditions.

Finally, at the clinical level, it is sometimes difficult, if not impossible, to distinguish between OCD and TS symptoms –  when is something a tic, and when is it a compulsion?

Tic Disorders and the Brain

Tics are thought to result from abnormalities or disruptions in brain regions that are involved in habit formation, including the basal ganglia, thalamus, and frontal cortex.

The basal ganglia are a group of structures located deep within the brain that help regulate voluntary movements and are thought to play a role in the automatic execution of learned motor patterns. The thalamus, located in the middle of the brain, acts as a relay station for sensory information and is involved in the processing of information related to movement, among other things. Finally, the frontal cortex is involved in higher-order cognitive processes such as decision making, attention, and working memory.

Other studies have also suggested that tics may be maladaptive habits that have become automatic responses to unwanted premonitory urges.

Treatment Options for Tic Disorders

Tic disorders can be managed through a variety of approaches, including medication, behavioral therapy, and lifestyle modifications. The most effective treatment approach will depend on the severity of symptoms and the individual’s specific needs.

Medications that block the action of dopamine, a neurotransmitter involved in the regulation of movement, can be effective in reducing the severity of tics. Unfortunately, they can bring with them several unwanted side effects.

Behavioral therapies, such as Cognitive behavioral therapy (CBT), habit reversal therapy, and exposure and response prevention (ERP) therapy, can also be effective in reducing the severity of tics. These therapies focus on helping individuals identify triggers and helping them better resist their premonitory urges.

[1] Versace V, Campostrini S, Sebastianelli L, Soda M, Saltuari L, Lun S, Nardone R, Kofler M. Adult-Onset Gilles de la Tourette Syndrome: Psychogenic or Organic? The Challenge of Abnormal Neurophysiological Findings. Front Neurol. 2019 May 3;10:461. doi: 10.3389/fneur.2019.00461. PMID: 31130912; PMCID: PMC6509948.



[4] Leckman JF, Bloch MH, Smith ME, Larabi D, Hampson M. Neurobiological substrates of Tourette’s disorder. J Child Adolesc Psychopharmacol. 2010 Aug;20(4):237-47. doi: 10.1089/cap.2009.0118. PMID: 20807062; PMCID: PMC2958453.

[5] Scholl, C., Baladron, J., Vitay, J., & Hamker, F. H. (2021). Enhanced habit formation in Tourette syndrome: dopamine release and striatal disinhibition modulate shortcut connections in a hierarchical model of cortico-basal ganglia loops. bioRxiv, 2021-02.

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