Tourette's Syndrome

Question 1

What is Tourette’s Syndrome

Answer 1

Neurodevelopmental d/o manifested by motor and phonic tics due to social + environmental + genetic factors

Question 2

What often accompanies Tourette’s

Answer 2

Psych disorder; OCD, ADHD

Question 3

What is a Tic

Answer 3

Sensation/urge to complete the tic (feeling of inner discomfort or burning) onset at 2-15 y/o (avg 6 y/o)
Can be motor, vocal/phonic
Improve when not thinking about them
Worsen with stress, anxiety, excitement

Question 4

What are motor tics

Answer 4

Sudden, brief intermittent movements;
simple (blinking, shrugging) 
complex (kick, jump, scratch)
Echopraxia (mimicking gestures) 
Copropraxia (obscene gesture)

Question 5

What are vocal/phonic tics

Answer 5

simple (sniff, cough, grunt)
Coprolalia (obscene words)
Echolalia (repetition of words)
Palalia (repetition of phrase with increasing rapidity)

Question 6

What are other clinical manifestations of Tourette’s

Answer 6

Ritualistic behavior (repeating until "just right" 
Normal PE (besides tic)

Question 7

What are diagnostic exams you can get

Answer 7

Brain MRI (if abn neuro exam) 
EEG (only to R/O seizure)

Question 8

What is diagnostic criteria for Tourette’s

Answer 8

1. Multiplemotor, 1+ phonic tics present at some point
2. Tics many times x day, nearly every day, for 1+ years
3. Severity of tic changes over time
4. Onset of tic <18 y/o
5. Tics need to be witnessed by reliable examiner
6. Tics cant be associated with another medical condition

Question 9

How do you treat Tourette’s

Answer 9

Treat underlying first (ADHD, OCD, etc.)
1st line for non-disabling tics: Comprehensive behavioral intervention for tics (CBIT)
Botox for localized facial motor tics

Question 10

What is first line treatment for moderate-severe tics

Answer 10

Clonidine, Guanfacine

-also Tetrabenazine, Haloperidol