The tics often occur several times a day, although the number, severity, type, and location may also change. In some cases, they disappear in between for an extended period of time. They often increase during stress, tension and anger, but also during joyful excitement. They can be kept in check to a limited extent by most Tourette’s patients, but this usually only means that their occurrence is pushed out but not prevented.
First symptoms usually in childhood or adolescence
The disease almost always begins in childhood or adolescence, usually around age seven or eight. Often, the first signs are mild facial stics such as puckering of the corner of the mouth, blinking, or squinting of the eyes. The severity of the tics tends to increase until puberty, after which – in about 70 percent of cases – they decrease or disappear altogether. However, the course of the disease varies greatly from case to case and does not allow a prediction of the further prognosis. Most of those affected, however, only suffer from a fairly mild form.
Many people with TS show additional behavioral problems. Quite typical are on the one hand the disproportionately frequent occurrence of an attention deficit syndrome and on the other hand compulsive or ritualistic behaviors, coupled with perfectionism. Some children have learning difficulties, and depression and sleep disturbances may also occur. On the other hand, there are some TS sufferers who combine their urge to move with particularly good reactivity and are thus very successful in appropriate sports or similar. However, the extent to which this occurs more frequently than in the average population is unclear.
How does the disease develop?
The exact cause of TS is still not clear. However, it is now thought that there is a disorder in the area of certain nerve cells in the brain called the basal ganglia, which have important roles in shaping movement patterns. For proper functioning, they depend on transmitter substances, so-called neurotransmitters, especially dopamine, but also serotonin and others. If their metabolism is disturbed, there is an imbalance in movement control. Incidentally, Parkinson’s syndrome is an example of another disease that is based on such a disorder.
Researchers agree that there is an inherited as well as a non-hereditary form of TS. If parents, siblings or other relatives are affected, the likelihood of developing TS is increased. Boys are up to four times more likely to be affected than girls. However, genetic changes alone are probably not sufficient for the disease to break out; other factors – not yet precisely known – such as environmental influences or infections must first interact with the hereditary predisposition. What triggers the non-hereditary form is as yet unknown.