Tourette Syndrome1 Essay

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Tourette Syndrome1





Tourette Syndrome

“When I breathe, it breathes. When I speak, it speaks. When I try to sleep, it
won’t let me. Whatever I attempt to do, it’s there, waiting to spoil the
moment. To a doctor, it’s a disorder, a medical oddity. To an onlooker, it’s
a spectacle—perhaps humorous, perhaps grotesque. To me, it’s a monster, a
demon, a hellish beast who has no right to exist in my world or anyone
else’s—it’s my unwelcome companion,” wrote Rick Fowler, a sufferer
of Tourette syndrome. In a recent film, one of the characters suffered from TS. This
disease was portrayed as humorous and easily controlled. However, actual research of TS
shows quite the opposite.

Touretts syndrome is mainly known as a tic disorder. Tics are involuntary, rapid,
repetitive, and stereotyped movements of individual muscle groups (Bruun, 1984, p. 2).
However, Tourette’s is not the only tic disorder that one can have. A transient tic
disorder begins during the early school years, occurring in up to 15 percent of all
children. These tics are said to not persist for more than a year, but it is not uncommon
for a child to have a series of transient tics over the course of several years. Chronic
tic disorders are differentiated from those that are transient, not only by their
duration, but by their relatively unchanging character (1984, p. 4). These tics are said
to persist unchanged for years. Chronic multiple tics suggest that an individual has
several chronic motor tics, with a hard line between to determine the differences. The
most debilitating tic disorder is Tourette syndrome (Fowler, 1996, p. 26). TS is a
complex behavioral disorder that is poised between the mind and body, governed by innate
vulnerabilities and environmental circumstances. The interaction of these forces within
the mediating influences of the individual’s personality and interpersonal
environment shapes the expression of this disorder and influences the individual’s
long-term adaptation (1996, p. 27). TS is so powerful that it can almost completely take
control over the mind and body, in some cases forcing a person to withdraw from society.

In the 1800s, Tourette’s was once thought to be a demonic possession (Kushner, 1999,
p. 15). However, a French neurologist, Georges Gilles de la Tourette, was fascinated by
these supposed “demons” in the person. In 1885, he studied and described to
medical doctors the symptoms of this disease, in which he discovered caused those
afflicted to exhibit uncontrollable “tics” (Fowler, 1996, p. 33). The disease
later became known as Gilles de la Tourette syndrome.

The symptoms of TS usually appear before the individual turns eighteen. When involuntary
tics occur in a person for over a year, they are usually diagnosed with TS. However, this
concept of “involuntary” tics may be hard to define operationally, since some
patients experience their tics as having a volitional component—a capitulation to an
internal urge for motor discharge accompanied by psychological tension and anxiety (Cohen,
1988, p. 19).

Tourette syndrome is a complex disorder that can mimic other disturbances, sometimes
making accurate diagnosis difficult. TS is commonly misdiagnosed as schizophrenia,
obsessive-compulsive disorder, epilepsy, or nervous habits (Bruun, 1984, p. 3). Some
doctors believe TS is relater to multiple personality disorder, which it is not. It is a
completely different disease because, unlike MPD, TS sufferers are aware of the mind being
engaged in a “never-ending struggle” (Fowler, 1996, p. 36). Since more
physicians are now aware of TS, where is a growing danger of over diagnosis and under
treatment.

Although TS involves a variety of symptoms, motor and vocal tics continue to be the
essential element of this disorder (Kushner, 1999, p. 23). The very first symptoms of TS
are usually motor tics—commonly eye blinking. However, there are four kinds of
motor tics: simple motor tics, complex motor tics, copropraxia, and echolpraxia. Simple
motor tics can be explained as eye blinking, nose twitching, and rapid jerking of any part
of the body. Complex motor tics are hopping, clapping, throwing, and writing
over-and-over the same letter or word. Copropraxia is “giving the finger” or
making other obscene gestures. Echopraxia, imitating the gestures or movements of other
people, varies from about 10 to 21 percent of all cases (1999, p. 27). In more severe
cases of TS, unusual complex motor tics, such as copropraxia, echokenesis (repeating or
mimicking of others’ movements), and coprographia (writing of obscene words or
statements) tend to appear.

Many different vocal tics are involved in the symptoms in TS. Simple vocal tics, which
are the most common, include coughing, spitting, barking, and sucking sounds. However,
complex vocal tics involve linguistically meaningful words, phrases, or sentences, like
“wow,” or “but, but….” Rituals are the repeating of a
phrase until it sounds “just right” or saying something over-and-over three
times. Speech atypicalities are unusual rhythms, tones, accents, loudness, and very rapid
speech. Coprolalia, which is the shouting of vulgar, unacceptable words, exist in less
than 30 percent of all TS cases (1996, p. 29). Although cursing is not present in every
case of TS, this symptom, more than any other, periodically has brought TS to medical and
popular notice. What is most interesting about coprolalia in TS sufferers is that they
invoke the most unacceptable curses of these particular times and cultures (Fowler, 1996,
p. 48). Early adolescence is the time when coprolalia first manifests itself. Another
vocal tic is palilalia, which is repeating one’s words or parts of words. Echolalia
is the repeating of sounds, words, or parts of word of others. These vocal tics are a
major contribution to Tourette syndrome.

Related disorders of TS are attention deficit disorder, attention deficit hyperactivity
disorder, and obsessive-compulsive disorder (Bruun, 1984, p. 7). Up to 50 percent of all
children with TS who come to the attention of a physician also have ADHD, which is
manifested by problems with attention span, concentration, distractibility, impulsivity,
and motor hyperactivity (Fowler, 1996, p. 58). Attention deficits may also persist unto
adulthood and together, with obsessions and compulsions, can seriously impair any
performance. Obsessive-compulsive disorder may actually be another expression of the TS
gene, and therefore, an integral part of the disorder (Kushner, 1999, p. 48). These
obsessions are defined at thoughts, images, or impulses that intrude on consciousness, are
involuntary and distressful, and while perceived as silly or excessive, cannot be
abolished (Fowler, 1996, p. 60). Some TS patients also have significant aggression
directed toward others, including temper fits. One important factor in TS influence on
behavior is its ability to cause a “disinhibiting” effect, in which an
individual performs, acts, or makes statements, which would otherwise be censored by the
conscious mind. Antisocial and inappropriate sexual behavior is considered to be
frequently associated with TS by Comings and Comings (1985), who find that 44 percent of
their patients have discipline problems, 42 percent with anger and violence problems, and
14 percent exhibit some form of exhibitionism (Marsden, 1986, p. 791). Excitement,
anxiety, and impatient anticipation will cause an increase in tics, which concentration on
an absorbing activity will produce a decrease in tics. Rather than trying to make a
distinction, it is perhaps more helpful to think of TS sufferers as having a
“thin-barrier” (Fowler, 1996, p. 72).

Family genetic studies strongly support an etiologic relationship with TS. Because
Tourette results from imbalances of neurotransmitters and other chemicals in the brain,
the primary approach to controlling symptoms continues to be the administration of drugs,
which affect these neurochemicals (Bruun, 1984, p. 9). There are over seventy different
chemicals in the brain, which may influence human behavior, but the number contributing to
TS is still unclear. Serotinin is the neurotransmitter believed to be primarily
responsible for censorship, or inhibition. Dopamine, another neurotransmitter, affects
muscle movements, as well as behavior. An increase in dopamine levels can cause
exaggerated behaviors, including aggression and increased sexual activity. A particularly
important risk factor in tics and TS is the use of stimulant medication (1984, p. 9).
Stimulants will increase the severity of tics in 25 to 50 percent of all TS patients
(Kushner, 1999, p. 42). However, over the past several years, studies have shown that the
use of stimulants has been correlated to the onset of motor and phonic tics (Bruun, 1984,
p. 10).

TS is now seen as a relatively common disorder affecting up to one person in every 2,500
in its complete form, and three times that number in its partial expressions that include
chronic motor tics and some forms of OCD (Fowler, 1996, p. 74). TS is a genetic disorder;
the vulnerability of TS is transmitted from one generation to another. The gene, called
Gts (Gilles de la Tourette syndrome) gene, primarily affects the functioning of
neurotransmitters, the brain’s chemical messengers, which carry signals from one
neuron to another across a gap called a synapse (Goldman, 1995, p. 69). Most people who
inherit the gene(s) will not develop symptoms severe enough to warrant medical attention.
A person with TS has a 50-50 chance of passing the gene(s) on to one of his/her offspring
(Bruun, 1984, p. 11). This pattern of inheritance is called autosomal dominant. For
female carriers, there is a 70 percent chance that they will express some kind of symptoms
of TS (1984, p. 11). There is a 99 percent chance that male carriers will show some
clinical expression of the gene (1984, p. 11) The degree of expression in gene carriers
is described as penetrance. In males, penetrance is higher than in females; thus, males
are more likely to have some form of expression of the genetic vulnerability. A 30
percent chance of female gene carriers will show no symptoms at all, while one percent of
males will have no symptoms (Kushner, 1999, p. 63). Males are more likely to have TS or
tics; females are more likely to have OCD; however, both may have any combination or
severity. TS involves a clinical diagnosis, but no blood tests or other laboratory tests
that definitely diagnosis this disorder are available. There is no genetic or biochemical
test to determine if a person with TS or an unaffected person carries the gene. Also,
there is no prenatal test for the vulnerability to TS. Non-genetic factors are also
responsible both as causes and as modifiers of TS. In 25 percent of all cases, there are
no apparent genetic inheritances (1999, p. 68). These non-genetic factors include
stressful processes or events during the prenatal, perinatal, or early life periods as
fatal compromise and exposure to drugs or other toxins (1999, p. 72).

In most cases of TS, careful repeated observation and questioning are the only diagnostic
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