Monday, March 18, 2013
Early treatment of Tourette's syndrome
Once considered a rare and sometimes strange disorder, some experts estimate that Tourette’s disorder impacts nearly 4% of young people between the ages of 5-18.
We are learning more about this disorder, which typically begins in childhood. Thankfully it is treatable, and we are beginning to break down barriers and reduce stigmas attached to these patients through education.
One of the reasons Tourette’s is so misunderstood is because its symptoms can be seen and heard. Tics — rapid, repetitive muscle contractions (movements) or sounds that are involuntary — are common signs of Tourette’s, and present themselves in various ways:
• Simple motor tics: Involve one or a small number of muscles, for example eye -blinking, grimacing, etc…
• Simple phonic tics: For example, sniffing, grunting, yelping and snorting.
• Complex motor tics: Contraction of several muscle groups and can mimic normal movements, for example knee bending, hopping, simultaneous extension of arms and legs, etc…
• Complex phonic tics: Includes words or phrases like “Hi,” “I love you,” or obscene words. Repetition of someone else’s words is another common example.
Tics most commonly affect the face, head and neck, then limbs and trunk. Examples include blinking, raising eye brows, winking, grunting, snorting or clearing the throat.
Emerging data support the notion that tic disorders are genetic and involve disturbances of neurotransmitters in the central nervous system.
There is a close association between Tourette’s and Obsessive Compulsive Disorder and Attention Deficit Disorder.
Treatment of tics includes a combination of prescription drugs (including Risperidone, Clonidine, Guanfacine and Imipramine), psychotherapy (behavioral therapy, habit reversal, awareness training, family therapy) and education (support groups and teaching families and teachers).
Research into Tourette’s continues. There is currently a clinical trial involving Aripiprazole , which has been on the market to treat other disorders like bipolar, schizophrenia and depression, which could have potentially excellent results. Progress is being made, and outcomes are improving.
Mahmoud Okasha, MD, is a psychiatrist with the Backus Medical Staff and an Associate Clinical Professor at the Yale University School of Medicine. To comment on this column or others, visit the Healthy Living blog at www.backushospital.org/backus-blogs or e-mail Dr. Okasha or any of the Healthy Living columnists at firstname.lastname@example.org.