Tics and Tourette Syndrome (TS)

Description of Tourette Syndrome (TS)

The primary characteristics associated with Tourette syndrome (TS) are multiple motor tics and one or more phonic tics. Motor and phonic tics may develop at about the same time or predominate at different times during the course of the disorder.

The DSM-IV-TR criteria8 for the diagnosis of Tourette syndrome (TS) include

• Both multiple motor tics and one or more vocal tics must be have been present at some time over the course of the illness but do not necessarily occur concurrently
• The tics must occur many times a day nearly every day or intermittently over a period of more than 1 year, during which time there must not have been a tic-free period of more than 3 consecutive months
• The age at onset is younger than 18 years
• The disturbance must not be due to the direct physiologic effects of a substance or a general medical condition

Most TS clinical populations develop associated behavioral problems, particularly obsessive-compulsive behaviors and attention-deficit/hyperactivity disorder (ADHD). Obsessive-compulsive behaviors include the performance of repetitive actions or rituals, e.g., touching particular objects in a predetermined sequence, repeatedly counting, or engaging in repetitive hand washing.9,10 In addition, as many as 60% of children with TS have symptoms of ADHD, possibly due to a common underlying neurobiological substrate.5,11 ADHD symptoms include difficulty maintaining attention, hyperactivity, and impulsivity. Other issues seen frequently in patients with TS include anxiety, depression, episodic outbursts, and school difficulties. These comorbidities can further impair social interactions, academic and occupational performance, and quality of life.12,13 In severe cases, patients may exhibit self-injurious behaviors, and, rarely, these behaviors may result in life-threatening situations.14