Tourette Syndrome Essay Example

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.