Tourette syndrome

Tourette syndrome, also (and perhaps more properly) known as Gilles de la Tourette syndrome, is a common neurodevelopmental disorder characterized by tics.

Epidemiology

Tourette syndrome, by definition, commences in childhood, with a mean onset of approximately 6 years ¹. It is more common in males ^1,2.

Associations

• obsessive-compulsive disorder

• attention-deficit/hyperactivity disorder

• anxiety and depression

Clinical presentation

The hallmark feature of Tourette syndrome are tics, which are sudden, rapid, recurrent movements or volcalisations ^1,2. The tics in Tourette syndrome typically wax and wane in frequency, anatomical location (typically starting in the face/head region), number, complexity, and severity over time ^1,2. Additionally, they are typically preceded by an unpleasant 'premonitory urge', during which they can be briefly suppressed ^1,2.

There are generally two types of tics described in Tourette syndrome ^1,2:

• motor tics

  • simple (involving a single group of muscles): e.g. eye blinking, nose twitching, head jerking, etc.

    • non-clonic tics, such as dystonic or tonic tics, are less common

  • complex (involving multiple groups of muscles and resembling normal motor acts): e.g. punching, kicking, jumping, copropraxia, echopraxia, palipraxia, etc.

• vocal (phonic) tics

  • simple: e.g. throat clearing, sniffing, grunting, barking, moaning, etc.

  • complex: e.g. words or sentences, coprolalia, echolalia, palilalia, etc.

Radiographic features

Conventional neuroimaging with CT and MRI is normal ¹.

Treatment and prognosis

Treatment is multimodal and may not be employed in every case of Tourette syndrome, but sometimes only in cases whereby the tics interfere significantly with daily life ^1-3. Management options broadly include ^1-3:

• psychotherapy

• pharmacotherapy: e.g. antipsychotics (aripiprazole, haloperidol, etc.), VMAT2 inhibitors (tetrabenazine, etc.), topiramate, clonidine, botulinum toxin A injections

• surgery: deep brain stimulation

  • reserved for refractory cases

History and etymology

The syndrome is named after Georges Albert Édouard Brutus Gilles de la Tourette (1857-1905), a French neurologist, who described the condition in 1885 ⁵.