What causes the Tourette syndrome?

In this brief guide we are going to answer the question ‘’What causes the Tourette syndrome?’’, we will explain what Tourette’s is, what causes it, its symptoms and its treatment.

What causes the Tourette syndrome?

The cause of Tourette syndrome isn’t known. But, research suggests that it may be due to genetic factors or changes in brain structure.

Tourette syndrome is a disorder that enters inside the category “Tics Disorders” that, in turn, is gathered inside the section “Neurodevelopmental Disorders”. Now then, it’s necessary to keep in mind what a tic is. 

According to the DSM-5 (Diagnostic Manual of the American Psychiatric Association (APA, 2013) a tic is a movement that appears suddenly or spontaneously, that is fast and that is not rhythmic. 

In other words, tics can be motor or vocal. An example of motor tic could be blinking the eyes or jumping and an example of vocal tic could be coughing or repeating words.

When we do not know what the disease is, we often associate it with people who say swear words or obscene words. However, this is not always the case. It’s true that there are people who have this type of tics, but also there are those who present vocal tics that are not related to this type of words.

Another important aspect is that it is necessary to distinguish between simple and complex tics. On the one hand, the simple ones, as its own name indicates simple, do not imply many muscles and are sudden and short.

On the other hand, the complex ones involve different muscular groups and the movements are coordinated and last more than the previous ones.

Continuing with the example of the previous tics, we emphasize that blinking the eyes and coughing are considered simple tics while jumping or repeating words are catalogued as complex tics.

Causes

Tourette syndrome is a neurodevelopmental disorder that originates in the area of the brain called the ventral striatum, which is responsible for filtering the movements that are most appropriate for each social context. In those affected, this area is overactive, which prevents them from inhibiting different types of movements.

It is not a psychiatric disease or the consequence of a state of anxiety. It is true that it may have some psychiatric symptoms, but it is a neurological disease that, in addition, has a certain heritability, i.e., it can occur in different members of the same family.

In fact, several research groups are conducting studies aimed at unraveling the genetic basis of this syndrome.

The existence of risk factors predisposing to this disorder has not been demonstrated. Although, it has been described that, sometimes, the children who have pharyngitis or tonsillitis of repetition can have more risk of developing tics.

This would be the only known environmental factor, which is also rare. Nevertheless, it can serve as a clue for early detection of the syndrome and initiation of treatment in some cases.

What are the symptoms of Tourette syndrome?

The defining symptoms of Tourette’s syndrome are the tics, but they are not always the only ones. The children with this disorder do not have stable tics, but they are having different types of repetitive movements, already they are motor or phonic, that are changeable and variable in the time in frequency and intensity. These are some of the most habitual tics.

Motor tics

• Repetitive and involuntary closing of eyes.
• Movements of the mouth.
• Elevation of shoulders.
• Lateral movements of the neck.
• Hand and leg movements.
• Touching another person.
• Sniffing objects.
• Touching the nose.
•  Spitting
• Imitating gestures or actions of another person

Phonic tics

• Slurping
• Grunt.
• Shout.
• Cough.
• Belching
• Barking
• Coprolalia (tendency to swear or say inappropriate phrases. This is the tic that is usually highlighted, but only 10% of patients suffer from it).
• Palilalia (the affected person repeats several times the last word said by himself).
• Echolalia (the affected person repeats what his interlocutor is saying).
• Humming.

Having a tic, or two, or even three is not synonymous with having Tourette syndrome. A 5% of the children in school age can have some tic. What defines this disease is to have motor tics and phonic tics that change in the time in intensity and in type of movement.

In addition, a significant percentage of patients have, in addition to tics, other cognitive or behavioral problems, such as attention deficit hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD).

Tics can be exacerbated by nervousness, anxiety, toxic environmental stimuli or the administration of certain drugs, but they can also appear in situations of relaxation.

Considering the above, we can better define what are the symptoms of this disease. According to the DSM-5 (APA, 2013), for this disease to be diagnosed, the following manifestations must occur:

• Different motor tics and at least one vocal tic have been present at some point.
• They are present for at least one year.
• The beginning of the first tic is produced before reaching the majority of age (18 years).
• The tics that are presented are not related to the consumption of drugs or medicines nor with the suffering of another disease.

Related to the above, it is important to note that cocaine or other drugs or medications and diseases such as some types of encephalitis can produce tics that resemble Tourette’s disorder.

Treatments

The treatment is fundamentally pharmacological and the medicines that are prescribed for the control of the tics are usually benzodiazepines and drugs that diminish the levels of the neurotransmitter dopamine. The latter should be administered progressively and with a close control, due to the side effects that they can have.

There are also different psychological techniques of control of the tics, although the specialist of the SEN warns that they do not always go always well.

Also, some selected severe cases can be intervened surgically by means of neurosurgery in order to place electrodes in the brain to stimulate very concrete zones.

In cases in which Tourette’s syndrome is accompanied by ADHD or obsessive-compulsive disorder, the specialist will prescribe the treatment established for these disorders.

Other facts: Famous people with Tourette syndrome.

Billie Eilish went public in 2019 that she suffers from Tourette syndrome and depression. The singer made it known on her Instagram account after compilations of videos with her motor tics were spread on Youtube. Since then she talks about her illnesses naturally.

Other celebrities who suffer from this syndrome are influencer and singer Lele Pons and footballer Tim Howard. It is believed that several historical figures, such as Mozart, Molière and Peter the Great, also suffered from it, but there is not enough data to corroborate it.

Conclusions

Tourette syndrome is characterized by the presence of vocal and motor tics that can be simple and/or complex and that are present for at least one year with onset before the person turns 18 years old.

The causes are unknown, although it is known that there are certain risk factors of temperamental, environmental and genetic origin. It is a disease that in its mild form people can live with it without many problems, but in its severe manifestation can endanger the lives of people who suffer from it.

If you or someone close to you has this syndrome, I recommend that you ask for help from a mental health professional. With proper therapy the symptoms can improve.

If you have any questions or comments please let us know!

References

Bloch, M.H., Leckman J.F. (2009). Clinical course of Tourette syndrome. J Psychosom Res (Revisión) 67(6): pp. 497-501.

Leckman, J.F., Cohen, D.J. Tourette’s Syndrome—Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care. John Wiley & Sons, Inc., Nueva York.

Moe, Barbara. (2000). Coping with Tourette Syndrome and tic disorders. Nueva York: Rosen Pub. Group.

O’Rourke, J.A.; Scharf, J.M.; Yu, D.; et al. (2009). The genetics of Tourette syndrome: A review. J Psychosom Res. 67(6): pp. 533 – 545.