Tourette’s Syndrome (TS)

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Tourette’s Syndrome (TS) is a neurological disorder that begins in childhood, characterized by repetitive, involuntary movements and vocalizations called tics.

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🧠 What Is Tourette’s Syndrome?

▶️ Core Features:

• Tics: Sudden, rapid, recurrent, non-rhythmic movements or sounds.

  • Motor tics: blinking, shrugging, facial grimacing.

  • Vocal tics: throat clearing, grunting, repeating words (including coprolalia, rare – involuntary swearing).

• Onset: Usually between ages 5 and 10.

• Course: Peaks in adolescence; may improve in adulthood.

▶️ Diagnosis Criteria (DSM-5):

• Multiple motor tics + at least one vocal tic.

• Occurring for more than 1 year.

• Onset before age 18.

• Not due to drugs or another medical condition.

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🔍 What Causes Tourette’s?

• Exact cause is unknown, but likely a mix of:

  • Genetic factors: TS often runs in families.

  • Neurobiological factors: Involves abnormalities in dopamine, serotonin, and brain circuits (especially basal ganglia).

  • Environmental factors: Perinatal issues, infections (e.g., PANDAS – Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections).

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💊 Treatments for Tourette’s Syndrome

1. Behavioral Therapies (first-line for mild to moderate TS):

• CBIT: Comprehensive Behavioral Intervention for Tics

  • Teaches awareness and habit reversal techniques.

• Habit Reversal Training (HRT): Replace tic with a competing voluntary action.

• Exposure and Response Prevention (ERP): Delay or suppress tics through gradual exposure.

2. Medications (used if tics are severe or impairing):

• Antipsychotics:

  • Aripiprazole, Risperidone, Haloperidol

  • Reduce dopamine activity in the brain.

• Alpha-2 adrenergic agonists:

  • Clonidine, Guanfacine (also used in ADHD)

• Botulinum toxin:

  • For local motor tics (e.g., facial tics).

• Benzodiazepines:

  • Used occasionally but not preferred due to dependency.

3. Treating Co-Occurring Conditions:

• Up to 85% have other neurodevelopmental disorders like:

  • ADHD, OCD, Anxiety, Learning difficulties.

• Tailored treatment plans may include:

  • Stimulants or non-stimulants for ADHD.

  • SSRIs for OCD or anxiety.

4. Deep Brain Stimulation (DBS) – for severe, drug-resistant TS:

• Electrodes implanted in specific brain regions.

• Still considered experimental but promising for some.

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🧩 Living with Tourette’s:

• Education and awareness reduce stigma.

• Support groups and psychoeducation help families.

• Many lead successful lives; symptoms often decrease after adolescence.

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🧪 Recent Advances in Research (Highlights):

Focus Area	Insight
Genetics	GWAS studies identify risk loci in CNTNAP2, SLITRK1
Neuroimaging	Abnormal activity in cortico-striato-thalamo-cortical loops
Inflammation	Links between immune dysfunction and tic onset in PANDAS
New therapies	Trials ongoing for VMAT2 inhibitors like tetrabenazine

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Key Sources (with summaries):

1. Robertson, M. M. (2015). Tourette syndrome, associated conditions and the complexities of treatment. Brain, 138(3), 602–623.
   Link

   Comprehensive overview of TS and its psychiatric comorbidities.

2. McNaught, K. S., & Mink, J. W. (2011). Advances in understanding and treatment of Tourette syndrome. Nature Reviews Neurology, 7(12), 667–676.
   Link

   Discusses neurobiology and treatment evolution.

3. Leckman, J. F. et al. (2006). Tourette syndrome. The Lancet, 360(9345), 1577–1586.
   Link

   Landmark review on clinical features and pathophysiology.

4. Conelea, C. A., et al. (2011). Habit reversal training in children with Tourette syndrome: A randomized clinical trial. JAMA, 305(6), 547–555.
   Link

   Strong evidence for behavioral treatment efficacy.

5. Singer, H. S. (2022). Neurobiology of Tourette syndrome: Current status and future perspectives. Pediatric Neurology, 130, 10-17.
   Link

   Reviews modern imaging and molecular genetics.

6. Martino, D., et al. (2020). Deep brain stimulation for Tourette syndrome: The international registry and database. Brain, 143(6), 1811–1831.
   Link

   Insights into long-term DBS outcomes.

7. Verdellen, C. et al. (2011). Behavioral treatment of tics: Habit reversal and exposure with response prevention. Behavioral Modification, 35(4), 387–402.
   Link

   Comparison of behavioral interventions.

8. Ganos, C. et al. (2018). The functional anatomy of tic generation. Neuropsychology Review, 28(1), 18–27.
   Link

   Functional MRI studies identifying brain regions in tic development.