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Treatment is aimed at controlling tics that interfere with everyday activities and functioning. When tics aren't severe, treatment might not be necessary.

Your self-esteem may suffer as a result of Tourette syndrome. You may be embarrassed about your tics and hesitate to engage in social activities, such as dating or going out in public.

As a result, you're at increased risk of depression and substance abuse. If you or your child has been diagnosed with Tourette syndrome, you may be referred to specialists, such as:.

It's a good idea to be well-prepared for your appointment. Here's some information to help you get ready, and what to expect from your doctor.

Your time with your doctor is limited, so preparing a list of questions can help ensure the best use of time. List your questions from most important to least important in case time runs out.

For Tourette syndrome, some basic questions to ask your doctor include:. Don't hesitate to ask other questions during your appointment anytime you don't understand something or need more information.

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow time later to cover other points you want to address.

Your doctor may ask:. Tourette syndrome care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

This content does not have an English version. This content does not have an Arabic version. Diagnosis There's no specific test that can diagnose Tourette syndrome.

The criteria used to diagnose Tourette syndrome include: Both motor tics and vocal tics are present, although not necessarily at the same time Tics occur several times a day, nearly every day or intermittently, for more than a year Tics begin before age 18 Tics aren't caused by medications, other substances or another medical condition Tics must change over time in location, frequency, type, complexity or severity.

More Information Tourette syndrome care at Mayo Clinic Botox injections Cognitive behavioral therapy Deep brain stimulation Psychotherapy Show more related information.

Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Jankovic J. Tourette syndrome. Accessed Nov. Ferri FF.

Tourette's syndrome. Philadelphia, Pa. Tics are movements or sounds that take place "intermittently and unpredictably out of a background of normal motor activity", [16] having the appearance of "normal behaviors gone wrong".

Tics may also occur in "bouts of bouts", which also vary among people. They sometimes decrease when an individual is engrossed in or focused on an activity like playing a musical instrument.

In contrast to the abnormal movements associated with other movement disorders such as choreas , dystonias , myoclonus , and dyskinesias , the tics of Tourette's are nonrhythmic, temporarily suppressible, and often preceded by an unwanted urge.

The urges and sensations that precede the expression of a tic are referred to as premonitory sensory phenomena or premonitory urges.

These urges may be physical or mental. The actual tic may be felt as relieving this tension or sensation, similar to scratching an itch or blinking to relieve an uncomfortable feeling in the eye.

Because of the urges that precede them, tics are described as semi-voluntary or " unvoluntary ", [1] [16] rather than specifically involuntary ; they may be experienced as a voluntary , suppressible response to the unwanted premonitory urge.

Children may be less aware of it than are adults, [10] but their awareness tends to increase with maturity; [16] by the age of ten, most children recognize the premonitory urge.

Complex tics related to speech include coprolalia , echolalia and palilalia. Coprolalia is the spontaneous utterance of socially objectionable or taboo words or phrases.

There is no typical case of Tourette syndrome, [32] but the age of onset and the severity of symptoms follow a fairly reliable course.

Although onset may occur anytime before eighteen years, the typical age of onset of tics is from five to seven, and is usually before adolescence.

The first tics to appear usually affect the head, face, and shoulders, and include blinking, facial movements, sniffing and throat clearing.

These stereotyped movements typically have an earlier age of onset; are more symmetrical, rhythmical and bilateral; and involve the extremities for example, flapping the hands.

The severity of symptoms varies widely among people with Tourette's, and many cases may be undetected. Because tics are more commonly expressed in private, Tourette syndrome may go unrecognized, [38] and casual observers might not notice tics.

Most adults have mild TS and do not seek medical attention. Because people with milder symptoms are unlikely to be referred to specialty clinics, studies of Tourette's have an inherent bias towards more severe cases.

Compulsions that resemble tics are present in some individuals with OCD; "tic-related OCD" is hypothesized to be a subgroup of OCD, distinguished from non-tic related OCD by the type and nature of obsessions and compulsions.

Among individuals with TS studied in clinics, between 2. Among those with an older age of onset, more substance abuse and mood disorders are found, and there may be self-injurious tics.

Adults who have severe, often treatment-resistant tics are more likely to also have mood disorders and OCD.

There are no major impairments in neuropsychological function among people with Tourette's, but conditions that occur along with tics can cause variation in neurocognitive function.

A better understanding of comorbid conditions is needed to untangle any neuropsychological differences between TS-only individuals and those with comorbid conditions.

Only slight impairments are found in intellectual ability , attentional ability , and nonverbal memory —but ADHD, other comorbid disorders, or tic severity could account for these differences.

In contrast with earlier findings, visual motor integration and visuoconstructive skills are not found to be impaired, while comorbid conditions may have a small effect on motor skills.

Comorbid conditions and severity of tics may account for variable results in verbal fluency , which can be slightly impaired.

There might be slight impairment in social cognition , but not in the ability to plan or make decisions. They are faster than average for their age on timed tests of motor coordination , and constant tic suppression may lead to an advantage in switching between tasks because of increased inhibitory control.

Learning disabilities may be present, but whether they are due to tics or comorbid conditions is controversial; older studies that reported higher rates of learning disability did not control well for the presence of comorbid conditions.

The exact cause of Tourette's is unknown, but it is well established that both genetic and environmental factors are involved. Psychosocial or other non-genetic factors—while not causing Tourette's—can affect the severity of TS in vulnerable individuals and influence the expression of the inherited genes.

These include paternal age; forceps delivery ; stress or severe nausea during pregnancy; and use of tobacco , caffeine, alcohol , [4] and cannabis during pregnancy.

Autoimmune processes may affect the onset of tics or exacerbate them. Both OCD and tic disorders may arise in a subset of children as a result of a post- streptococcal autoimmune process.

There is also a broader hypothesis that links immune-system abnormalities and immune dysregulation with TS. The exact mechanism affecting the inherited vulnerability to Tourette's is not well established.

Cortico-striato-thalamo-cortical CSTC circuits , or neural pathways, provide inputs to the basal ganglia from the cortex. These circuits connect the basal ganglia with other areas of the brain to transfer information that regulates planning and control of movements, behavior, decision-making, and learning.

Abnormalities in these circuits may be responsible for tics and premonitory urges. The caudate nuclei may be smaller in subjects with tics compared to those without tics, supporting the hypothesis of pathology in CSTC circuits in Tourette's.

Histamine and the H3 receptor may play a role in the alterations of neural circuitry. According to the Diagnostic and Statistical Manual of Mental Disorders DSM-5 , Tourette's may be diagnosed when a person exhibits both multiple motor tics and one or more vocal tics over a period of one year.

The motor and vocal tics need not be concurrent. The onset must have occurred before the age of 18 and cannot be attributed to the effects of another condition or substance such as cocaine.

There are no specific medical or screening tests that can be used to diagnose Tourette's; [29] the diagnosis is usually made based on observation of the individual's symptoms and family history, [30] and after ruling out secondary causes of tic disorders.

Delayed diagnosis often occurs because professionals mistakenly believe that TS is rare, always involves coprolalia, or must be severely impairing.

Pediatricians, allergists and ophthalmologists are among the first to identify a child as having tics, [31] although the majority of tics are first identified by the child's parents.

Patients referred for a tic disorder are assessed based on their family history of tics, vulnerability to ADHD, obsessive—compulsive symptoms, and a number of other chronic medical, psychiatric and neurological conditions.

An MRI can rule out brain abnormalities, [81] but such brain imaging studies are not usually warranted. In teenagers and adults presenting with a sudden onset of tics and other behavioral symptoms, a urine drug screen for cocaine and stimulants might be necessary.

If there is a family history of liver disease , serum copper and ceruloplasmin levels can rule out Wilson's disease.

Although not all those with Tourette's have comorbid conditions, most presenting for clinical care exhibit symptoms of other conditions along with their tics.

There is no cure for Tourette's. Most medications prescribed for tics have not been approved for that use, and no medication is without the risk of significant adverse effects.

Education, reassurance and psychobehavioral therapy are often sufficient for the majority of cases. Pharmacological intervention is reserved for more severe symptoms, while psychotherapy or cognitive behavioral therapy CBT may ameliorate depression and social isolation , and improve family support.

Knowledge, education and understanding are uppermost in management plans for tic disorders, [30] and psychoeducation is the first step.

This support can also lower the chance that their child will be unnecessarily medicated [94] or experience an exacerbation of tics due to their parents' emotional state.

People with Tourette's may suffer socially if their tics are viewed as "bizarre". If a child has disabling tics, or tics that interfere with social or academic functioning, supportive psychotherapy or school accommodations can be helpful.

Some children feel empowered by presenting a peer awareness program to their classmates. By learning to identify tics, adults can refrain from asking or expecting a child to stop ticcing, [23] [95] because "tic suppression can be exhausting, unpleasant, and attention-demanding and can result in a subsequent rebound bout of tics".

Adults with TS may withdraw socially to avoid stigmatization and discrimination because of their tics. Behavioral therapies using habit reversal training HRT and exposure and response prevention ERP are first-line interventions in the management of Tourette syndrome, [98] and have been shown to be effective.

When disruptive behaviors related to comorbid conditions exist, anger control training and parent management training can be effective.

Beyond HRT, the majority of behavioral interventions for Tourette's for example, relaxation training and biofeedback have not been systematically evaluated and are not empirically supported.

Children with tics typically present when their tics are most severe, but because the condition waxes and wanes, medication is not started immediately or changed often.

Instead, the lowest dose that manages symptoms without adverse effects is used, because adverse effects may be more disturbing than the symptoms being treated with medication.

The classes of medication with proven efficacy in treating tics— typical and atypical neuroleptics —can have long-term and short-term adverse effects.

Complementary and alternative medicine approaches, such as dietary modification, neurofeedback and allergy testing and control have popular appeal, but they have no proven benefit in the management of Tourette syndrome.

There is low confidence that tics are reduced with tetrahydrocannabinol , [3] and insufficient evidence for other cannabis -based medications in the treatment of Tourette's.

Deep brain stimulation DBS has become a valid option for individuals with severe symptoms that do not respond to conventional therapy and management.

A quarter of women report that their tics increase before menstruation , however studies have not shown consistent evidence of a change in frequency or severity of tics related to pregnancy.

Tourette syndrome is a spectrum disorder—its severity ranges from mild to severe. Another four will have minimal or mild tics in adulthood, but not complete remission.

The remaining two will have moderate or severe tics as adults, but only rarely will their symptoms in adulthood be more severe than in childhood.

Regardless of symptom severity, individuals with Tourette's have a normal life span. Symptoms may be lifelong and chronic for some, but the condition is not degenerative or life-threatening.

Tics may be at their highest severity when they are diagnosed, and often improve as an individual's family and friends come to better understand the condition.

Studies report that almost eight out of ten children with Tourette's experience a reduction in the severity of their tics by adulthood, [10] [34] and some adults who still have tics may not be aware that they have them.

A study that used video to record tics in adults found that nine out of ten adults still had tics, and half of the adults who considered themselves tic-free displayed evidence of mild tics.

People with Tourette's are affected by both the consequences of living with tics as well as efforts to suppress them. A supportive family and environment generally give those with Tourette's the skills to manage the disorder.

A person who was misunderstood, punished or teased at home or at school is likely to fare worse than a child who enjoyed an understanding environment.

Factors impacting quality of life change over time, given the natural fluctuating course of tic disorders, the development of coping strategies, and a person's age.

As ADHD symptoms improve with maturity, adults report less negative impact in their occupational lives than do children in their educational lives.

Tourette syndrome is a common but underdiagnosed condition that reaches across all social, racial and ethnic groups. Most individuals with tics do not seek a diagnosis, so epidemiological studies of TS "reflect a strong ascertainment bias " towards those with co-occurring conditions.

A French doctor, Jean Marc Gaspard Itard , reported the first case of Tourette syndrome in , [] describing the Marquise de Dampierre, an important woman of nobility in her time.

Following the 19th-century descriptions, a psychogenic view prevailed and little progress was made in explaining or treating tics until well into the 20th century.

During the s and s, as the beneficial effects of haloperidol on tics became known, the psychoanalytic approach to Tourette syndrome was questioned.

Shapiro —described as "the father of modern tic disorder research" [] —used haloperidol to treat a person with Tourette's, and published a paper criticizing the psychoanalytic approach.

During the s, a more neutral view of Tourette's emerged, in which a genetic predisposition is seen to interact with non-genetic and environmental factors.

Not everyone with Tourette's wants treatment or a cure, especially if that means they may lose something else in the process.

Accomplished musicians, athletes, public speakers and professionals from all walks of life are found among people with Tourette's.

Samuel Johnson is a historical figure who likely had Tourette syndrome, as evidenced by the writings of his friend James Boswell.

There is little support [] [] for speculation that Mozart had Tourette's : [] the potentially coprolalic aspect of vocal tics is not transferred to writing, so Mozart's scatological writings are not relevant; the composer's available medical history is not thorough; the side effects of other conditions may be misinterpreted; and "the evidence of motor tics in Mozart's life is doubtful".

Research since has advanced knowledge of Tourette's in the areas of genetics, neuroimaging , neurophysiology , and neuropathology , but questions remain about how best to classify it and how closely it is related to other movement or psychiatric disorders.

Compared to the progress made in gene discovery in certain neurodevelopmental or mental health disorders—autism, schizophrenia and bipolar disorder —the scale of related TS research is lagging in the United States due to funding.

Tourette syndrome. For other uses, see Tourette disambiguation. Play media. Main article: Causes and origins of Tourette syndrome.

Main screening and assessment tools [79] [80]. Main article: Management of Tourette syndrome. Main article: History of Tourette syndrome.

Main article: Societal and cultural aspects of Tourette syndrome. Pract Neurol Historical review.

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January Health Technology Assessment. Diagnostic and Statistical Manual of Mental Disorders 5th ed.

American Psychiatric Association. Parkinsonism Relat. Expert Rev Neurother Review. Practical Neurology : 22— Archived from the original PDF on March 24, Retrieved March 24, Handbook of Clinical Neurology Review.

Asian J Psychiatr Review. Archived from the original on May 10, Retrieved December 29, Archived from the original PDF on February 3, Retrieved June 5, World Health Organization.

Archived from the original on April 4, Retrieved January 13, See also ICD version Research support. October Archived from the original on April 26, Adv Neurol Review.

Brain Topogr Review. J Child Health Care Review. Dtsch Arztebl Int Review. Archived from the original on August 22, Retrieved August 10, February J Clin Psychiatry.

CNS Spectr Review and meta-anlysis. Archived from the original on February 10, Hyperkinetic Movement Disorders Historical review.

Handbook of Clinical Neurology. Also see Singer HS March Lancet Neurol Review. Adv Neurol Historical review. Pediatr Rev Review. July Pediatrics Research support.

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