Tourette syndrome (TS) (synonyms: Gilles-de-la-Tourette syndrome; Gilles disease; Tourette disease; ICD-10 F95.2: Combined vocal and multiple motor tics [Tourette syndrome]) is a disorder of the nervous system. It is assigned to the central nervous movement disorders and here to the extrapyramidal hyperkineses (lightning-like movements). The cause is a dysfunction of certain parts of the basal ganglia (nuclei basales; core area in the brain) – see “Etiology/Causes”. Characteristic of the syndrome are involuntary movements, so-called tics (French), which translated means “nervous twitching“, combined with tic-like vocal or verbal utterances.The disease was named after the French neurologist and psychiatrist Georges Gilles de la Tourette, who first described it in 1884/85.
The following characteristics define Tourette syndrome:
- Multiple motor tics and at least one vocal (phonetic) tic.
- The disorder begins before the age of 18 years
- The disease persists for more than one year
- Fluctuations (fluctuations/changes) of tics in the course of the disease in terms of number, intensity, frequency, complexity.
- Other diseases could be ruled out (see “Differential diagnoses”).
Sex ratio: boys to girls is 3: 1.
Frequency peak: tics occur at primary school age, between 6 and 8 years, and are fully developed by 12 years of age.
The prevalence (disease incidence) is 1% in the 5- to 18-year-old age group (worldwide).
Course and prognosis: Symptoms vary greatly from patient to patient. During puberty, the tics may increase. After the age of 16, a decrease is often observed. The appearance may fluctuate (change/fluctuate) in the course. External influences such as stress, excitement or even fatigue can intensify the tics. With increasing age, the complaints caused by the tics decrease considerably.The basis of therapy is psychoeducation (comprehensive education of affected persons and relatives). In the case of children, it is important to also inform teachers about the clinical picture so that the daily school routine can be individually adapted. Parents can apply for compensation for disadvantages for their children. Drug therapy is only recommended for severe tics. In most cases, the tics are only mild, so there is no need for pharmacological treatment. Some even manage to suppress the tics for a certain period of time.Problematic for those affected are the reactions of others to their tics, which often manifest themselves in incomprehension, teasing and exclusion.As a rule, the treatment of comorbidities (see below ) is in the foreground, since they often impair the quality of life more than the tics themselves. A cure for the disease is not possible.
Life expectancy is not limited by Tourette’s syndrome.
Comorbidities: Tourette’s syndrome is associated with the following disorders in 80-90% of cases: ADHD (attention deficit hyperactivity disorder), anxiety disorders, autoaggression, depression, and obsessive-compulsive disorder. The number and severity of comorbidities increases with the severity of tics.In children, the comorbidity ADHD (attention-deficit/hyperactivity disorder) is most common (50-90%), especially in boys. Other comorbidities in childhood include anxiety and compulsions, the latter especially in girls, emotional dysregulation, impulse control disorders, social behavior disorders, and autism spectrum disorders (ASD) such as Asperger syndrome or high-functioning autism.
Guideline
- S1 guideline: extrapyramidal motor disorders – tics. German Society of Neurology, September 2012.
