When eight-year-old Sammy came to see me his mom was concerned about his constant clearing of the throat and his motor tics. What causes this? Can he be medicated for it? Will he outgrow it?
I informed her that we are looking at a case of Tourette’s syndrome. George Gilles de la Tourette first described the disorder in 1885. He had been noting a syndrome among several patients that included multiple motor tics, coprolalia (the use of obscene phrases or words) and echolalia (repeating words last heard by others).
This is a tic disorder involving multiple motor and one or more vocal tics. They can occur many times a day, for more than one year. The disorder causes significant impairment and distress in functioning. Boys are affected three times more often than girls. Many children with TS also have other psychiatric disorders indicating that there may be a genetic link between them. Nearly half the number of children with TS also has ADHD. Forty percent of these children with TS also have obsessive-compulsive disorder. Intense research is ongoing at this time.
Motor tics generally occur by age seven years. They begin in the face and neck with grimacing, puckering and winking. They tend to travel in a downward progression, involving the arms, legs and body.
Vocal tics often occur later, around age eleven years. They include grunting, sniffing, and clearing the throat as well as saying or repeating words or phrases. Coprolalia (the use of obscene phrases or words) is relatively uncommon, occurring in about one-third of adolescents.
It is important for us to take a family history as we are diagnosing Sammy. Are there others in the family with similar symptoms? It must be determined that Sammy’s movements are not caused by some other movement disorder. Stereotypic disorders such as rocking and head banging must also be differentiated from a tic disorder. Some compulsions of the obsessive-compulsive disorder are difficult to distinguish from complex tics. They may even be in the same spectrum. Other neurological disorders must also be ruled out.
Children with Tourette’s syndrome usually respond well to certain medications. Haldol, clonidine, pimozide and the SSRI’s give an 80% favorable response. Of course there are risks and benefits with these medications that must be monitored by the physician.
Generally the disorder lasts throughout a life span. There are support groups to help children, adolescents and adults in coping with Tourette’s syndrome. You can find resources on-line in the way of information, current research and support groups.