Tourette Syndrome or TS is a Neurodevelopmental or brain-based condition that causes people who have it to make involuntary sounds and movements called tics.
What is a tic?
Tourette Syndrome (TS) tics are sudden, intermittent, repetitive, unpredictable, purposeless, nonrhythmic, involuntary movements or sounds. Tics that produce movement are called “motor tics,” while tics that produce sound are called “vocal tics” or “phonic tics.” Tics can be either simple or complex.
Simple motor tics involve one muscle group and include eye blinking, lip-licking, shoulder shrugging, and head jerking. Complex motor tics involve a coordinated movement produced by a number of muscle groups. For example, touching objects, jumping, or spinning around. Complex motor tics may also include imitating someone else’s actions (echopraxia) or exhibiting inappropriate or taboo gestures of behaviours (copropraxia.)
Simple vocal tics include sniffing, grunting, throat clearing, uttering single syllables (e.g. uh-uh-uh) and humming. Complex vocal tics include uttering linguistically meaningful utterances (words and phrases), or changing the pitch and volume of voice. Complex vocal tics may also involve repeating a phrase he/she has heard over and over (echolalia), repeating one’s own words (palilalia) or uttering obscenities or socially taboo phrases (coprolalia).
The most important thing to understand about the tics associated with Tourette Syndrome is they are the result of a neuropsychiatric condition. The sounds and behaviours are involuntary and are not being done by choice.
What is the impact of tics on the person with TS?
Whether they are simple or complex, tics can be troubling to individuals with TS. They can cause embarrassment and discomfort. In some cases, they can cause physical pain, such as headaches, muscle strain, or soreness. Issues such as repetitive strain injuries have also been reported.
The disorder can be stigmatizing especially if the person with TS is in environments that do not support or tolerate anyone who may appear a bit different. Most parents of children with TS worry about the psychological impact of TS and how their child will be viewed by other children, by their teacher, and by society at large. They are concerned about teasing and bullying, about the ability to make friends, succeed at school and get and keep a job.
Peer education and awareness can help with acceptance. See our Support page for how Tourette Canada can help with education and awareness.
Can tics be suppressed?
Many people describe a premonitory urge that precedes a tic. This premonitory urge is a feeling similar to what you feel when you need to sneeze or when you have an insect bite that itches. With tics, the premonitory urge is described as a build up of pressure, tension or energy that is relieved when the tic is expressed.
The temporary ability to withhold or suppress a tic is somewhat like the feeling of holding in a sneeze or trying not to scratch an insect bite. The ability to suppress tics varies between individuals. Tic suppression can take a lot of energy, making it hard to concentrate on other tasks. The effort required to suppress tics can also be exhausting. Most people who try to suppress their tics report that the tic will eventually be released.
Young children may not be aware of their tics, and even if they are aware they may have no ability to suppress their tics. Asking a child to suppress their tics is generally not a good idea because the effort involved in suppressing the tics involves a high level of concentration and it makes it difficult for the child to pay attention to other tasks such as paying attention in class. In fact many children and teens with TS find that when they are in a supportive environment where they can tic without attention being paid to the tics, there is a decrease in the number of tics they experience.
It used to be thought that suppressing tics caused a rebound effect after the suppression is stopped. This was described as the expression of all the tics that had been suppressed when the person could no longer suppress them. However, more recent studies have disproven this rebound effect. The study resulted showed that the number of tics did not substantially increase following a period of suppression.
Many parents observe that their child or teen will try to suppress their tics at school and then will come home and explode in bouts of tics. This is often accompanied by other emotional behaviours. The studies on the rebound effect of suppressing tics indicates this behaviour is not the result of suppressing tics, and that further study is required to fully understand the behaviour.
What causes TS?
TS is a genetic condition, meaning it is passed on from parent to child. This does not mean that if someone has TS their son or daughter will also be born with TS. Studies indicate that a person with TS has between a 5-15% chance of having a child, sibling or parent with the condition. Scientists originally thought that TS was carried in a single gene, but it’s now believed that TS involves multiple genes. Though it appears that there is likely to be a significant genetic factor, some studies indicate prenatal, perinatal, autoimmune, and environmental factors may contribute to or modulate the severity of symptoms. More research is required to fully understand the disorder.
When do the symptoms start?
The symptoms of TS usually begin in early childhood around age five, but may occur as early as age one or two, or as late as the age of 17. Typically the first tics to appear are facial tics like eye blinking, nose twitching, or grimacing.
Why do people tic?
Brain imaging studies suggest that people with TS have neurological differences in their brains, specifically in their cortico-striatal-thalamo-cortical (CSTC) circuitry. What these differences are precisely and whether or not other areas of the brain are also involved continues to be explored by researchers. Currently, the basal ganglia and the frontal lobes of the cerebral cortex are believed to be involved in TS. The frontal lobes plan and execute movements and thoughts, while the basaI ganglia acts as a brake to prevent unwanted movements and sounds. For individuals with TS, something abnormal happens when the frontal cortex “tells” the basal ganglia to stop particular movements. As a result, unwanted movements and sounds, or tics, occur.