Tourette syndrome (TS) is a neuropsychiatric tic disorder that usually develops in early childhood. Tic disorders are characterized by motor and/or vocal tics (the compelling need to produce a sound or movement repetitively and out of context). TS in particular requires the presence of two motor and one vocal tic present for at least a year. Here is a look at potential treatments for TS.
A Word on Treatment
TS generally appears in early childhood, often around ages 6 or 7. During adolescence, symptoms may start to get worse; luckily, they often begin improving in adulthood. In the meantime, however, TS can be difficult to deal with. While some cases are mild enough that treatment may not be necessary, others may be more prominent or embarrassing—not to mention self injurious if motor tics are volatile and self-aimed. Every case of TS is different, and some patients have very severe cases. When seeking treatment, it’s important to remember that there is no cure. It can take a great deal of work on the part of the patient and a great deal of support on the part of the patient’s family.
Counseling and Psychotherapy
The goal of TS treatment is not to get rid of the disorder but to learn to manage or control tics—particularly those that interfere with everyday life and normal functioning. Behavioral therapy is a great therapeutic option for TS patients. Behavioral therapy is aimed at learning to reverse these habits. An example of how this might work involves identifying and recognizing promontory urges. A promontory urge is the sensation (often felt as a tingle or discomfort in a part of the body) that occurs just before the compulsory behavior (or tic). Then, the patient can make intentional movements that make it difficult to carry out the impending motor tic.
TS often occurs in tandem with other psychiatric disorders (called comorbid conditions) like Obsessive Compulsive Disorder (OCD) or Attention Deficit Hyperactivity Disorder (ADHD). Counseling can help manage these comorbid conditions, making it easier to focus on managing tics; the feelings of sadness, depression, and isolation that are not uncommon when dealing with a chronic psychological issue can also be managed through therapy. This is particularly important in light of the fact that heightened emotions (anger, anxiety, excitement) or illness can make TS symptoms more pronounced.
Without an exact cause, developing a medication specifically for those with TS is difficult. Research suggests the neurotransmitters dopamine, norepinephrine, and serotonin have something to do with tics. Thus, dopamine blockers (like Haldol) are effective for some people. Vocal tics and simple motor tics may be helped by botox injections.
Stimulants used for the treatment of ADHD are helpful for some patients, while others find it makes tics worse. Antiadrenergic medications, typically used for high blood pressure, can also be effective; they block the production of certain neurotransmitters and decrease central nervous system stimulation. Topiramate, used more commonly for epilepsy, has shown some efficacy for TS patients. Antidepressants may be necessary for secondary symptoms, such as anxiety caused by the fear of demonstrating tics in inappropriate settings—unfortunately this anxiety can actually increase the chances of the need to express a tic.
Deep Brain Stimulation
Deep Brain Stimulation (DBS) is a relatively new treatment method for severe cases of TS that fail to respond to conventional treatments. Researchers are still questioning exactly why it works, but many patients find DBS to be effective. Essentially, a device made up of electrodes is implanted into a specific part of the brain, and a pulse generator is implanted near the collarbone or abdomen connected by a thin cable. The pulses emitted by the device target the abnormal movement impulses a TS brain sends out. While there has been success for patients, DBS is still a work in progress.