Tourette syndrome: tics, insults, how do you know if you have it?

Tourette’s syndrome is a neurological disease responsible for spasms. the Scottish singer Lewis Capaldi revealed to have it during a live on Instagram in September 2022. “It happens all the time (spasms, editor’s note), When I am excited, happy, nervous or stressed. It’s not as horrible as it sounds. It’s just, sometimes, quite uncomfortable”he explained. Guest on the Star Academy show in October 2022, he showed these famous spasms, similar to ticsmainly in the face.

What is Tourette syndrome?

“Tourette’s syndrome (GTS) is a complex neuropsychiatric disorder, with a genetic component, characterized by motor, sound and vocal tics”, explains Dr. Henri Rubinstein, neurologist, medical doctor and specialist in the functional exploration of the nervous system. Described for the first time in the 19th century by the French neurologist Georges Gilles de la Tourette, it would affect one person in 2000 in France.

What are the causes of Tourette’s syndrome?

Tourette’s syndrome is a neurological disease whose exact causes are currently unknown. Nevertheless, the genetic factor is often mentioned to explain the occurrence of TS. The disease could also be due to a defect in the metabolism of certain neurotransmitters. “It would find its origin in theinability to manage emotions effectively due to dysfunction of the thalamus. There is also talk of disinhibition phenomena in the frontal lobe, the area of ​​the brain that controls behavior and conduct. says Dr. Rubinstein. the environmental factor also seems to play an important role: toxic factors, immune reactions or stress could play a role.

Is Tourette syndrome linked to autism?

In 2019, a team of scientists discovered that the Tourette syndrome and autism would share the deletion (genetic mutation characterized by the loss of genetic material on a chromosome) of a region of chromosome 2 carrying a gene essential to the proper functioning of the thalamus. A link that probably exists due to a genetic alterationexplains Dr. Rubinstein: “The deletion of chromosome 2p16.3 is often the cause of a developmental delay and learning difficulties. It has been established that patients with this genetic anomaly have a 15-fold increased risk of developing autistic-related disorders (ASD) and a 20-fold increased risk of developing Gilles de la Tourette syndrome.

At what age does Tourette syndrome occur?

Disease often appears in childhoodon average around the age of 7. It evolves in stages, with more or less long remission phases, which can last up to one or even several years. “The disease affects between 0.05 and 3% of school-aged childrenmore often boys than girls, says Dr. Henri Rubinstein. It should also be noted that symptoms such as motor, auditory and vocal tics worsen during childhood and reach a peak around the age of 11.

What are the symptoms of Tourette syndrome?

TS is characterized by “a set of neurological symptoms including maladaptive behaviors. These manifestations are accompanied by language tics, insults, involuntary muscle movements, sometimes grotesque facial expressions, etc..”, explains Dr. Rubinstein. “Generally, the muscle tics appear first, followed by sound ticks”, he adds. Motor tics correspond to involuntary and sudden movements, due to muscle contractions:

• Eye blinks;
• Shaking of the head;
• Shrugs (simple motor tics);
• Other actions like obscene gestures (complex motor tics).

Motor and sound tics

Motor tics are usually accompanied by sound ticks, emitted by the mouth or by the nose:

• Throat clearing;
• Cries, laughter;
• Word repetition;
• Use of foul language, insults.

In the more severe forms of TS, a person may also develop other symptoms :

• Behavioral disorders;
• Self-harm;
• Attention deficit;
• Hyperactivity;
• Panic or rage attacks;
• Obsessive compulsive disorder (OCD), sleep or learning.

Why does Tourette syndrome lead to insults?

Generally, Tourette’s syndrome is associated with coprolalia (to say profanity and insults) and at the copropraxia (make rude gestures). “Insults, often violent and/or inappropriate to the situation experienced, are part of the usual symptoms of Gilles de la Tourette syndrome”, comments Dr. Rubinstein. However, not all people with TS manifest not necessarily these symptoms.

There is no specific drug treatment.

It is sometimes necessary to wait years before the diagnosis of Gilles de la Tourette syndrome is made. First, because it can be confused with many other diseases such as simple tics or hereditary diseases associated with tics. TS can also be difficult to diagnose during adolescence and have severe repercussions in adulthood: “it often disappears during adolescence but can persist into adulthood, becoming a real handicap to social integration” comments Dr. Rubinstein.

The diagnosis of Gilles de la Tourette’s disease is established after description and observation of motor and/or sound tics and their evolution. Some specific criteria have been established:

• Presence of several motor tics and at least one sound tic at a certain time but not necessarily at the same time;
• Presence of tics several times a day, almost daily or intermittently for at least a year, with no tic-free interval for more than three consecutive months.
• There is no no medical examination specific to this neurological pathology. The doctor may request additional neurological examinations (scanner, electroencephalogram) to rule out other diseases that may cause the same type of symptoms. No neurological abnormality is detected during traditional examinations: X-ray, MRI, scanner, electroencephalogram, etc.

What are the treatments for Gilles de la Tourette syndrome?

There is no no specific drug treatment for Gilles de la Tourette syndrome allowing a total cure. “Many chemical molecules make it possible to alleviate the symptoms, without curing them. explains Dr. Rubinstein. However, the disease can be support to alleviate behavioral problems the most disabling on a daily basis. A medical treatment can be offered in parallel, depending on the needs of the patient, but it should only be implemented when really necessary. Indeed, most drugs cause side effects: weight gain, fatigue, depression… Regular psychological care is recommended. It usually consists of a cognitive and behavioral therapy (CBT). The drugs prescribed are neuroleptics, which should be monitored for possible side effects. A adapted school monitoring may also be necessary in case of learning disabilities.

Does hypnosis work?

“Hypnotherapy seeks to address the mechanics of the problem“, explains Dr. Rubinstein. “Free yourself from tics, control involuntary movements, learn to relax, developing better management of emotions, improving self-control, strengthening self-image and self-confidence, are examples of possibilities what does hypnosis offer to treat Gilles de la Tourette’s disease”he says. “A hypnosis session is broken down into several parts: the collection of information, the entry into a trance, the hypnotherapy technique and the exit from the trance. The session is followed by a feedback intended to verify that everything goes well and that the change requested is part of a dynamic that respects the physical and moral integrity of the patient”, concludes Dr. Rubinstein.

Thanks to Dr. Henri Rubinstein, neurologist, medical doctor and specialist in the functional exploration of the nervous system. Comments collected in 2021.