Named after the famous neurologist and physician, Georges Gilles de la Tourette, this condition is a neurological problem in that it affects the brain and the nervous system. It is important to note, however, that the evidence seems to suggest that Tourette’s normally first occurs in childhood and worsens in early adulthood; in addition, its cause seems to be a combination of genetic and environmental factors. Indeed, the exact mechanism in the brain responsible for this condition, and the aetiology, are unknown; however, neuroimaging studies seem to indicate that the tics occur as a result of dysfunction in the cortical and subcortical regions of the brain—that is to say, the thalamus, basal ganglia and frontal cortex.
Individuals suffering from this condition involuntarily make noises or jerking movements (tics). Patients may make a number of sounds, and these include one or a combination of the following: grunting, coughing, or sudden bursts of shouting. Some of the involuntary utterances are senseless one or two-syllable words, although sufferers occasionally call out longer phrases. But, because the process is involuntary, individuals are unable to edit what they are saying, the result being that swear words or other inappropriate utterances may be heard out of context. Patients suffering from this condition tend also to make other involuntary movements such as: jerking motions of the head, eye blinking, loud throat noises, sniffing and other facial distortions. Although this condition often causes a great deal of embarrassment for the individual, it is not life threatening and has no bearing on life expectancy.
Most people suffering from Tourette’s experience fairly mild symptoms and do not require medication. In these cases, patients are able to manage the condition with behavioural therapy, CBT and/or relaxation techniques. If the problem is severe, it is important, if medication is prescribed, to combine this with behavioural therapy, which may include coping strategies, relaxation techniques, ongoing psychotherapeutic support and other techniques. The ongoing psychotherapy is particularly helpful because many sufferers face long periods of isolation as a result of their condition. In addition, psychoeducation is also very important particularly when explaining the condition to members of the immediate family. There is no universally-known medication which helps sufferers; usually, the physician will try drugs which are used to treat patients who suffer from tics during the day and in the evening. The drugs are known as typcial and atypical neuroleptics and these include risperidone, ziprasidone, pimozide, haloperidol and fluphenazine. This condition has also been treated with stimulant drugs which are normally used to treat ADHD. Furthermore, antidepressant medication has also been employed in treating Tourette’s, especially when the patient exhibits OCD behaviours: these include clomipramine and floexetine. It is important to remember that, when treating children, the clinician must provide the child and the family with positive re-assurance and support. And, with careful explanation and guidance, these tics often disappear or reduce significantly.
Tourette’s may also be treated with a combination of CBT and habit reversal techniques. Further, relaxation techniques—such as hypnosis, mindfulness and yoga—may also be extremely beneficial to patients.
David Kraft PhD
UKCP Registered Psychotherapist
10 Harley Street
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