Tourette syndrome  

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Kunstformen der Natur (1904) by Ernst Haeckel
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Kunstformen der Natur (1904) by Ernst Haeckel

Tourette syndrome (TS or simply Tourette's) is a common neurodevelopmental disorder with onset in childhood, characterized by multiple motor tics and at least one vocal (phonic) tic. Some common tics are eye blinking, coughing, throat clearing, sniffing, and facial movements. These tics characteristically wax and wane, can be suppressed temporarily, and are typically preceded by an unwanted urge or sensation in the affected muscles. Tics are often unnoticed by casual observers.

Tourette's was once considered a rare and bizarre syndrome, most often associated with coprolalia (the utterance of obscene words or socially inappropriate and derogatory remarks), but this symptom is present in only a small minority of people with Tourette's. It is no longer considered a rare condition; about 1% of school-age children and adolescents have Tourette's. Many individuals with Tourette's go undiagnosed or never seek medical care. There are no specific tests for diagnosing Tourette's; it is not always correctly identified because most cases are mild and the severity of tics decreases for most children as they pass through adolescence. Extreme Tourette's in adulthood, though sensationalized in the media, is a rarity. Tourette's does not adversely affect intelligence or life expectancy.

In most cases, medication for tics is not necessary. Education is an important part of any treatment plan, and explanation and reassurance alone are often sufficient treatment. Among those who are seen in specialty clinics, attention-deficit hyperactivity disorder (ADHD) and obsessive–compulsive disorder (OCD) are present at higher rates. These co-occurring diagnoses often cause more impairment to the individual than the tics; hence, it is important to correctly identify associated conditions and treat them.

Tourette's is defined as part of a spectrum of tic disorders, which includes provisional, transient and persistent (chronic) tics. While the exact cause is unknown, it is believed to involve a combination of genetic and environmental factors. The condition was named by Jean-Martin Charcot (1825–1893) on behalf of his resident, Georges Albert Édouard Brutus Gilles de la Tourette (1857–1904), a French physician and neurologist, who published an account of nine patients with Tourette's in 1885.

History

A French doctor, Jean Marc Gaspard Itard, reported the first case of Tourette syndrome in 1825, describing the Marquise de Dampierre, an important woman of nobility in her time. 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 chorea.

In 1885, Gilles de la Tourette published an account in Study of a Nervous Affliction describing nine persons with "convulsive tic disorder", concluding that a new clinical category should be defined.

Little progress was made over the next century in explaining or treating tics, and a psychogenic view prevailed well into the 20th century. 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.

During the 1960s and 1970s, as the beneficial effects of haloperidol (Haldol) on tics became known, the psychoanalytic approach to Tourette syndrome was questioned. The turning point came in 1965, when Arthur K. Shapiro—described as "the father of modern tic disorder research" —treated a Tourette's patient with haloperidol, and published a paper criticizing the psychoanalytic approach.

Since the 1990s, a more neutral view of Tourette's has emerged, in which biological vulnerability and adverse environmental events are seen to interact. 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, recognizing that clinicians often see patients who meet all the other criteria for Tourette's, but do not have distress or impairment.

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 or psychiatric disorders. Good epidemiologic data is still lacking, and available treatments are not risk free and not always well tolerated. 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.

The first presentation of Tourette syndrome is thought to be in the book, Malleus Maleficarum (Witch's Hammer) by Jakob Sprenger and Heinrich Kraemer, published in the late 15th century and describing a priest whose tics were "believed to be related to possession by the devil".




Unless indicated otherwise, the text in this article is either based on Wikipedia article "Tourette syndrome" or another language Wikipedia page thereof used under the terms of the GNU Free Documentation License; or on original research by Jahsonic and friends. See Art and Popular Culture's copyright notice.

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