Tourette Syndrome

When Josh was only 7 years old, he began doing strange things such as twitching his nose for minutes on end and stamping his foot constantly. He was never able to sit still in class and made several rude noises that disrupted his daily life. Months later, he began jumping up, swooping down, and touching the ground over and over again. One day his teacher finally called his parents in one day and told them of a student she once had that had Tourette Syndrome, a disorder Josh's parents had never heard of before. A condition that affects over 200,000 people in the United States. (Dreher 1) Tourette Syndrome is a multiple tic disorder that begins in childhood characterized by involuntary, rapid, repetitive movements of functionally related muscle groups. (Shapiro 1) it is not a racist disorder. It is seen in all ethnic groups, but males are three to four times more likely than females to be affected. Though the difference in symptom severity is sometimes thought to be genetic, the real reason TS sufferers exhibit variations of symptom severity is because of the concentration level of a brain chemical found in a small region of the midbrain.
Georges de la Tourette, a French neurologist, originally described Tourette Syndrome in 1885 as a neuropsychiatric disorder characterized by chronic motor and vocal tics that begin in childhood. (Wolf 1) The tics, said Georges, are not completely involuntary but usually involve rapid, sudden movements. Since the tics are not completely involuntary, sufferers can suppress them, but a majority of TS victims say


suppressing only strengthens their urge for a massive catharsis. A possible genetic theory is suggested be the fact that 8% of TS victims have a family history of the disorder and 42% have a family history of tics.
The tics, usually beginning at age seven, affect the eyes, face, head, shoulder, limbs, and trunk. Most common examples of simple tics include continuous eye blinking, shoulder shrugging, grimacing, head jerking, yelping and sniffing. More complicated tics, concerning several muscle groups, include jumping, smelling objects, touching one's nose, or touching other people. The strangest of the symptoms is Coprolalia, the involuntary use of curse words. Coprolalia is found in 35% of patients, but do not occur until up to 35 years after the onset of the disorder. Palilalia is the repetition of one's own words, often sounding as though the patient is trying to take a running start to finish a sentence. Another type of symptom is echolalia. Echolalia is the constant repetition of words of other people. About 25-50% of patients are also hyperactive and exhibit similar symptoms to Attention Deficit Disorder (ADD) such as impairment of concentration and attention. (Shapiro 1)
A popular concept is that there is in fact a specific TS gene, that it is important in the way the body makes the brain messenger chemical dopamine, and that it causes tics and compulsions. Interacting with this gene to determine the features of an individual patient are other genes which influence the way dopamine is metabolized in the brain once it's made, but there are lots of confounding factors and biases which make it very



hard to be sure if it's itself important, or just sits on a chunk of DNA that contain other genetic material that's important.
While the cause of Tourette Syndrome is unknown, researchers at the Mount Sinai School of Medicine suggest that the central nervous system may be involved. Postsynaptic neurons in victims may be supersensitive to a neurotransmitter called dopamine. Dopamine acts to slow or inhibit the action of the caudate nucleus. The caudate nucleus is involved in the kinds of movements people do on purpose. It functions in the thinking of and planning aspects of these movements, not the motor acts. (Blakeslee 2) So, in other words, it acts as a brake on certain motor activities. So the
change in D2 (a type of dopamine receptor) releases the brake, and the power of the caudate nucleus to suppress involuntary tics is decreased.
Researchers at the mental health institute have studied five sets of identical twins with Tourette Syndrome whose tics vary in severity. In each case, one twin has tics that are so obvious that it can be diagnosed by an observer from a distance, and