Tourette's syndrome (TS) treatment

TS is a neurological disorder that is characterised by repetitive involuntary movements and vocalisations known as tics. You would usually observe symptoms of tics associated with TS in your child between the ages of three and nine years, with boys thought to be affected up to three or four times as much as girls.

Due to the cause of TS involving problems in brain communication and functioning, it is 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 which are characteristic of OCD. This is why you or your child may require a comprehensive treatment plan which can treat the complexities of a range of conditions alongside TS, with anxiety and depression also reported, particularly as the difficulties and impact of quality of life in those with TS becomes overwhelming.

If your child is diagnosed with TS, they will be told whether their condition is severe or milder, with as many as 1 in 100 children experiencing the less complex form of TS. The condition can last into adulthood, although symptoms are often at their worst between the ages of 10 and 12 years, before getting better during adolescence and young adulthood.

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 a small percentage of people with TS, believed to be between 10 and 15 percent of those diagnosed, 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.

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 is feeling particularly anxious or excited, with therapy sessions able to work towards observing and understanding these triggering situations for improvement management of the condition.            

TS is diagnosed by the presence of motor and vocal tics, not necessarily concurrently, many times a day, nearly every day for more than one year, with no tic-free periods lasting longer than two months. Tics may include:

Motor tics

• Eye blinking
• Eye rolling
• Shoulder shrugging or jerking
• Jumping
• Twirling
• Touching objects and other people

Vocal ticks

• Grunting
• Throat clearing
• Coughing
• Whistling
• Swearing (only affecting around 1 in 10 with TS)
• Tongue clicking
• Repeating a sound, word or phrases overheard in others
• Saying random words or phrases

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 fatigued or even during periods when you or your child are particularly relaxed.

The urge to tic

If you or your child have tics, then it is likely that you will 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 is believed that some people with TS can control their tics, particularly when they are especially unwanted, such as during social situations, a work meeting or school classroom, although it requires a great deal of practice and concentration.

Even if you are 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 are reading, playing sports, or are taking part in any activity requiring a greater amount of concentration during your day.

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

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

Further risk factors of 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, then this may increase the risk of developing the disorder
• Gender - it is believed that males are three to four times more likely than females to develop TS

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