Tourette's syndrome (TS) treatment

Tourette’s syndrome (TS) is a neurological disorder that usually starts in childhood. It includes sudden, rapid, repetitive, non-rhythmic movements or vocalisations known as ‘tics’.

TS is a much misunderstood condition in society, where symptoms of TS manifesting in the form of repeated swearing or generally inappropriate comments, affect only a small percentage of people with the disorder.

For two thirds of children with TS, tics get better in the course of adolescence, and disappear completely or reduce very substantially to the point of not being at all bothersome by early adult life. However, it's estimated that there are currently over 300,000 children and adults living with TS in the UK. Tics in TS tend to fluctuate in frequency and severity, with their peak being at around the age of 10 to 12 years. TS frequently co-exists with other conditions like attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), or other neurodevelopmental and mental health issues.

While there's no cure for TS, mental health treatment can help you to manage your symptoms and improve your overall quality of life. If your tics are particularly severe to the extent that they're causing you significant frustration, stress or physical pain, Priory’s nationwide network of highly experienced specialists can help to alleviate your symptoms.

What is Tourette's syndrome (TS)?

TS is a neurological disorder that's characterised by repetitive involuntary movements and vocalisations known as tics. You would usually observe symptoms of tics in your child, with boys thought to be affected up to three or four times more than girls.

The tics that are associated with TS can include simple movements, usually concentrated within certain groups of muscles such as the face and shoulders. Some of the most common tics include repeated eye blinking, shoulder jerking and grimacing, while simple vocal tics may involve throat clearing or sniffing.

Alternatively, you or your child may experience more complex tics, which tend to combine the more simple involuntary movements and vocalisations together. For example, repetitive eye blinking could coincide with shrugging shoulders and facial movements, while more complex vocal tics could involve words or phrases. Although it only applies to around 10% to 15% of people with TS, complex tics can involve involuntary swearing or repeating the words or phrases of others. TS may also be associated with forms of self-harm such as physically punching yourself.

Whether you or your child’s TS symptoms are diagnosed as mild or severe, these symptoms can vary in type, frequency and severity as time goes by. For example, symptoms of TS can initially start in the head and shoulder area, before moving elsewhere on the body. Simple tics and involuntary movements will generally happen before you notice any vocal tics or more complex patterns of movement.

Due to the cause of TS involving problems in brain communication and functioning, it's possible that a diagnosis of TS can include associated behavioural problems and mental health conditions at the same time. These can include hyperactivity and problems with attention as part of ADHD, or the intrusive thoughts and worries that are characteristic of OCD. This is why you or your child may need a comprehensive treatment plan that also aims to treat other conditions that may be present.

Treatment available at Priory hospitals and wellbeing centres can help to alleviate some of the most debilitating symptoms of TS. Behavioural therapy sessions can help you or your child to learn coping mechanisms and alternative voluntary movements to reduce the urge to repeat a tic a certain number of times before the desire goes away. Many tics can be worse if you or your child are feeling particularly anxious or excited. Therapy sessions are designed to help you to observe and understand these triggers to help you manage your condition.

What causes TS?

The precise cause of TS is still unknown, although it's believed to develop from a problem in the part of your brain that regulates body movements.

Due to the complexity of many instances of TS, there are likely to be a combination of genetic and environmental factors that influence the brain’s ability to correctly transfer information required for movement. Therefore, chemicals such as dopamine and serotonin, which play a part in sending these messages, may also be involved.

Further risk factors for developing TS include:

• Family history - if an immediate family member to either yourself or your child has had a history of TS or associated behavioural disorders, this may increase the risk of developing the disorder
• Gender - it's believed that boys are 3 to 4 times more likely than girls to develop TS

Priory understands that living with TS can be very difficult and can even stop you living the life you want. That’s why we offer flexible outpatient therapy programmes delivered by specialist therapists, that help to improve symptoms of Tourette’s and work towards improving your quality of life.

The urge to tic

While tics aren’t unduly harmful to you or your child’s health, motor tics involving sudden, jerky movements can feel painful. The frequency and severity of these tics can vary from day-to-day, with symptoms feeling worse on some days, and improved on others. Tics may be triggered when you or your child are feeling particularly stressed, anxious or tired, or even during periods when you or your child are particularly relaxed.

If you or your child have tics, then it's likely that you'll feel an internal urge to relieve a tic before it happens. This is referred to as a ‘premonitory sensation’, and is similar to the anticipation felt before having to sneeze. The only way to relieve the urge is to complete the motor or vocal tic, or repeat the tic a specific number of times.

These premonitory sensations may include:

• Burning sensation in your eyes before having to blink
• Dry or sore throat before grunting or coughing
• ‘Itchy’ joints or muscle before jerking

Can tics be controlled?  

It's believed that some people with TS can control their tics, particularly when they're especially unwanted, such as during social situations, a work meeting or school classroom, although this takes a great deal of practice and concentration.

Even if you're able to control when tics occur, it can be very tiring each time you suppress the urge. This can lead to an increase in tics subsequently as your body’s way of compensating.

You may notice that tics occur less in certain situations, like when you're reading, playing sports, or are taking part in any activity that needs more concentration during your day.