Tourette Syndrome

Abstract

Tourette syndrome is a tic disorder characterised by the presence of both motor and vocal tics, with onset in childhood and chronic course. Most patients report that their tics are preceded by subjective feelings of mounting inner tension (so-called premonitory urges), which are temporarily relieved by tic expression. Tourette syndrome is no longer considered a rare medical condition, as up to 1% of school-age children fulfil current diagnostic criteria. Coprolalia (swearing as a complex vocal tic) is relatively rare and is not included among current diagnostic criteria. Converging evidence from large clinical studies has shown that the majority of patients with Tourette syndrome present with specific behavioural problems. The most common behavioural co-morbidities are obsessive-compulsive disorder (including tic-related obsessive-compulsive behaviours) and attention-deficit hyperactivity disorder. Other common behavioural co-morbidities include affective disorders, anxiety disorders, and impulse control disorders. The findings of recent studies dissecting the neuropsychiatric spectrum of tic disorders have suggested that Tourette syndrome is a clinically heterogeneous condition, with multiple motor and behavioural phenotypes.

In its ‘highest’ forms, Tourette’s syndrome involves every aspect of the affective, the instinctual and the imaginative life; in its ‘lower’, and perhaps commoner, forms, there may be little more than abnormal movements and impulsivity, though even here there is an element of strangeness

Oliver Sacks, Witty Ticcy Ray, in The Man Who Mistook His Wife for a Hat (1985)