Gilles de la Tourette syndrome
Victoria Olivares
PSYC 430: Abnormal Psychology
Professor Cindy Bremer
August 9, 2021
Gilles de la Tourette syndrome
Intro
Tourette’s syndrome (TS) is a neurological disorder characterized by tics that begin in
childhood and often improves in adulthood. To qualify, according to the DSM-5, multiple motor
and vocal tics that began before the age of 18 and lasting more than 1 year, with tics not a
secondary condition to a physiological or neurological disorder.
Tics affect any part of the body but prominent in the face. In an analysis of 50 patients,
73% had sensory tics in their face, 39% in their arms, 34% in their hands, and 30% in other
places. Tourette’s International Consortium reported that the male to female ratio is 4.4:1 with a
mean age of 6.4 years. ADHD co-occurring with Tourette’s in 55.6% of patients and OCD
affecting 54.9% of Tourette patients (Hallett, 2015).
Historical
In 1885, George Gilles de la Tourette described his syndrome, Gilles de la Tourette’s
syndrome, by publishing, in Archives de Neurologie, an article about 9 patients that shared a
triad of symptoms. Symptoms include motor/vocal tics, echolalia ( repeating of others words),
and coprolalia (involuntary swearing). However in 1886, authors started to shorten the name to
Tourette’s syndrome and even TS (Cavanna, 2019).
Cause
Tourette’s syndrome has a multifactorial etiology with immunological, environmental,
and genetic factors contribute; “The gene Slit and Turk-like 1 (SLITRK1) on the chromosome
13q31.1 has been proposed as one of the possible gene involved in TS” (Rizzo, 2012). Appears
to be autosomal recessive in inheritance but difficult to find actual gene that causes it. Qi et al,
(2017) found several chromosomal regions that could be potential candidates for TS: 3p21-p14,
4q34-q35, 5q35.2-q35.3, 6p21, 7q31, 11q23-24, 13q31.1, 15q21.1-15q21.3, 17q25.
Researches have been using neuroimaging studies to determine abnormalities in the
brain. Physiological studies revealed some valuable details; sensory tics are very bothersome for
patients. Functional neuroimaging studies reveal little information; two seconds before a tic is
when their urge is the strongest. Physiological studies have shown an understanding of dopamine
and tics, scratching the itch of the urge releases dopamine into the system and making tics a form
of a habit (Hallett, 2015).
Treatment
Treatment is only symptomatic therefore could cause more damage or worsen the
disease. A popular approach to avoid drug use is behavioral therapy which helps to recognize tics
as a habit and how to deal by doing something socially acceptable instead. The three main
treatments consist of behavioral, medical, and surgical.
Several behavioral treatments are used to help manage tics. Some of the most effect
treatment are habit reversal treatment (HRT), comprehensive behavioral intervention for tics
(CBIT), and exposure with response prevention (ERP), (Varadharajan et al, 2021). HRT uses
awareness training (being aware of the onset of a tic), response training (replacing the tic with
something more socially acceptable), and care giver support. CBIT uses the core of HRT and
adds relaxation training and functional intervention. ERP uses exposure to urges while refraining
from acting on the tic.
CBIT consists of 8 or more sessions consisting of habit reversal, relaxation, and
functional interventions to address situations that worsen tics. A study with 126 children going
through behavioral therapy treatment showed significant improvement with 87% having
continued benefits following a 6 month review (Mittal, 2020). Similar results were found in an
adult study. CBIT without medication had slightly better results than those who were on
medication.
Medical treatment is considered under certain circumstances. Variety of medication is
available but evidence is not robust. The use of alpha-adrenergic is used first, than second-
generation or atypical antipsychotics are used next, the last step would be using first generations
or antipsychotics drugs.
When CBIT and medication don’t work, deep brain stimulation (DBS) is considered an
effective treatment. In 1999, the first case of DBS reported 90% reduction of tics at 1 year follow
up.
Cross cultural
Tourette’s syndrome was thought to be rare, but now recognized more commonly, with
an estimated 1 % of children and adolescents in majority of cultures, (Eapen, 2021). While
present in all ethnic and cultural groups, TS has an over representation in European and North
American literature. Research shows that the role of environment and cultural has a variation in
symptoms and comorbidities. There is also a difference in levels of distress and dysfunction, a
study showed that Caucasian’s show less distress and impairment than Latinos, (Eapen, 2021).
Indian literature consist of one case series and a dozen cars reports with most being
treated with medication or deep Brian stimulation when medication didn’t work. Patient series
describes treatment consisting of behavioral treatment in 7 patients, typically behavioral
treatment last 45 minutes. After treatment, results showed a significant drop in tics along with a
drop on comorbidites severity.
Biblical
It’s important to remember that those who suffer with Tourette’s don’t want the disease
and can not control their tics or outburst. As Christians, it’s important to treat them with
compassion and patience, accept them for who they are and help them lead normal lives. Genesis
1:27 reminds us that God made everyone in His image, even people who have Tourette’s are
made into His image and how He wants them to be.
We need to help them find scripture that gives them strength and teach them how to
mediate so when the urge hits them they are given strength from scripture and God. Psalm
139:13-14 states “For You formed my inward parts; You covered me in my mother’s womb. I
will praise You, for I am fearfully and wonderfully made; Marvelous are Your works,
And that my soul knows very well.”
Conclusion
Gilles de la Tourette’s syndrome is a disorder characterized by tics that begin in
childhood and often improves in adulthood. The cause of Tourette’s is yet unknown and research
is still being done to determine it. Not much can be done treatment wise but behavioral therapy is
used to help reduce or mange tics. Tourette’s has been seen throughout the world in different
cultures and groups.
Resources
Cavanna, A. E., & Seri, S. (2019). Georges Gilles de la Tourette and his legacy. Archives of
Medicine and Health Sciences, 7(2), 303.
Eapen, V. (2021). Gilles de la Tourette Syndrome: Cross-Cultural Perspectives With a Focus on
the Asia-Pacific Region. Frontiers in Psychiatry, 12.
Hallett, M. (2015). Tourette syndrome: update. Brain and Development, 37(7), 651-655.
Mittal, S. O. (2020). Tics and Tourette’s syndrome. Drugs in context, 9.
Qi Y, Zheng Y, Li Z, Xiong L. Progress in Genetic Studies of Tourette’s Syndrome. Brain
Sciences. 2017; 7(10):134. https://doi.org/10.3390/brainsci7100134
Rizzo, R., Gulisano, M., Calì, P. V., & Curatolo, P. (2012). Long term clinical course of Tourette
syndrome. Brain and Development, 34(8), 667-673.
Varadharajan, N., Chakrabarti, S., Sahoo, S., & Balachander, S. (2021). behavior Therapy for the
Treatment of Tourette’s Disorder in India: a Patient Series from an Indian General
Hospital Psychiatric Unit. Indian Journal of Psychological Medicine, 43(1), 81-85.
