Tourette syndrome Classification and external resources
Georges Gilles de la Tourette (1859–1904)
ICD-10	F95.2
ICD-9	307.23
OMIM	137580
DiseasesDB	5220
MedlinePlus	000733
eMedicine	med/3107  neuro/664
MeSH	D005879

Tourette syndrome (also called Tourette's syndrome, Tourette's disorder, Gilles de la Tourette syndrome, GTS or, more commonly, simply Tourette's or TS) is an inherited neuropsychiatric disorder with onset in childhood, characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic; these tics characteristically wax and wane. Tourette's is defined as part of a spectrum of tic disorders, which includes transient and chronic tics. Tourette (etymologically, French diminutive of tour) can refer to: Tourette syndrome, a neurological condition Georges Gilles de la Tourette, a French physician who described the syndrome Tourettes (song), a song by Nirvana Tourettes (band), a Heavy Metal band Donny Tourette of the Towers of London Tourrettes, Var, a commune... Image File history File links Download high-resolution version (810x900, 251 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Tourette syndrome Georges Gilles de la Tourette Portal:Medicine/Selected Article Archive Portal:Medicine/Selected article/39, 2006... Georges Gilles de la Tourette (1857-1904) was a French neurologist who first described the symptoms of Tourette syndrome. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... The ancients had a variety of ideas about heredity: Theophrastus proposed that male flowers caused female flowers to ripen; Hippocrates speculated that seeds were produced by various body parts and transmitted to offspring at the time of conception, and Aristotle thought that male and female semen mixed at conception. ... Neuropsychiatry is the branch of medicine dealing with mental disorders attributable to diseases of the nervous system. ... Not to be confused with Tick. ... A tic is a repeated, impulsive action, almost reflexive in nature, which the actor feels powerless to control or avoid. ...

Tourette's was once considered a rare and bizarre syndrome, most often associated with the exclamation of obscene words or socially inappropriate and derogatory remarks (coprolalia). However, this symptom is present in only a small minority of people with Tourette's.^[1] Tourette's is no longer considered a rare condition, but it may not always be correctly identified because most cases are classified as mild. Between 1 and 11 children per 1,000 have Tourette's; as many as 10 per 1,000 people may have tic disorders,^[2][3] with the more common tics of eye blinking, coughing, throat clearing, sniffing, and facial movements. People with Tourette's have normal life expectancy and intelligence. The severity of the tics decreases for most children as they pass through adolescence, and extreme Tourette's in adulthood is a rarity. Notable individuals with Tourette's are found in all walks of life.^[4] In medicine, the term syndrome is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others. ... Coprolalia is involuntary swearing or the involuntary utterance of obscene words or socially inappropriate and derogatory remarks. ... This article is about the measure of remaining life. ... Teen redirects here. ... Tourette syndrome (also Tourettes syndrome, Tourettes or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of motor and phonic tics. ...

Genetic and environmental factors each play a role in the etiology of Tourette's, but the exact causes are unknown. In most cases, medication is unnecessary. There is no effective medication for every case of tics, but there are medications and therapies that can help when their use is warranted. Explanation and reassurance alone are often sufficient treatment;^[5] education is an important part of any treatment plan.^[6] This article is about the general scientific term. ... This article is about the medical term. ...

The eponym was bestowed by Jean-Martin Charcot (1825–93) on behalf of his resident, Georges Albert Édouard Brutus Gilles de la Tourette (1859–1904), a French physician and neurologist, who published an account of nine patients with Tourette's in 1885. An eponym is the name of a person, whether real or fictitious, who has (or is thought to have) given rise to the name of a particular place, tribe, discovery, or other item. ... Categories: People stubs | French physicians | 1825 births | 1893 deaths | History of medicine ... Georges Gilles de la Tourette (1857-1904) was a French neurologist who first described the symptoms of Tourette syndrome. ... Neurology is a branch of medicine dealing with disorders of the nervous system. ...

Classification

Tics are sudden, repetitive, stereotyped, nonrhythmic movements (motor tics) and utterances (phonic tics) that involve discrete muscle groups.^[7] Motor tics are movement-based tics, while phonic tics are involuntary sounds produced by moving air through the nose, mouth, or throat. Not to be confused with Tick. ...

Tourette's is one of several tic disorders, which are classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM) according to type (motor or phonic tics) and duration (transient or chronic). Transient tic disorder consists of multiple motor tics, phonic tics or both, with a duration between four weeks and twelve months. Chronic tic disorder is either single or multiple, motor or phonic tics (but not both), which are present for more than a year.^[7] Tourette's is diagnosed when multiple motor tics, and at least one phonic tic, are present for more than a year.^[8] Tic disorders are defined similarly by the World Health Organization (International Statistical Classification of Diseases and Related Health Problems, ICD-10 codes).^[9] A tic is a repeated, impulsive action, almost reflexive in nature, which the actor feels powerless to control or avoid. ... The Diagnostic and Statistical Manual published by the American Psychiatric Association The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a handbook for mental health professionals that lists different categories of mental disorder and the criteria for diagnosing them, according to the publishing organization the American Psychiatric Association. ... WHO redirects here. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ...

Although Tourette's is the more severe expression of the spectrum of tic disorders,^[10] most cases are mild.^[11] The severity of symptoms varies widely among people with Tourette's, and mild cases may be undetected.^[7]

Characteristics

Tics are movements or sounds "that occur intermittently and unpredictably out of a background of normal motor activity",^[12] having the appearance of "normal behaviors gone wrong."^[13] The tics associated with Tourette's constantly change in number, frequency, severity and anatomical location. Waxing and waning—the ongoing increase and decrease in severity and frequency of tics—occurs differently in each individual. Tics also occur in "bouts of bouts", which vary for each person.^[7]

Coprolalia (the spontaneous utterance of socially objectionable or taboo words or phrases) is the most publicized symptom of Tourette's, but it is not required for a diagnosis of Tourette's. According to the Tourette Syndrome Association, fewer than 15% of Tourette's patients exhibit coprolalia.^[14] Echolalia (repeating the words of others) and palilalia (repeating one's own words) occur in a minority of cases,^[7] while the most common initial motor and vocal tics are, respectively, eye blinking and throat clearing.^[15] Coprolalia is involuntary swearing or the involuntary utterance of obscene words or socially inappropriate and derogatory remarks. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ... Echolalia is the repetition or echoing of verbal utterances made by another person. ... Palilalia is the repetition or echoing of ones own spoken words. ...

In contrast to the abnormal movements of other movement disorders (for example, choreas, dystonias, myoclonus, and dyskinesias), the tics of Tourette's are stereotypic, temporarily suppressible, nonrhythmic, and often preceded by a premonitory urge.^[16] Immediately preceding tic onset, most individuals with Tourette's are aware of an urge^[17] that is similar to the need to sneeze or scratch an itch. Individuals describe the need to tic as a buildup of tension^[18] which they consciously choose to release, as if they "had to do it".^[19] Examples of the premonitory urge are the feeling of having something in one's throat, or a localized discomfort in the shoulders, leading to the need to clear one's throat or shrug the shoulders. The actual tic may be felt as relieving this tension or sensation, similar to scratching an itch. Another example is blinking to relieve an uncomfortable sensation in the eye. These urges and sensations, preceding the expression of the movement or vocalization as a tic, are referred to as "premonitory sensory phenomena". Published descriptions of the tics of Tourette's identify sensory phenomena as the core symptom of the syndrome, even though they are not included in the diagnostic criteria.^[18][20][21] List of Movement disorders Akinesia (lack of movement) Athetosis (contorted torsion or twisting) Ataxia Ballismus (violent involuntary rapid and irregular movements) Hemiballismus Bradykinesia (slow movement) Chorea (rapid, involuntary movement) Sydenhams chorea Rheumatic chorea Huntingtons chorea Dystonia (sustained torsion) Dystonia muscularum Blepharospasm Writers cramp Spasmodic torticollis (twisting of... // Chorea sancti viti (Latin for St. ... Dystonia is a neurological movement disorder in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. ... Myoclonus is brief, involuntary twitching of a muscle or a group of muscles. ... Dyskinesia refers to an impairment of voluntary movement. ... Sensory phenomena are general feelings, urges or bodily sensations that precede or accompany repetitive behaviors[1] associated with Tourette syndrome and tic disorders. ... A symptom is a manifestation of a disease, indicating the nature of the disease, which is noticed by the patient. ...

Tics are described as semi-voluntary or "unvoluntary",^[12] because they are not strictly involuntary—they may be experienced as a voluntary response to the unwanted, premonitory urge. A unique aspect of tics, relative to other movement disorders, is that they are suppressible yet irresistible;^[13] they are experienced as an irresistible urge that must eventually be expressed.^[12] People with Tourette's are sometimes able to suppress their tics to some extent for limited periods of time, but doing so often results in an explosion of tics afterward.^[5] People with Tourette's may seek a secluded spot to release their symptoms, or there may be a marked increase in tics, after a period of suppression at school or at work.^[13]

Some people with Tourette's may not be aware of the premonitory urge. Children may be less aware of the premonitory urge associated with tics than are adults, but their awareness tends to increase with maturity.^[12] They may have tics for several years before becoming aware of premonitory urges. Children may suppress tics while in the doctor's office, so they may need to be observed while they are not aware they are being watched.^[22] The ability to suppress tics varies among individuals, and may be more developed in adults than children.

Although there is no such thing as a "typical" case of Tourette syndrome,^[5] the condition follows a fairly reliable course in terms of the age of onset and the history of the severity of symptoms. Tics may appear up to the age of eighteen, but the most typical age of onset is from five to seven.^[7] The ages of highest tic severity are eight to twelve (average ten), with tics steadily declining for most patients as they pass through adolescence.^[23] The most common, first-presenting tics are eye blinking, facial movements, sniffing and throat clearing. Initial tics present most frequently in midline body regions where there are many muscles, usually the head, neck and facial region.^[5] This can be contrasted with the stereotyped movements of other disorders (such as stims and stereotypies of the autism spectrum disorders), which typically have an earlier age of onset, are more symmetrical, rhythmical and bilateral, and involve the extremities (e.g., flapping the hands).^[24] Tics that appear early in the course of the condition are frequently confused with other conditions, such as allergies, asthma, and vision problems: pediatricians, allergists and ophthalmologists are typically the first to see a child with tics.^[7] Stimming is a behavior observed in people who have Aspergers syndrome or autism. ... Stimming is a jargon term for stereotypy, a repetitive body movement that self-stimulates one or more senses in a regulated manner. ... A boy with autism and his mother Autism refers to a spectrum of disorders, and lies somewhere under the umbrella of a greater encompassing spectrum, that of pervasive developmental disorders that involve the functioning of the brain. ... This article needs cleanup. ...

Among patients whose symptoms are severe enough to warrant referral to clinics, obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) are often associated with Tourette's. Not all persons with Tourette's have ADHD or OCD or other comorbid conditions (co-occurring diagnoses other than Tourette's), although in clinical populations, a high percentage of patients presenting for care do have ADHD.^[25] One author reports that a ten-year overview of patient records revealed about 40% of patients with Tourette's have "TS-only" or "pure TS", referring to Tourette syndrome in the absence of ADHD, OCD and other disorders.^[26] Another author reports that 57% of 656 patients presenting with tic disorders had uncomplicated tics, while 43% had tics plus comorbid conditions.^[13] "Full-blown Tourette's" is a term used to describe patients who have significant comorbid conditions in addition to tics.^[13] Attention-Deficit Hyperactivity Disorder (ADHD), is a neurobehavioural developmental disorder[1] [2] [3] affecting about 3-5% of the worlds population under the age of 19[4]. It typically presents itself during childhood, and is characterized by a persistent pattern of inattention and/or hyperactivity, as well as forgetfulness... In medicine and in psychiatry, comorbidity refers to: The presence of one or more disorders (or diseases) in addition to a primary disease or disorder. ...

Causes

Main article: Causes and origins of Tourette syndrome

The exact cause of Tourette's is unknown, but it is well established that both genetic and environmental factors are involved.^[27] Genetic studies have shown that the overwhelming majority of cases of Tourette's are inherited, although the exact mode of inheritance is not yet known,^[28] and no gene has been identified.^[5] In some cases, tics may not be inherited; these cases are identified as "sporadic" Tourette syndrome (also known as tourettism) because a genetic link is missing.^[29] Causes and origins of Tourette syndrome have not been fully elucidated. ... Tourettism refers to tics associated with conditions other than Tourette syndrome. ...

Brain structures implicated in Tourette's syndrome

A person with Tourette's has about a 50% chance of passing the gene(s) to one of his or her children, but Tourette's is a condition of variable expression and incomplete penetrance.^[30] Thus, not everyone who inherits the genetic vulnerability will show symptoms; even close family members may show different severities of symptoms, or no symptoms at all. The gene(s) may express as Tourette's, as a milder tic disorder (transient or chronic tics), or as obsessive compulsive symptoms without tics. Only a minority of the children who inherit the gene(s) have symptoms severe enough to require medical attention.^[14] Gender appears to have a role in the expression of the genetic vulnerability: males are more likely than females to express tics.^[22] Image File history File links Brain_structure. ... Image File history File links Brain_structure. ... Expressivity refers to variations of a phenotype in genetics. ... Penetrance is a term used in genetics that describes the extent to which the properties controlled by a gene, its phenotype, will be expressed. ...

Non-genetic, environmental, infectious, or psychosocial factors—while not causing Tourette's—can influence its severity.^[5] Autoimmune processes may affect tic onset and exacerbation in some cases. In 1998, a team at the National Institute of Mental Health proposed a hypothesis that both obsessive-compulsive disorder (OCD) and tic disorders may arise in a subset of children as a result of a poststreptococcal autoimmune process.^[31] Children who meet five diagnostic criteria are classified, according to the hypothesis, as having Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS).^[32] This contentious hypothesis is the focus of clinical and laboratory research, but remains unproven.^[33][34] Psychosocial refers to ones psychological development in the context of a social environment. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... The National Institute of Mental Health (NIMH) is part of the federal government of the United States and the largest research organization in the world specializing in mental illness. ... Panda can have several different meanings: The Giant Panda is a large black-and-white bear-like mammal native to China. ...

The exact mechanism affecting the inherited vulnerability to Tourette's has not been established, and the precise etiology is unknown. Tics are believed to result from dysfunction in cortical and subcortical regions, the thalamus, basal ganglia and frontal cortex.^[27] Neuroanatomic models implicate failures in circuits connecting the brain's cortex and subcortex,^[5] and imaging techniques implicate the basal ganglia and frontal cortex.^[35] For the computer game developer, see Thalamus Ltd. ... The basal ganglia (or basal nuclei) are a group of nuclei in the brain interconnected with the cerebral cortex, thalamus and brainstem. ... {{Infobox Brain| Name = Frontal lobe | Latin = lobus frontalis | GraySubject = 189 | GrayPage = 821 | Map = Cerebrum map| MapPos = | MapCaption = Principal fissures and lobes of the cerebrum viewed laterally. ... Neuroanatomy is the anatomy of the nervous system. ... It has been suggested that this article or section be merged with functional neuroimaging. ...

Some forms of OCD may be genetically linked to Tourette's.^[36] A subset of OCD is thought to be etiologically related to Tourette's and may be a different expression of the same factors that are important for the expression of tics.^[37] The genetic relationship of ADHD to Tourette syndrome, however, has not been fully established.^[26] This article is about the medical term. ...

Diagnosis

According to the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), Tourette’s Disorder may be diagnosed when a person exhibits both multiple motor and one or more vocal tics (although these do not need to be concurrent) over the period of a year, with no more than three consecutive tic-free months. The previous DSM-IV included a requirement for "marked distress or significant impairment in social, occupational or other important areas of functioning", but this requirement was removed in the most recent update of the manual, in recognition that clinicians see patients who meet all the other criteria for Tourette's, but do not have distress or impairment.^[38] The onset must have occurred before the age of 18, and cannot be attributed to the "direct physiological effects of a substance or a general medical condition".^[8] Hence, other medical conditions that include tics or tic-like movements—such as autism or other causes of tourettism—must be ruled out before conferring a Tourette's diagnosis. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and other countries. ... Autism is a brain development disorder characterized by impairments in social interaction and communication, and restricted and repetitive behavior, all exhibited before a child is three years old. ... Tourettism refers to tics associated with conditions other than Tourette syndrome. ...

There are no specific medical or screening tests that can be used in diagnosing Tourette's;^[7] it is frequently misdiagnosed or underdiagnosed, partly because of the wide expression of severity, ranging from mild (the majority of cases) or moderate, to severe (the rare, but more widely-recognized and publicized cases).^[23] The diagnosis is made based on observation of the individual's symptoms and family history, and after ruling out secondary causes of tic disorders.^[14] In patients with a typical onset and a family history of tics or obsessive–compulsive disorder, a basic physical and neurological examination may be sufficient.^[10] Tourettism refers to tics associated with conditions other than Tourette syndrome. ...

If a physician believes that there may be another condition present that could explain tics, tests may be ordered as necessary to rule out that condition. An example of this is when diagnostic confusion between tics and seizure activity exists, which would call for an EEG, or if there are symptoms that indicate an MRI to rule out brain abnormalities.^[39] TSH levels can be measured to rule out hypothyroidism, which can be a cause of tics. Brain imaging studies are not usually warranted.^[39] In teenagers and adults presenting with a sudden onset of tics and other behavioral symptoms, a urine drug screen for cocaine and stimulants might be necessary. If a family history of liver disease is present, serum copper and ceruloplasmin levels can rule out Wilson's disease.^[10] However, most cases are diagnosed by merely observing a history of tics.^[5][14] This article is about epileptic seizures. ... EEG redirects here. ... The mri are a fictional alien species in the Faded Sun Trilogy of C.J. Cherryh. ... Thyroid-stimulating hormone (also known as TSH or thyrotropin) is a hormone synthesized and secreted by thyrotrope cells in the anterior pituitary gland which regulates the endocrine function of the thyroid gland. ... This article or section does not cite its references or sources. ... Brain imaging is a fairly recent discipline within medicine and neuroscience. ... For the episode of the American television series The Office, see Drug Testing. A drug test is commonly a technical examination of urine, semen, blood, sweat, or oral fluid samples to determine the presence or absence of specified drugs or their metabolized traces. ... For other uses, see Cocaine (disambiguation). ... A stimulant is a drug which increases the activity of the sympathetic nervous system and produces a sense of euphoria or awakeness. ... The liver is an organ in vertebrates including humans. ... Ceruloplasmin Ceruloplasmin (or caeruloplasmin), officially known as ferroxidase or iron(II):oxygen oxidoreductase, is a copper transport protein found in the blood. ... Wilsons disease or hepatolenticular degeneration is an autosomal recessive hereditary disease, with an incidence of about 1 in 30,000 in most parts of the world and a male preponderance. ...

Secondary causes of tics (not related to inherited Tourette syndrome) are commonly referred to as tourettism.^[29] Dystonias, choreas, other genetic conditions, and secondary causes of tics should be ruled out in the differential diagnosis for Tourette syndrome.^[10] Other conditions that may manifest tics or stereotyped movements include developmental disorders, autism spectrum disorders,^[40] and stereotypic movement disorder;^[41][42] Sydenham's chorea; idiopathic dystonia; and genetic conditions such as Huntington's disease, neuroacanthocytosis, Hallervorden-Spatz syndrome, Duchenne muscular dystrophy, Wilson's disease, and tuberous sclerosis. Other possibilities include chromosomal disorders such as Down syndrome, Klinefelter's syndrome, XYY syndrome and fragile X syndrome. Acquired causes of tics include drug-induced tics, head trauma, encephalitis, stroke, and carbon monoxide poisoning.^[10][29] The symptoms of Lesch-Nyhan syndrome may also be confused with Tourette syndrome.^[24] Most of these conditions are rarer than tic disorders, and a thorough history and examination may be enough to rule them out, without medical or screening tests.^[5] Tourettism refers to tics associated with conditions other than Tourette syndrome. ... Dystonia is a neurological movement disorder in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. ... This article does not cite any references or sources. ... Developmental disorders are disorders that occur at some stage in a childs development, often retarding the development. ... A boy with autism and his mother Autism refers to a spectrum of disorders, and lies somewhere under the umbrella of a greater encompassing spectrum, that of pervasive developmental disorders that involve the functioning of the brain. ... This page may meet Wikipedias criteria for speedy deletion. ... Sydenhams chorea (or Rheumatic chorea) is a disease characterized by rapid, uncoordinated jerking movements affecting primarily the face, feet and hands. ... Idiopathic means arising spontaneously or from an obscure or unknown cause. ... Neuroacanthocytosis (also known as Levine-Critchley syndrome or choreoacanthocytosis) is a rare movement disorder marked by progressive muscle weakness and atrophy, progressive cognitive loss, chorea (involuntary twisting movements of the body), and acanthocytosis (spiked red blood cells associated with several inherited neurological disorders). ... Hallervorden-Spatz syndrome is a degenerative disease of the globus pallidus and substantia nigra of the brain, which can lead to parkinsonism. ... Duchenne muscular dystrophy (DMD) is a form of muscular dystrophy that is characterized by decreasing muscle mass and progressive loss of muscle function in male children. ... Tuberous sclerosis is a rare genetic disorder characterized by a triad of signs: seizures, mental retardation, and small benign facial skin tumors (angiofibromas). ... Not to be confused with XXX syndrome. ... Not to be confused with XXY syndrome. ... Fragile X syndrome is a syndrome of X-linked mental retardation. ... Encephalitis is an acute inflammation of the brain, commonly caused by a viral infection. ... For other uses, see Stroke (disambiguation). ... Carbon monoxide poisoning occurs after the inhalation of carbon monoxide gas. ... -1...

Screening

Although not all people with Tourette's have comorbid conditions, most Tourette's patients presenting for clinical care at specialty referral centers may exhibit symptoms of other conditions along with their motor and phonic tics.^[26] Associated conditions include attention-deficit hyperactivity disorder (ADD or ADHD), obsessive–compulsive disorder (OCD), learning disabilities and sleep disorders.^[2] Disruptive behaviors, impaired functioning, or cognitive impairment in patients with comorbid Tourette's and ADHD may be accounted for by the comorbid ADHD, highlighting the importance of identifying and treating comorbid conditions.^[25][43] Disruption from tics is commonly overshadowed by comorbid conditions that present greater interference to the child.^[5] Tic disorders in the absence of ADHD do not appear to be associated with disruptive behavior or functional impairment,^[3] while impairment in school, family, or peer relations is greater in patients who have more comorbid conditions and often determines whether therapy is needed.^[13] In broad terms, the phrase learning disability covers any of a range of conditions that affect a persons ability to learn new information. ... Cognitive The scientific study of how people obtain, retrieve, store and manipulate information. ...

Because comorbid conditions such as OCD and ADHD can be more impairing than tics, these conditions are included in an evaluation of patients presenting with tics. "It is critical to note that the comorbid conditions may determine functional status more strongly than the tic disorder," according to Samuel Zinner, MD.^[5] The initial assessment of a patient referred for a tic disorder should include a thorough evaluation, including a family history of tics, ADHD, obsessive–compulsive symptoms, and other chronic medical, psychiatric and neurological conditions. Children and adolescents with TS who have learning difficulties are candidates for psychoeducational testing, particularly if the child also has ADHD.^[39] Undiagnosed comorbid conditions may result in functional impairment, and it is necessary to identify and treat these conditions to improve functioning. Complications may include depression, sleep problems, social discomfort and self-injury.^[10] On the Threshold of Eternity. ... A sleep disorder (somnipathy) is a disorder in the sleep patterns of a person or animal. ... Self-harm (SH) is deliberate injury to ones own body. ...

Management

Main article: Treatment of Tourette syndrome

Clonidine (or the clonidine patch) is one of the medications typically tried first when medication is needed for Tourette's.

The treatment of Tourette's focuses on identifying and helping the individual manage the most troubling or impairing symptoms.^[5] Most cases of Tourette's are mild, and do not require pharmacological treatment;^[11] instead, psychobehavioral therapy, education, and reassurance may be sufficient.^[44] Treatments, where warranted, can be divided into those that target tics and comorbid conditions, which, when present, are often a larger source of impairment than the tics themselves.^[39] Not all people with tics have comorbid conditions,^[26] but when those conditions are present, they often take treatment priority. Tourette syndrome (also Tourettes syndrome or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of motor and phonic tics. ... ImageMetadata File history File links Clonidine_pills_and_patch. ... ImageMetadata File history File links Clonidine_pills_and_patch. ... Clonidine is a direct-acting adrenergic agonist prescribed historically as an anti-hypertensive agent. ... Pharmacology (in Greek: pharmakon (φάρμακον) meaning drug, and lego (λέγω) to tell (about)) is the study of how drugs interact with living organisms to produce a change in function. ...

There is no cure for Tourette's and no medication that works universally for all individuals without significant adverse effects. Knowledge, education and understanding are uppermost in management plans for tic disorders.^[5] The management of the symptoms of Tourette's may include pharmacological, behavioral and psychological therapies. While pharmacological intervention is reserved for more severe symptoms, other treatments (such as supportive psychotherapy or cognitive behavioral therapy) may help to avoid or ameliorate depression and social isolation, and to improve family support. Educating a patient, family, and surrounding community (such as friends, school, and church) is a key treatment strategy, and may be all that is required in mild cases.^[5][45] This article does not cite any references or sources. ... {redirect|Psychological science|the journal|Psychological Science (journal)}} Not to be confused with Phycology. ... A Cognitive Behavioral Therapy (CBT) is a psychotherapy based on modifying cognitions, assumptions, beliefs and behaviors, with the aim of influencing disturbed emotions. ... For other uses, see Depression. ...

Model of a haloperidol molecule. Haloperidol is an antipsychotic medication sometimes used to treat severe cases of Tourette's.

Medication is available to help when symptoms interfere with functioning.^[14] The classes of medication with the most proven efficacy in treating tics—typical and atypical neuroleptics including risperidone (trade name^[A] Risperdal), ziprasidone (Geodon), haloperidol (Haldol), pimozide (Orap) and fluphenazine (Prolixin)—can have long-term and short-term adverse effects.^[39] The antihypertensive agents clonidine (trade name Catapres) and guanfacine (Tenex) are also used to treat tics; studies show variable efficacy, but a lower side effect profile than the neuroleptics.^[1] Stimulants and other medications may be useful in treating ADHD when it co-occurs with tic disorders. Drugs from several other classes of medications can be used when stimulant trials fail, including guanfacine (trade name Tenex), atomoxetine (Strattera) and tricyclics. Clomipramine (Anafranil), a tricyclic antidepressant, and SSRIs—a class of antidepressants including fluoxetine (Prozac), sertraline (Zoloft), and fluvoxamine (Luvox)—may be prescribed when a Tourette's patient also has symptoms of obsessive–compulsive disorder.^[39] Image File history File links Download high-resolution version (1100x433, 131 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Tourette syndrome Haloperidol Wikipedia:Featured article candidates/Featured log Wikipedia:Featured article candidates/Tourette syndrome Wikipedia:Featured article... Image File history File links Download high-resolution version (1100x433, 131 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Tourette syndrome Haloperidol Wikipedia:Featured article candidates/Featured log Wikipedia:Featured article candidates/Tourette syndrome Wikipedia:Featured article... Haloperidol (sold under the tradenames Aloperidin, Bioperidolo, Brotopon, Dozic, Duraperidol (Germany), Einalon S, Eukystol, Haldol, Halosten, Keselan, Linton, Peluces, Serenace, Serenase, Sigaperidol) is a conventional, or typical, butyrophenone antipsychotic drug. ... Typical antipsychotics (sometimes referred to as conventional antipsychotics or conventional neuroleptics) are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis (in particular, schizophrenia), and are generally being replaced by atypical antipsychotic drugs. ... The atypical antipsychotics (also known as second generation antipsychotics) are a class of prescription medications used to treat psychiatric conditions. ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ... Risperdal tablets Risperidone (pronounced Ris-PER-ǐ-dōn and sold under the trade name Risperdal in the United States, Canada, the United Kingdom, Portugal and several other countries, Risperdal or Ridal in New Zealand, Rispolept in Eastern Europe, and Belivon, or Rispen elsewhere) is an atypical antipsychotic medication developed by... Ziprasidone (marketed as Geodon, Zeldox) was the fifth atypical antipsychotic to gain FDA approval (February 2001). ... Haloperidol (sold under the tradenames Aloperidin, Bioperidolo, Brotopon, Dozic, Duraperidol (Germany), Einalon S, Eukystol, Haldol, Halosten, Keselan, Linton, Peluces, Serenace, Serenase, Sigaperidol) is a conventional, or typical, butyrophenone antipsychotic drug. ... Pimozide (sold as Orap®) is an antipsychotic drug. ... Fluphenazineis a typical antipsychoticdrug. ... Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ... Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension (high blood pressure). ... Clonidine is a direct-acting adrenergic agonist prescribed historically as an anti-hypertensive agent. ... Guanfacine is a centrally acting antihypertensive agent. ... A stimulant is a drug which increases the activity of the sympathetic nervous system and produces a sense of euphoria or awakeness. ... Tourette syndrome (also Tourettes syndrome or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of motor and phonic tics. ... Guanfacine is a centrally acting antihypertensive agent. ... Atomoxetine is the first non-stimulant drug approved for the treatment of attention-deficit hyperactivity disorder (ADHD). ... Chemical structure of the tricyclic antidepressant amitriptyline. ... Clomipramine (brand-name Anafranil®) is a tricyclic antidepressant. ... Chemical structure of the tricyclic antidepressant amitriptyline. ... SSRI redirects here; for other uses, see SSRI (disambiguation). ... Prozac, a selective serotonin reuptake inhibitor (SSRI) Serotonin-norepinephrine reuptake inhibitor, Venlafaxine An antidepressant is a psychiatric medication or other substance (nutrient or herb) used for alleviating depression or dysthymia (milder depression). ... Prozac redirects here. ... Zoloft bottles, with blue and green tablets Sertraline hydrochloride (also sold under brand names Zoloft, Lustral, Apo-Sertral, Asentra, Gladem, Serlift, Stimuloton, Xydep, Serlain, Concorz) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. ... Fluvoxamine (brand name as Luvox®, Faverin®, Fevarin® and Dumyrox®) is an antidepressant which functions pharmacologically as a selective serotonin reuptake inhibitor. ...

Because children with tics often present to physicians when their tics are most severe, and because of the waxing and waning nature of tics, it is recommended that medication not be started immediately or changed often.^[5] Frequently, the tics subside with explanation, reassurance, understanding of the condition and a supportive environment.^[5] When medication is used, the goal is not to eliminate symptoms: it should be used at the lowest possible dose that manages symptoms without adverse effects, given that these may be more disturbing than the symptoms for which they were prescribed.^[5]

Cognitive behavioral therapy (CBT) is a useful treatment when OCD is present,^[46] and there is increasing evidence supporting the use of habit reversal in the treatment of tics.^[47] Relaxation techniques, such as exercise, yoga or meditation, may be useful in relieving the stress that may aggravate tics, but the majority of behavioral interventions (such as relaxation training and biofeedback, with the exception of habit reversal) have not been systematically evaluated and are not empirically supported therapies for Tourette's.^[48] A Cognitive Behavioral Therapy (CBT) is a psychotherapy based on modifying cognitions, assumptions, beliefs and behaviors, with the aim of influencing disturbed emotions. ... Habit reveral training (HRT) is a multicomponent behavioral treatment package originally developed to address a wide variety of repetitive behavior disorders.[1] Behavioral disorders treated with HRT include tics, trichotillomania, nail biting, thumb sucking, and skin picking. ... Relaxation techniques are used by people who wish to relax, for a wide variety of reasons. ... Biofeedback mechanism. ...

Prognosis

André Malraux (1901–1976) was a French author, adventurer and statesman who had Tourette syndrome.^[49][50] President Kennedy, Mme Malraux, French Minister of Culture André Malraux, Jackie Kennedy and Vice President Johnson were photographed at the unveiling of the Mona Lisa at the National Gallery of Art, Washington DC, in 1963.^[51]

Tourette syndrome is a spectrum disorder—its severity ranges over a spectrum from mild to severe. The majority of cases are mild and require no treatment.^[11] In these cases, the impact of symptoms on the individual may be mild, to the extent that casual observers might not know of their condition. The overall prognosis is positive, but a minority of children with Tourette syndrome have severe symptoms that persist into adulthood.^[27] A study of 46 subjects at 19 years of age found that the symptoms of 80% had minimum to mild impact on their overall functioning, and that the other 20% experienced at least a moderate impact on their overall functioning.^[7] The rare minority of severe cases can inhibit or prevent individuals from holding a job or having a fulfilling social life. In a follow-up study of thirty-one adults with Tourette's, all patients completed high school, 52% finished at least two years of college, and 71% were full-time employed or were pursuing higher education.^[52] André Malraux, French author, adventurer, and statesman André Malraux (November 3, 1901 – November 23, 1976) was a French author, adventurer and statesman, and a dominant figure in French politics and culture. ... For other uses, see Author (disambiguation). ... Statesman is a respectful term used to refer to politicians, and other notable figures of state. ... John Kennedy and JFK redirect here. ... Jacqueline Bouvier redirects here. ... LBJ redirects here. ... For other uses, see Mona Lisa (disambiguation). ... The West building of the National Gallery of Art with the East building visible behind and to to the left The National Gallery of Art is an art museum, located on the National Mall in Washington, D.C. The museum was established in 1937 by the Congress, with funds for...

Regardless of symptom severity, individuals with Tourette's can expect to live a normal life span. Although the symptoms may be lifelong and chronic for some, the condition is not degenerative or life-threatening. Intelligence is normal in those with Tourette's, although there may be learning disabilities.^[14] There is no reliable means of predicting the outcome for a particular individual. The gene or genes associated with Tourette's have not been identified, and there is no potential "cure".^[14] This article is about the measure of remaining life. ... Degeneration is deterioration in the medical sense. ... Intelligence is the mental capacity to reason, plan, solve problems, think abstractly, comprehend ideas and language, and learn. ...

Several studies have demonstrated that the condition in most children improves with maturity. Tics may be at their highest severity at the time that they are diagnosed, and often improve with understanding of the condition by individuals and their families and friends. The statistical age of highest tic severity is typically between eight and twelve, with most individuals experiencing steadily declining tic severity as they pass through adolescence. One study showed no correlation with tic severity and the onset of puberty, in contrast with the popular belief that tics increase at puberty. In many cases, a complete remission of tic symptoms occurs after adolescence.^[23][53] However, a study using videotape to record tics in adults found that, although tics diminished in comparison with childhood, and all measures of tic severity improved by adulthood, 90% of adults still had tics. Half of the adults who considered themselves tic-free still displayed evidence of tics.^[52]

It is not uncommon for the parents of affected children to be unaware that they, too, may have had tics as children. Because Tourette's tends to subside with maturity, and because milder cases of Tourette's are now more likely to be recognized, the first realization that a parent had tics as a child may not come until their offspring is diagnosed. It is not uncommon for several members of a family to be diagnosed together, as parents bringing children to a physician for an evaluation of tics become aware that they, too, had tics as a child.

Children with Tourette's may suffer socially if their tics are viewed as "bizarre". If a child has disabling tics, or tics that interfere with social or academic functioning, supportive psychotherapy or school accommodations can be helpful.^[14] Because comorbid conditions (such as ADHD or OCD) can cause greater impact on overall functioning than tics, a thorough evaluation for comorbidity is called for when symptoms and impairment warrant.^[10] Psychotherapy is an interpersonal, relational intervention used by trained psychotherapists to aid clients in problems of living. ... In medicine and in psychiatry, comorbidity refers to: The presence of one or more disorders (or diseases) in addition to a primary disease or disorder. ...

Tim Howard, goalkeeper for Everton F.C., says, "Tourette's Syndrome is not a problem. It is part of my life. It doesn't affect me one way or another on or off the field."^[54]

A supportive environment and family generally gives those with Tourette's the skills to manage the disorder.^[55][56] People with Tourette's may learn to camouflage socially inappropriate tics or to channel the energy of their tics into a functional endeavor. Accomplished musicians, athletes, public speakers, and professionals from all walks of life are found among people with Tourette's. Outcomes in adulthood are associated more with the perceived significance of having severe tics as a child than with the actual severity of the tics. A person who was misunderstood, punished, or teased at home or at school will fare worse than children who enjoyed an understanding and supportive environment.^[7] Image File history File linksMetadata Download high-resolution version (1971x1313, 1414 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Tim Howard Metadata This file contains additional information, probably added from the digital camera or scanner used to... Image File history File linksMetadata Download high-resolution version (1971x1313, 1414 KB) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Tim Howard Metadata This file contains additional information, probably added from the digital camera or scanner used to... For other persons named Tim Howard, see Tim Howard (disambiguation). ... A football goalkeeper leaves the ground to parry a shot on goal In many team sports, a goalkeeper (termed goaltender, netminder, goalie, or keeper in some sports) is a designated player that is charged with directly preventing the opposite team from scoring by defending the goal. ... Everton Football Club is an English football club located in the city of Liverpool. ... Tourette syndrome (also Tourettes syndrome, Tourettes or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of motor and phonic tics. ...

A controlled study on a small group of individuals with Tourette's found that young people with the syndrome have greater cognitive control over movements than their age-matched controls, possibly because the need to suppress tics results in a more efficient control over inhibitory movements, a skill that confers an advantage when switching between tasks. Children with Tourette's (in the absence of comorbid ADHD) performed more accurately on a goal-oriented eye-movement task, requiring active inhibition of automatic eye movements, and they made fewer errors than their unaffected peers, suggesting compensatory changes in the brain resulting in greater cognitive control.^[57] A subsequent study confirmed and extended the paradoxical result that individuals with Tourette's exhibit greater levels of cognitive control than age-matched healthy peers.^[58] A study of eight children, age 8–17, found that children with Tourette syndrome were quicker at processing certain mental grammar skills than are children without the condition. The abnormalities that lead to tics may also lead to "other rapid behaviors, including the cognitive processing of rule-governed forms in language and other types of procedural knowledge".^[59] This article belongs in one or more categories. ...

Epidemiology

Tourette syndrome is found among all social, racial and ethnic groups,^[2][60] has been reported in all parts of the world,^[61] and is three to four times more frequent among males than among females.^[62] The tics of Tourette syndrome begin in childhood and tend to remit or subside with maturity; thus, a diagnosis may no longer be warranted for many adults, and prevalence is much higher among children than adults.^[23] Children are five to twelve times more likely than adults to be identified as having tic disorders;^[63] as many as 1 in 100 people experience tic disorders, including chronic tics and transient tics in childhood.^[2] In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. ... A tic is a repeated, impulsive action, almost reflexive in nature, which the actor feels powerless to control or avoid. ...

Discrepancies across current and prior prevalence estimates come from several factors: ascertainment bias in earlier samples drawn from clinically referred cases, assessment methods that may fail to detect milder cases, and differences in diagnostic criteria and thresholds.^[64] There were few broad-based community studies published before 2000 and until the 1980s, most epidemiological studies of Tourette syndrome were based on individuals referred to tertiary care or specialty clinics.^[1][65] Children with milder symptoms are unlikely to be referred to specialty clinics, so these studies have an inherent bias towards more severe cases.^[1][66] Studies of Tourette syndrome are vulnerable to error because tics vary in intensity and expression, are often intermittent, and are not always recognized by clinicians, patients, family members, friends or teachers;^[5][67] approximately 20% of persons with Tourette syndrome do not recognize that they have tics.^[5] Recent studies—recognizing that tics may often be undiagnosed and hard to detect—use direct classroom observation and multiple informants (parent, teacher, and trained observers), and therefore record more cases than older studies relying on referrals.^[68][45] As the diagnostic threshold and assessment methodology have moved towards recognition of milder cases, the result is an increase in estimated prevalence.^[64] Ascertainment bias describes the incorrect results of a study due to the way in which the data were collected. ... Sampling is that part of statistical practice concerned with the selection of individual observations intended to yield some knowledge about a population of concern, especially for the purposes of statistical inference. ... An Epidemiological study is a statistical study on human populations, which attempt to link human health effects to a specified cause. ... In medicine, tertiary healthcare is specialized consultative care, usually on referral from primary or secondary medical care personnel, by specialists working in a center that has personnel and facilities for special investigation and treatment. ... A biased sample is one that is falsely taken to be typical of a population from which it is drawn. ... Penetrance is a term used in genetics that describes the extent to which the properties controlled by a gene, its phenotype, will be expressed. ...

Tourette syndrome was once thought to be rare: in 1972, the US National Institutes of Health (NIH) believed there were fewer than 100 cases in the United States,^[69] and a 1973 registry reported only 485 cases worldwide.^[70] However, multiple studies published since 2000 have consistently demonstrated that the prevalence is much higher than previously thought.^[71] The emerging consensus is that 1–11 children per 1,000 have Tourette's, with several studies supporting a tighter range of 6–8 children per 1,000.^[3] Using year 2000 census data, a prevalence range of 1–10 per 1,000 yields an estimate of 53,000–530,000 school-age children with Tourette's in the US^[3] and a prevalence range of 6–10 per 1,000 means that 64,000–106,000 children aged 5–18 years may have Tourette's in the UK.^[45] Most of these children are undiagnosed and have mild symptoms without distress or impairment.^[61][68] National Institutes of Health Building 50 at NIH Clinical Center - Building 10 The National Institutes of Health (NIH) is an agency of the United States Ministry of Health and Human Services and is the primary agency of the United States government responsible for biomedical and health-related research. ...

History and research directions

Main article: History of Tourette syndrome

Jean-Martin Charcot (1825–1893) was a French neurologist and professor who bestowed the eponym for Tourette syndrome on behalf of his resident, Georges Albert Édouard Brutus Gilles de la Tourette. Charcot is shown here during a lesson with a "hysterical" woman patient at the Salpêtrière hospital.

A French doctor, Jean Marc Gaspard Itard, reported the first case of Tourette syndrome in 1825,^[72] describing Marquise de Dampierre, an important woman of nobility in her time.^[11] Jean-Martin Charcot, an influential French physician, assigned his resident Georges Albert Édouard Brutus Gilles de la Tourette, a French physician and neurologist, to study patients at the Salpêtrière Hospital, with the goal of defining an illness distinct from hysteria and from chorea.^[22] Tourette syndrome is an inherited neurological disorder with onset in childhood, characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic. ... Download high resolution version (968x1466, 192 KB) Wikipedia does not have an article with this exact name. ... Download high resolution version (968x1466, 192 KB) Wikipedia does not have an article with this exact name. ... Neurology is the branch of medicine that deals with the nervous system and disorders affecting it. ... The Pitié-Salpêtrière Hospital is a hospital in Paris. ... Jean Marc Gaspard Itard (April 24, 1774 – 1838) was a French physician born in Provence. ... The Pitié-Salpêtrière Hospital is a hospital in Paris. ... Hysteria is a diagnostic label applied to a state of mind, one of unmanageable fear or emotional excesses. ... // Chorea sancti viti (Latin for St. ...

In 1885, Gilles de la Tourette published an account of nine patients, Study of a Nervous Affliction, concluding that a new clinical category should be defined.^[73] The eponym was later bestowed by Charcot after and on behalf of Gilles de la Tourette.^[22][74]

Little progress was made over the next century in explaining or treating tics, and a psychogenic view prevailed well into the 20th century.^[22] The possibility that movement disorders, including Tourette syndrome, might have an organic origin was raised when an encephalitis epidemic from 1918–1926 led to a subsequent epidemic of tic disorders.^[75] An organic disease is one which involves or affects physiology or bodily organs. ... Encephalitis is an acute inflammation of the brain, commonly caused by a viral infection. ... In epidemiology, an epidemic (from [[Latin language] epi- upon + demos people) is a disease that appears as new cases in a given human population, during a given period, at a rate that substantially exceeds what is expected, based on recent experience (the number of new cases in the population during...

During the 1960s and 1970s, as the beneficial effects of haloperidol (Haldol) on tics became known, the psychoanalytic approach to Tourette syndrome was questioned.^[76] The turning point came in 1965, when Arthur K. Shapiro—described as "the father of modern tic disorder research"^[77]—treated a Tourette’s patient with haloperidol, and published a paper criticizing the psychoanalytic approach.^[75] Haloperidol (sold under the tradenames Aloperidin, Bioperidolo, Brotopon, Dozic, Duraperidol (Germany), Einalon S, Eukystol, Haldol, Halosten, Keselan, Linton, Peluces, Serenace, Serenase, Sigaperidol) is a conventional, or typical, butyrophenone antipsychotic drug. ... Arthur K. Shapiro (1923-1995), was a psychiatrist and expert on Tourette syndrome. ...

Since the 1990s, a more neutral view of Tourette's has emerged, in which biological vulnerability and adverse environmental events are seen to interact.^[5][22] In 2000, the American Psychiatric Association published the DSM-IV-TR, revising the text of DSM-IV to no longer require that symptoms of tic disorders cause distress or impair functioning.^[78] Due to the epidemic of medical errors, readers are cautioned to be aware that the American Psychiatric Association isnt immune to this. ...

Findings since 1999 have advanced TS science in the areas of genetics, neuroimaging, neurophysiology, and neuropathology. Questions remain regarding how best to classify Tourette syndrome, and how closely Tourette's is related to other movement disorders or psychiatric disorders. Good epidemiologic data is still lacking, and available treatments are not risk free and not always well tolerated.^[79] High-profile media coverage focuses on treatments that do not have established safety or efficacy, such as deep brain stimulation, and alternative therapies involving unstudied efficacy and side effects are pursued by many parents.^[33] It has been suggested that this article or section be merged with functional neuroimaging. ... Neurophysiology is a part of physiology as a science, which is concerned with the study of the nervous system. ... Neuropathology is the study of diseases of the nervous system, and is a medical subspecialty within the specialty of anatomical pathology, itself a division within pathology in many English speaking countries. ... An MRI scan of a human brain and head. ... Epidemiology (Greek epi = upon, among; demos = people, district; logos = word, discourse), defined literally, is the study of epidemics in humans. ... Tourette syndrome (also Tourettes syndrome or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of motor and phonic tics. ... In neurotechnology, deep brain stimulation (DBS) is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain. ...

Society and culture

Main article: Sociological and cultural aspects of Tourette syndrome

Samuel Johnson (1709–1784) circa 1772. Johnson had Tourette syndrome.

Not everyone with Tourette's wants treatment or a "cure", especially if that means they may "lose" something else in the process.^[80][81] Some people believe that there may be latent advantages associated with genetic vulnerability to the syndrome.^[81] Cognitive control may be enhanced in young people with Tourette's because the need to suppress tics results in a more efficient control of inhibitions.^[57] There is evidence to support the clinical lore that children with "TS-only" (Tourette's in the absence of comorbid conditions) are unusually gifted: neuropsychological studies have identified advantages in children with TS-only.^[26][82] One study found that children with TS-only are faster than the average for their age group on timed motor coordination.^[83] Tourette syndrome (also Tourettes syndrome, Tourettes or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of motor and phonic tics. ... Image File history File links Samuel_Johnson_by_Joshua_Reynolds. ... Image File history File links Samuel_Johnson_by_Joshua_Reynolds. ... For other persons named Samuel Johnson, see Samuel Johnson (disambiguation). ... In medicine and in psychiatry, comorbidity refers to: The presence of one or more disorders (or diseases) in addition to a primary disease or disorder. ... Explain the dystonias connected with motor coordination. ...

Notable individuals with Tourette syndrome are found in all walks of life, including musicians, athletes and authors. The best-known example of a person who may have used obsessive–compulsive traits to advantage is Dr Samuel Johnson, the 18th-century English man of letters, who had Tourette syndrome as clearly evidenced by the writings of James Boswell.^[84] Johnson wrote A Dictionary of the English Language in 1747, and was a prolific writer, poet, and critic. Tourette syndrome (also Tourettes syndrome, Tourettes or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of motor and phonic tics. ... Samuel Johnson circa 1772, painted by Sir Joshua Reynolds. ... James Boswell, 9th Laird of Auchinleck and 1st Baronet (October 29, 1740 - May 19, 1795) was a lawyer, diarist, and author born in Edinburgh, Scotland. ... A Dictionary of the English Language, one of the most influential dictionaries in the history of the English language, was prepared by Samuel Johnson and published on April 15, 1755. ...

Although it has been speculated that Mozart had Tourette's,^[85][86] no Tourette's expert or organization has presented credible evidence to show that this was the case,^[86] and there are problems with the available data.^[87] Tourette syndrome (also Tourettes syndrome, Tourettes or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of motor and phonic tics. ...

The entertainment industry often depicts those with Tourette syndrome as social misfits whose only tic is coprolalia, which has furthered stigmatization and the public's misunderstanding of those with Tourette's.^[88] The coprolalic symptoms of Tourette's are also fodder for radio and television talk shows in the US^[89] and in the British media.^[90] Tourette syndrome (also Tourettes syndrome, Tourettes or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of motor and phonic tics. ...

Notes

References

The National Institute of Neurological Disorders and Stroke is a part of the U.S. National Institutes of Health. ... National Institutes of Health Building 50 at NIH Clinical Center - Building 10 The National Institutes of Health (NIH) is an agency of the United States Ministry of Health and Human Services and is the primary agency of the United States government responsible for biomedical and health-related research. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 45th day of the year in the Gregorian calendar. ... is the 134th day of the year (135th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ... is the 4th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 134th day of the year (135th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... WHO redirects here. ... is the 298th day of the year (299th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ... is the 144th day of the year (145th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 116th day of the year (117th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ... is the 6th day of the year in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 81st day of the year (82nd in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 178th day of the year (179th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 301st day of the year (302nd in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 254th day of the year (255th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... NIH can refer to: National Institutes of Health Norwegian School of Sports Sciences: (Norges idrettshøgskole - NIH) Not Invented Here This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... is the 329th day of the year (330th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 25th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 25th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 39th day of the year in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... The Tourette Syndrome Foundation of Canada (or TSFC) is a Canadian voluntary organization based in Toronto, Ontario. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 301st day of the year (302nd in leap years) in the Gregorian calendar. ... is the 60th day of the year (61st in leap years) in the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance with the Gregorian calendar. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ... is the 206th day of the year (207th in leap years) in the Gregorian calendar. ... Year 2003 (MMIII) was a common year starting on Wednesday of the Gregorian calendar. ... 2008 (MMVIII) is the current year, a leap year that started on Tuesday of the Anno Domini (or common era), in accordance with the Gregorian calendar. ... is the 60th day of the year (61st in leap years) in the Gregorian calendar. ... is the 165th day of the year (166th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 213th day of the year (214th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... The National Institute of Neurological Disorders and Stroke is a part of the U.S. National Institutes of Health. ... National Institutes of Health Building 50 at NIH Clinical Center - Building 10 The National Institutes of Health (NIH) is an agency of the United States Ministry of Health and Human Services and is the primary agency of the United States government responsible for biomedical and health-related research. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 162nd day of the year (163rd in leap years) in the Gregorian calendar. ... is the 217th day of the year (218th in leap years) in the Gregorian calendar. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 179th day of the year (180th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 162nd day of the year (163rd in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... is the 81st day of the year (82nd in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 178th day of the year (179th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 25th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... Ole Daniel Enersen is a Norwegian climber, photographer, journalist, writer and medical historian. ... Who Named It is a Norwegian database of several thousand eponymous medical signs and the doctors associated with their identification. ... is the 134th day of the year (135th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 134th day of the year (135th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 134th day of the year (135th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... Oliver Sacks in 2005. ... The Man Who Mistook His Wife for a Hat is a 1985 book by neurologist Oliver Sacks describing the case histories of some of his patients. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ... April 7 is the 97th day of the year in the Gregorian calendar (98th in leap years). ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 134th day of the year (135th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ... April 7 is the 97th day of the year in the Gregorian calendar (98th in leap years). ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 253rd day of the year (254th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... The Cincinnati Enquirer is a daily morning newspaper published at Cincinnati, Ohio. ... is the 11th day of the year in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 16th day of the year in the Gregorian calendar. ... 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Sources

• Bagheri MM, Kerbeshian J, Burd L. "Recognition and management of Tourette's syndrome and tic disorders". American Family Physician. 1999; 59:2263–74. PMID 10221310 Retrieved on 28 October 2006.
• Leckman JF, Cohen DJ. Tourette's Syndrome—Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care. John Wiley & Sons, Inc., New York, 1999. ISBN 0-471-16037-7 Outline. Retrieved on 28 October 2006.
• Robertson MM. "Tourette syndrome, associated conditions and the complexities of treatment" (PDF). Brain. 2000;123 Pt 3:425–62. PMID 10686169 Retrieved on 25 January 2007
• Tourette Syndrome: Frequently Asked Questions. Tourette Syndrome Association. Retrieved on January 6, 2006.
• What is Tourette syndrome? Tourette Syndrome Association. Archived May 24, 2006.
• The Tourette Syndrome Classification Study Group. "Definitions and classification of tic disorders". Arch Neurol. 1993 Oct;50(10):1013–16. PMID 8215958 Archived April 26, 2006.
• Walkup, JT, Mink, JW, Hollenback, PJ, (eds). Advances in neurology, Vol. 99, Tourette syndrome. Lippincott, Williams & Wilkins, Philadelphia, PA, 2006. ISBN 0-7817-9970-8
• Zinner SH. "Tourette disorder". Pediatr Rev. 2000;21(11):372–83. PMID 11077021

is the 301st day of the year (302nd in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 301st day of the year (302nd in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 25th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ... is the 6th day of the year in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 144th day of the year (145th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 116th day of the year (117th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ...

Further reading

• Kushner, HI. A cursing brain?: The histories of Tourette syndrome. Harvard University Press, 2000. ISBN 0-674-00386-1.
• Olson, S. "Making Sense of Tourette's" (PDF). Science. 2004 Sep 3;305(5689):1390–92. PMID 15353772

External links

• Tourette syndrome at the Open Directory Project—Organizations
• Tourette syndrome at the Open Directory Project
• Tourette's Syndrome: minimizing confusion—a blog by Roger Freeman, MD, clinical head of the Neuropsychiatry Clinic, British Columbia's Children's Hospital, professional advisory board member of the Tourette Syndrome Foundation of Canada, and former member of the Tourette Syndrome Association Medical Advisory Board. Dr. Freeman has over 180 journal-published articles on PubMed.
• Tourette syndrome: Newly diagnosed—a 3-hour video/slide presentation by John Walkup, MD, deputy director of the Division of Child and Adolescent Psychiatry, Johns Hopkins Hospital and 2007 Chair of the Tourette Syndrome Association Medical Advisory Board

The Open Directory Project (ODP), also known as dmoz (from , its original domain name), is a multilingual open content directory of World Wide Web links owned by Netscape that is constructed and maintained by a community of volunteer editors. ... The Open Directory Project (ODP), also known as dmoz (from , its original domain name), is a multilingual open content directory of World Wide Web links owned by Netscape that is constructed and maintained by a community of volunteer editors. ... British Columbias Childrens Hospital (BC Childrens) is a medical facility located in Vancouver, British Columbia. ... The Tourette Syndrome Foundation of Canada (or TSFC) is a Canadian voluntary organization based in Toronto, Ontario. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ... The Dome of the Johns Hopkins Hospital as seen from Broadway. ... The Tourette Syndrome Association (TSA), based in Bayside, New York, United States, is a non-profit voluntary organization, founded in 1972 by a group of parents of children with Tourette syndrome. ...