Is there a cure for Tourettes?
Treatment of Tourette syndrome
Tourette syndrome (also Tourette's syndrome or TS) is an inherited neuropsychiatric disorder with onset in childhood, characterized by the presence of motor and phonic tics. Treatment of Tourette syndrome has the goal of managing symptoms to achieve optimum functioning, rather than eliminating symptoms; not all persons with Tourette's require treatment, and there is no cure or universally effective medication. Explanation and reassurance alone are often sufficient treatment; education is an important part of any treatment plan.
Treatment of Tourette syndrome
There is increasing evidence supporting the use of HRT in the treatment of tics; a 2013 systematic review (Dutta, Cavanna) found evidence that HRT reduced tic severity in children and adults, but also identified methodological limitations in all studies, and said that more specialists need to be better trained to administer HRT so that better large-scale studies can be conducted.
Tourette syndrome
Tourette syndrome is found among all social, racial and ethnic groups and has been reported in all parts of the world; it is three to four times more frequent among males than among females. The tics of Tourette syndrome begin in childhood and tend to remit or subside with maturity; thus, a diagnosis may no longer be warranted for many adults, and observed prevalence rates are higher among children than adults. As children pass through adolescence, about one-quarter become tic-free, almost one-half see their tics diminish to a minimal or mild level, and less than one-quarter have persistent tics. Only 5 to 14% of adults experience worse tics in adulthood than in childhood.
Tourette syndrome
Cognitive behavioral therapy (CBT) is a useful treatment when OCD is present, and there is increasing evidence supporting the use of habit reversal (HRT) in the treatment of tics. There is evidence that HRT reduces tic severity, but there are methodological limitations in the studies, and a need for more trained specialists and better large-scale studies.
Tourette syndrome
Tourette syndrome was once thought to be rare: in 1972, the US National Institutes of Health (NIH) believed there were fewer than 100 cases in the United States, and a 1973 registry reported only 485 cases worldwide. However, multiple studies published since 2000 have consistently demonstrated that the prevalence is much higher than previously thought. Discrepancies across current and prior prevalence estimates come from several factors: ascertainment bias in earlier samples drawn from clinically referred cases, assessment methods that may fail to detect milder cases, and differences in diagnostic criteria and thresholds. There were few broad-based community studies published before 2000 and until the 1980s, most epidemiological studies of Tourette syndrome were based on individuals referred to tertiary care or specialty clinics. Individuals with mild symptoms may not seek treatment and physicians may not confer an official diagnosis of TS on children out of concern for stigmatization; children with milder symptoms are unlikely to be referred to specialty clinics, so prevalence studies have an inherent bias towards more severe cases. Studies of Tourette syndrome are vulnerable to error because tics vary in intensity and expression, are often intermittent, and are not always recognized by clinicians, patients, family members, friends or teachers; approximately 20% of persons with Tourette syndrome do not recognize that they have tics. Newer studies—recognizing that tics may often be undiagnosed and hard to detect—use direct classroom observation and multiple informants (parent, teacher, and trained observers), and therefore record more cases than older studies relying on referrals. As the diagnostic threshold and assessment methodology have moved towards recognition of milder cases, the result is an increase in estimated prevalence.
Societal and cultural aspects of Tourette syndrome
André Malraux, the French author, adventurer and statesman, also is thought to have had Tourette syndrome. Howard Ahmanson, Jr, an American millionaire philanthropist who funds Christian causes, has Tourette's. Brad Cohen is an award-winning teacher and author. Catalan writer Quim Monzó has Tourette’s and is Honorary President of the Spanish Tourette Syndrome Association (APTT). Mariah Cary, Miss Iowa, with TS finished fifth in the Miss America 2013 contest.
Tourette syndrome
There are no specific medical or screening tests that can be used in diagnosing Tourette's; it is frequently misdiagnosed or underdiagnosed, partly because of the wide expression of severity, ranging from mild (the majority of cases) or moderate, to severe (the rare, but more widely recognized and publicized cases). Coughing, eye blinking, and tics that mimic unrelated conditions such as asthma are commonly misdiagnosed.
History of Tourette syndrome
In Europe, the ESSTS published the first European clinical guidelines for Tourette syndrome and tic disorders in 2011. As of 2011, the only other guidelines in Europe were for Germany. In an editorial that accompanied the release of the guidelines, its authors said that in spite of a "high level of clinical experience, particularly in specialized centers", relative to other childhood-onset disorders, TS had been neglected in the research, possibly because TS had historically been viewed as a rare disorder, and due to the "high rate of relatively mild cases and an often favorable course with good chance of spontaneous remission". They also indicated a fragmentation in clinical approach to TS, as its core symptoms can be viewed as part of a neurology specialty (movement disorder) or child and adolescent psychiatry. They hoped the guidelines would "help clinicians to offer the best clinical service ... and inspire clinical researchers as well as politicians to no longer overlook the high burden of tic disorders".
Treatment of Tourette syndrome
Patients with Tourette's who are referred to specialty clinics have a high rate of comorbid attention-deficit hyperactivity disorder (ADHD), so the treatment of ADHD co-occurring with tics is often part of the clinical treatment of Tourette's. Patients who have ADHD along with Tourette's may also have problems with disruptive behaviors, overall functioning, and cognitive function, accounted for by the comorbid ADHD, highlighting the importance of identifying and treating other conditions when present.
Steffanie A. Strathdee
In 2016, Strathdee enlisted the help of an international team of physicians and researchers to save her husband’s life with bacteriophage (phage) therapy after he acquired a life-threatening infection with a ‘superbug ’, Acinetobacter baumannii. Although phage therapy had been used for one hundred years in Eastern Europe, it was not licensed for clinical use in the United States or most of Western Europe. Her husband, Dr. Tom Patterson, appears to be the first person in the U.S. to be successfully cured from a systemic multi-drug-resistant bacterial infection with cocktails of intravenous bacteriophages. After the case was published, it received considerable attention in top medical journals including JAMA and Lancet, as well as numerous reports in the international press (see below) and a TEDx talk. "The Guardian" listed this case as one of the top science stories of 2017. Since her husband’s release from hospital in 2016, Strathdee and her physician friend, Chip Schooley, who was responsible for treating her husband, have been actively involved in helping other patients receive phage therapy and are hoping to launch an institute for phage therapy at UCSD where rigorous studies are needed to determine if it is efficacious to enable its licensure and widespread use. Dr. Patterson made a full recovery and returned to work in April 2017. Strathdee and her husband are writing a book about their story called "The Perfect Predator: An Epidemiologist’s Journey to Save Her Husband from a Deadly Superbug", which will be published by Hachette Book Group, in spring 2019.In 2016, Strathdee enlisted the help of an international team of physicians and researchers to save her husband’s life with bacteriophage (phage) therapy after he acquired a life-threatening infection with a ‘superbug’, Acinetobacter baumannii. Although phage therapy had been used for one hundred years in Eastern Europe, it was not licensed for clinical use in the United States or most of Western Europe. Her husband, Dr. Tom Patterson, appears to be the first person in the U.S. to be successfully cured from a systemic multi-drug resistant bacterial infection with cocktails of intravenous bacteriophages. After the case was published, it received considerable attention in top medical journals including JAMA and Lancet, as well as numerous reports in the international press (see below) and a TEDx talk. The Guardian listed this case as one of the top science stories of 2017. Since her husband’s release from hospital in 2016, Strathdee and her physician friend, Chip Schooley, who was responsible for treating her husband, have been actively involved in helping other patients receive phage therapy and are hoping to launch an institute for phage therapy at UCSD where rigorous studies are needed to determine if it is efficacious to enable its licensure and widespread use. Patterson made a full recovery and returned to work in April 2017. Strathdee and her husband are writing a book about their story called The Perfect Predator: An Epidemiologist’s Journey to Save Her Husband from a Deadly Superbug, which will be published by Hachette Book Group, in Spring 2019.
Sensory phenomena
In contrast to the stereotyped movements of other movement disorders (e.g.; choreas, dystonias, myoclonus, and dyskinesias), the tics of Tourette's are temporarily suppressible and preceded by a premonitory urge. Immediately preceding tic onset, most individuals with Tourette syndrome are aware of an urge, which is similar to the need to sneeze or scratch an itch. Individuals describe the need to tic as the buildup of tension in a particular anatomical location, which they consciously choose to release, as if the subject "had to do it". Examples of the premonitory urge are the feeling of having something in one's throat, or a localized discomfort in the shoulders, leading to the need to clear one's throat or shrug the shoulders. The actual tic may be felt as relieving this tension or sensation, similar to scratching an itch. Another example is blinking to relieve an uncomfortable sensation in the eye. Published descriptions of the tics of Tourette's identify sensory phenomena as the core symptom of Tourette syndrome, even though they are not included in the diagnostic criteria.
Tourette syndrome
The reported prevalence of TS varies "according to the source, age, and sex of the sample; the ascertainment procedures; and diagnostic system", with a range reported between .4% and 3.8% for children ages 5 to 18. Robertson (2011) says that 1% of school-age children have Tourette's. According to Lombroso and Scahill (2008), the emerging consensus is that .1 to 1% of children have Tourette's, with several studies supporting a tighter range of .6 to .8%. Bloch and Leckman (2009) and Swain (2007) report a range of prevalence in children of .4 to .6%, Knight et al. (2012) estimate .77% in children, and Du et al. (2010) report that 1 to 3% of "Western" school-age children have Tourette's.
History of Tourette syndrome
In the USA, the NIH has ongoing clinical trials, and the TSA funds ongoing research through its Research Program and Research Grant Awards. Other worldwide ongoing trials can be found by contacting Tourette syndrome advocacy groups.
Dash Mihok
Mihok said that one of the early reasons he became an actor was because he had so much experience in hiding his Tourette's. He said the focus required of acting allows him to mask many of his tics. Mihok says the biggest misconception about Tourette's Syndrome is about vocal tics, called coprolalia. Not everyone with Tourette's does that: "Tics tend to wax and wane, not everybody's screaming obscenities all the time." Mihok said he took medication during high school for the Tourette's.
History of Tourette syndrome
Findings reported in published studies of Tourette syndrome since 1999 have advanced TS science in the areas of genetics, neuroimaging, neurophysiology, and neuropathology. The TAA supports a clinical database that may help identify genes involved in Tourette syndrome, and the TSA International Genetic Consortium has collected a database on large extended families for future studies. Novel neuroimaging studies are being employed to study tic expression and functional or cognitive deficits in TS patients. Studies of Tourette's neurophysiology and neuropathology are attempting to link deficits in Tourette's to specific brain mechanisms, and have taken advantage of a brain bank sponsored by the TSA. Clinical trials have focused on understanding tic suppression, comorbid conditions, novel treatment approaches such as botulinum toxin, and targeted behavioral therapies. Controversy remains in the areas of deep brain stimulation and PANDAS.
Tourette syndrome
Regardless of symptom severity, individuals with Tourette's have a normal life span. Although the symptoms may be lifelong and chronic for some, the condition is not degenerative or life-threatening. Intelligence is normal in those with Tourette's, although there may be learning disabilities. Severity of tics early in life does not predict tic severity in later life, and prognosis is generally favorable, although there is no reliable means of predicting the outcome for a particular individual. The gene or genes associated with Tourette's have not been identified, and there is no potential "cure". A higher rate of migraines than the general population and sleep disturbances are reported.
Tourettes Action
Tourettes Action is a United Kingdom support and research charity for people with Tourette syndrome (TS) and their families. TS is a neurological condition characterised by tics—involuntary sounds and movements.
Tourette syndrome
Tourette syndrome (TS or simply Tourette's) is a common neurodevelopmental disorder with onset in childhood, characterized by multiple motor tics and at least one vocal (phonic) tic. These tics characteristically wax and wane, can be suppressed temporarily, and are typically preceded by an unwanted urge or sensation in the affected muscles. Some common tics are eye blinking, coughing, throat clearing, sniffing, and facial movements. Tourette's does not adversely affect intelligence or life expectancy.
Tourette's is defined as part of a spectrum of tic disorders, which includes provisional, transient and persistent (chronic) tics. While the exact cause is unknown, it is believed to involve a combination of genetic and environmental factors. There are no specific tests for diagnosing Tourette's; it is not always correctly identified because most cases are mild and the severity of tics decreases for most children as they pass through adolescence. Extreme Tourette's in adulthood, though sensationalized in the media, is a rarity; tics are often unnoticed by casual observers.
In most cases, medication for tics is not necessary. Education is an important part of any treatment plan, and explanation and reassurance alone are often sufficient treatment. Many individuals with Tourette's go undiagnosed or never seek medical care. Among those who are seen in specialty clinics, attention-deficit hyperactivity disorder (ADHD) and obsessive–compulsive disorder (OCD) are present at higher rates. These co-occurring diagnoses often cause more impairment to the individual than the tics; hence, it is important to correctly identify associated conditions and treat them.
About 1% of school-age children and adolescents have Tourette's. It was once considered a rare and bizarre syndrome, most often associated with coprolalia (the utterance of obscene words or socially inappropriate and derogatory remarks), but this symptom is present in only a small minority of people with Tourette's. The condition was named by Jean-Martin Charcot (1825–1893) on behalf of his resident, Georges Albert Édouard Brutus Gilles de la Tourette (1857–1904), a French physician and neurologist, who published an account of nine patients with Tourette's in 1885.
History of Tourette syndrome
The first presentation of Tourette syndrome is thought to be from the late 15th century in the book, "Malleus Maleficarum" ("Witch's hammer") by Jakob Sprenger and Heinrich Kraemer, describing a priest whose tics were "believed to be related to possession by the devil".
Hyperkinesia
When both motor and vocal tics are present and persist for more than one year, a diagnosis of Tourette syndrome (TS) is likely. TS is an inherited neurobehavioral disorder characterized by both motor and vocal tics. Many individuals with TS may also develop obsessions, compulsions, inattention and hyperactivity. TS usually begins in childhood. Up to 5% of the population suffers from tics, but at least 20% of boys will have developed tics at some point in their lifetimes.
Arthur K. Shapiro
Working with the New York patient families who founded the Tourette Syndrome Association (TSA, since renamed to TAA) in 1972, the Shapiros advanced the argument that Tourette's was neurological rather than psychological, and the medical view of Tourette syndrome was "freed from its century-long submission to discredited psychoanalytic theory". In 1978, the Shapiros published a "landmark book" on the disorder, "Gilles de la Tourette Syndrome". In 1981, Shapiro was chosen honorary co-president of the First International Tourette Syndrome Symposium, held in New York. Since the 1990s, a more neutral view of Tourette's is emerging as a condition involving an interaction between biological vulnerability and adverse environmental events.
Georges Gilles de la Tourette
During 1873 Tourette began medical studies at Poitiers. He later relocated to Paris where he became a student, amanuensis, and house physician of his mentor, the influential contemporary neurologist Jean-Martin Charcot, director of the Salpêtrière Hospital. Charcot also helped him to advance in his academic career. Tourette studied and lectured in psychotherapy, hysteria and medical and legal ramifications of mesmerism (modern-day hypnosis).
Tourettes: I Swear I Can't Help It
The film follows John Davidson, who has Tourette syndrome (TS), and the changes in his life since the 1989 QED documentary "John's Not Mad". Another individual with TS, Greg, was filmed by his mother; his tics occasionally make him collapse or appear frozen. In this film, the pair meet and see how each copes with the condition.
Tourette syndrome
In contrast to the abnormal movements of other movement disorders (for example, choreas, dystonias, myoclonus, and dyskinesias), the tics of Tourette's are temporarily suppressible, nonrhythmic, and often preceded by an unwanted premonitory urge. Immediately preceding tic onset, most individuals with Tourette's are aware of an urge, similar to the need to sneeze or scratch an itch. Individuals describe the need to tic as a buildup of tension, pressure, or energy which they consciously choose to release, as if they "had to do it" to relieve the sensation or until it feels "just right". Examples of the premonitory urge are the feeling of having something in one's throat, or a localized discomfort in the shoulders, leading to the need to clear one's throat or shrug the shoulders. The actual tic may be felt as relieving this tension or sensation, similar to scratching an itch. Another example is blinking to relieve an uncomfortable sensation in the eye. These urges and sensations, preceding the expression of the movement or vocalization as a tic, are referred to as "premonitory sensory phenomena" or premonitory urges. Because of the urges that precede them, tics are described as semi-voluntary or ""unvoluntary"", rather than specifically "involuntary"; they may be experienced as a "voluntary", suppressible response to the unwanted premonitory urge. Published descriptions of the tics of Tourette's identify sensory phenomena as the core symptom of the syndrome, even though they are not included in the diagnostic criteria.
While individuals with tics are sometimes able to suppress their tics for limited periods of time, doing so often results in tension or mental exhaustion. People with Tourette's may seek a secluded spot to release their symptoms, or there may be a marked increase in tics after a period of suppression at school or at work. Some people with Tourette's may not be aware of the premonitory urge. Children may be less aware of the premonitory urge associated with tics than are adults, but their awareness tends to increase with maturity. They may have tics for several years before becoming aware of premonitory urges. Children may suppress tics while in the doctor's office, so they may need to be observed while they are not aware they are being watched. The ability to suppress tics varies among individuals, and may be more developed in adults than children.
Tuberculosis in human culture
Several major operas have exploited the theme of heroines dying tragically of tuberculosis, including
Mimì in Puccini's opera "La bohème". 
Giuseppe Verdi's "La Traviata" features the consumptive Violetta Valéry, based on Marguerite Gautier in Alexandre Dumas, "fils"'s 1848 novel "La Dame aux Camélias". In Jacques Offenbach's opera "The Tales of Hoffmann", Antonia has tuberculosis and is under the control of a Svengali-like quack doctor who forces her to sing herself to death by conjuring the shade of her dead mother, an opera singer. Numerous stage and film adaptations have been made, usually titled "Camille" or "The Lady of the Camellias" in English-language versions, and more loosely, as the 2001 film "Moulin Rouge!", where Satine dies of tuberculosis. The real life Paris courtesan Marie Duplessis, the historical Lady of the Camellias, died of the disease at age 23.
National Organization for Rare Disorders
The initial coalition was led by Abbey Meyers, whose son had Tourette syndrome. Tourette syndrome is a rather common neurological disorder that was estimated by the National Institutes of Health (NIH) to affect 100,000 people in the United States. Meyers' son was helped by an experimental drug that the manufacturer ceased to develop because they assumed it would not be profitable enough. After passage of the Orphan Drug Act the coalition founded NORD with Meyers as its president. In 2007 Meyers announced her retirement from the NORD presidency; the president is now Peter Saltonstall.
Front of the Class (film)
Twelve-year-old Brad lives in Missouri with his divorcée mother, Ellen, and younger brother, Jeff. He constantly gets into trouble with his father Norman and his teachers at school due to his tics. In one class, his teacher calls him to the front to make him apologize to his class for disrupting the class and promise he won't do it again. Determined to find out what is wrong with her son, Ellen seeks medical help. A psychiatrist believes that Brad's tics are the result of his parents' divorce. One lady suggests an exorcism. Ellen takes her search to the library and comes across Tourette syndrome (TS) in a medical book. She shows this to the psychiatrist, who agrees with the diagnosis, and says that there is no cure. Brad and his mother attend a support group for the first and last time. From then on, Brad aspires to never be like the other members of the support group and to become successful.
Arthur K. Shapiro
Until the early 1970s, the preferred intervention for Tourette syndrome was psychoanalysis. Shapiro wanted to prove that Tourette's was an organic disorder, and that psychotherapy was not the treatment of choice. "The turning point in the diagnosis and treatment of Tourette Syndrome occurred in 1965", when Dr. Shapiro and his wife, Elaine Schlaffer Shapiro (Ph.D.), treated a patient with haloperidol (Haldol). The Shapiros reported the treatment in a 1968 article, published by the "British Journal of Psychiatry", after it was rejected by American journals. The paper "severely criticized" the psychoanalytic approach, which had endured throughout the previous century, to treating the condition.
Causes and origins of Tourette syndrome
The exact mechanism affecting the inherited vulnerability has not been established, and the precise cause of Tourette syndrome is not known. Tics are believed to result from dysfunction in the central nervous system, in the cortical and subcortical regions, the thalamus, basal ganglia, and frontal cortex of the brain. Neuroanatomic models implicate failures in circuits connecting the brain's cortex and subcortex, and imaging techniques implicate the basal ganglia and frontal cortex.
Research presents considerable evidence that abnormal activity of the brain chemical, or neurotransmitter, dopamine is involved. Dopamine excess or supersensitivity of the postsynaptic dopamine receptors may be an underlying mechanism of Tourette syndrome.
Erotomania
Prognosis differs from person to person, and the ideal treatment is not completely understood. Treatment for this disorder gains the best results when tailored specifically for each individual. To date, the mainline pharmacological treatments have been pimozide (a typical antipsychotic which was also approved for treating Tourette's Syndrome), and atypical anti-psychotics like risperidone and clozapine. Non-pharmacologic treatments that have shown some degree of efficacy are electroconvulsive therapy (ECT), supportive psychotherapy, family and environment therapy, rehousing, risk management and treating underlying disorders in cases of secondary erotomania. ECT may provide temporary remission of delusional beliefs; anti-psychotics help attenuate delusions and reduce agitation or associated dangerous behaviors, and SSRIs may be used to treat secondary depression. In delusional disorder there is some evidence that pimozide has superior efficacy compared with other antipsychotics. Psychosocial psychiatric interventions can enhance the quality of life through allowing some social functioning, and treating comorbid disorders is a priority for secondary erotomania. Family therapy, adjustment of socio-environmental factors, and replacing delusions with something positive may be beneficial to all. In most cases, harsh confrontation should be avoided. Structured risk assessment helps to manage risky behaviors in those individuals more likely to engage in actions that include violence, stalking, and crime. For particularly troublesome cases, neuroleptics and enforced separation may be moderately effective.
Tourette syndrome
Not everyone with Tourette's wants treatment or a "cure", especially if that means they may "lose" something else in the process. Researchers Leckman and Cohen, and former US Tourette Syndrome Association (TSA) national board member Kathryn Taubert, believe that there may be latent advantages associated with an individual's genetic vulnerability to developing Tourette syndrome, such as a heightened awareness and increased attention to detail and surroundings that may have adaptive value. There is evidence to support the clinical lore that children with "TS-only" (Tourette's in the absence of comorbid conditions) are unusually gifted: neuropsychological studies have identified advantages in children with TS-only. Children with TS-only are faster than the average for their age group on timed tests of motor coordination.
Notable individuals with Tourette syndrome are found in all walks of life, including musicians, athletes, media figures, teachers, physicians, and authors. The best-known example of a person who may have used obsessive–compulsive traits to advantage is Samuel Johnson, the 18th-century English man of letters, who likely had Tourette syndrome as evidenced by the writings of James Boswell. Johnson wrote "A Dictionary of the English Language" in 1747, and was a prolific writer, poet, and critic. Tim Howard, described by the "Chicago Tribune" as the "rarest of creatures – an American soccer hero" and by the TSA as the "most notable individual with Tourette Syndrome around the world" says that his neurological makeup gave him an enhanced perception and an ability to hyper-focus that contributed to his success on the field.
Kevin Trudeau
In 2004, Trudeau self-published his book "Natural Cures "They" Don't Want You to Know About", in which he made a number of unsubstantiated claims—for example, that sunlight does not cause cancer, sunscreen is one of the major causes of skin cancer, and that AIDS was a hoax devised as an excuse to stimulate medication usage. Trudeau further suggested—again without documentation—that various "natural cures" for serious illnesses, including cancer, herpes, arthritis, AIDS, acid reflux disease, various phobias, depression, obesity, diabetes, multiple sclerosis, lupus, chronic fatigue syndrome, attention deficit disorder, and muscular dystrophy, had been deliberately hidden from the public by the Food and Drug Administration, the Federal Trade Commission, and the major food and drug companies. In one widely quoted example, he asserted that the University of Calgary had developed a "natural" diabetes treatment, then quashed its data, fearing reprisals from the pharmaceutical industry. (A spokesman for the school told ABC News that "there have been no human studies conducted at the University of Calgary in the past 20 years on herbal remedies for diabetes." The university later sent Trudeau a "cease and desist" letter, ordering him to stop using its name.) Rose Shapiro cited "Natural Cures" as a prime example in her book, "Suckers: How Alternative Medicine Makes Fools of Us All".
Eradication of infectious diseases
Unlike diseases such as smallpox and polio, there is no vaccine or drug therapy for guinea worm. Eradication efforts have been based on making drinking water supplies safer (e.g. by provision of borehole wells, or through treating the water with larvicide), on containment of infection and on education for safe drinking water practices. These strategies have produced many successes: two decades of eradication efforts have reduced guinea worm's global incidence to 22 cases in 2015, after which cases rose to 25 cases in 2016, and 30 cases in 2017, but this is still down from an estimated 3.5 million in 1986. Success has been slower than was hoped—the original goal for eradication was 1995. The WHO has certified 180 countries free of the disease, and only three countries—South Sudan, Ethiopia, and Chad—reported cases of guinea worm in 2016, and only two—Ethiopia and Chad—in 2017. , the WHO predicted it would be "a few years yet" before eradication is achieved, on the basis that it took 6–12 years for the countries that have so far eliminated guinea worm transmission to do so after reporting a similar number of cases to that reported by Sudan in 2009. The number of cases in 2016 (25) was less than 1% of the number in 2009, so real progress has been made towards this prediction. Nonetheless, the last 1% may be the hardest, and cases have increased from 2015 (22) to 2017 (30). The worm is able to infect dogs, domestic cats and baboons as well as humans, complicating eradication efforts.
Yaws is a rarely fatal but highly disfiguring disease caused by the spiral-shaped bacterium (spirochete) "Treponema pallidum pertenue", a close relative of the syphilis bacteria "Treponema pallidum pallidum", spread through skin to skin contact with infectious lesions. The global prevalence of this disease and the other endemic treponematoses, bejel and pinta, was reduced by the Global Control of Treponematoses (TCP) programme between 1952 and 1964 from about 50 million cases to about 2.5 million (a 95% reduction). However, following the cessation of this program these diseases remained at a low prevalence in parts of Asia, Africa and the Americas with sporadic outbreaks. According to a 2012 official WHO roadmap, the elimination should be achievable by 2020. Yaws is currently targeted by the South-East Asian Regional Office of the WHO for elimination from the remaining endemic countries in this region (India, Indonesia and East Timor) by 2010, and so far, this appears to have met with some success, since no cases have been seen in India since 2004. The discovery that oral antibiotic azithromycin can be used instead of the previous standard, injected penicillin, was tested on Lihir Island from 2013 to 2014; a single oral dose of the macrolide antibiotic reduced disease prevalence from 2.4% to 0.3% at 12 months. The campaign was in an early stage in 2013, still gathering data on disease incidence and planning initial large-scale treatment campaigns in Cameroon, Ghana, Indonesia, Papua New Guinea, the Solomon Islands, and Vanuatu.
Tic Talk: Living with Tourette Syndrome
Peters introduces himself by telling the reader how old he is and about his family. To delve further into his personality he states what sports and school subjects he likes most. When he was four years old he began to have tics, and his parents took him to a neurologist who prescribed medicine which would help reduce the intensity of the tics. The tics still occurred with medication. As the tics progressed in strength and intensity, Peters began to wonder if his friends would notice and if they would think he was strange. His friends began to ask questions about why he would do certain things such as blink twice or jerk his head. In the third grade, he decided to tell his friends and classmates of his Tourette syndrome. As the date of getting in front of his class to tell of his syndrome approached, his tics worsened. The day came and his mother went in to define Tourette syndrome for the class. Dylan then told his friends of his story so they could better understand him. After he did this his tics decreased in intensity. In the end he stated that this was most likely because he was not scared or nervous about what his friends would think anymore. In his last paragraph Peters stated that having Tourette syndrome does not change a person, it is just what makes that person who they are as a part of their personality.
Causes and origins of Tourette syndrome
A person with Tourette syndrome has about a 50% chance of passing the gene(s) to one of his/her children. Gender appears to have a role in the expression of the genetic vulnerability, with males more likely to express tics than females. Tourette syndrome is a condition of incomplete penetrance, meaning not everyone who inherits the genetic vulnerability will show symptoms. Tourette's also shows variable expression—even family members with the same genetic makeup may show different levels of symptom severity. The gene(s) may express as Tourette syndrome, as a milder tic disorder (transient or chronic tics), or as obsessive compulsive symptoms with no tics at all. Only a minority of the children who inherit the gene(s) will have symptoms severe enough to require medical attention. There is currently no way to predict the symptoms a child may display, even if the gene(s) are inherited.
Tourette syndrome
Relaxation techniques, such as exercise, yoga or meditation, may be useful in relieving the stress that may aggravate tics, but the majority of behavioral interventions (such as relaxation training and biofeedback, with the exception of habit reversal) have not been systematically evaluated and are not empirically supported therapies for Tourette's. Deep brain stimulation has been used to treat adults with severe Tourette's that does not respond to conventional treatment, but it is regarded as an invasive, experimental procedure that is unlikely to become widespread.
Treatment of Tourette syndrome
There are no medications specifically designed to target tics, although some antipsychotics (for example, pimozide) have been FDA-approved for treating Tourette's. Medications which are used as primary treatment in other conditions are used with some success in treating tics. Neuroleptic medications (antipsychotics), such as haloperidol (brand name Haldol) or pimozide (brand name Orap), have historically been and continue to be the medications with the most proven efficacy in controlling tics. These medications work by blocking dopamine receptors, and are associated with a high side effect profile. The traditional antipsychotic drugs are associated with tardive dyskinesia when used long-term; and parkinsonism, dystonia, dyskinesia, and akathisia when used short-term. Additional side effects can be school phobia (a form of separation anxiety), depression, weight gain, and cognitive blunting (dulling of cognitive ability). Another traditional antipsychotic used in treating Tourette's is fluphenazine (brand name Prolixin), although the evidence supporting its use is less than that of haloperidol and pimozide.
Central nervous system disease
Tourette's syndrome is an inherited neurological disorder. Early onset may be during childhood, and it is characterized by physical and verbal tics.TS often also includes symptoms of both OCD and ADHD indicating a link between the three disorders. The exact cause of Tourette's, other than genetic factors, is unknown.
Tourette syndrome
There is no cure for Tourette's and no medication that works universally for all individuals without significant adverse effects. Knowledge, education and understanding are uppermost in management plans for tic disorders. The management of the symptoms of Tourette's may include pharmacological, behavioral and psychological therapies. While pharmacological intervention is reserved for more severe symptoms, other treatments (such as supportive psychotherapy or cognitive behavioral therapy) may help to avoid or ameliorate depression and social isolation, and to improve family support. Educating a patient, family, and surrounding community (such as friends, school, and church) is a key treatment strategy, and may be all that is required in mild cases.
Medication is available to help when symptoms interfere with functioning. The classes of medication with the most proven efficacy in treating tics—typical and atypical neuroleptics including risperidone (trade name Risperdal), ziprasidone (Geodon), haloperidol (Haldol), pimozide (Orap) and fluphenazine (Prolixin)—can have long-term and short-term adverse effects. The antihypertensive agents clonidine (trade name Catapres) and guanfacine (Tenex) are also used to treat tics; studies show variable efficacy, but a lower side effect profile than the neuroleptics. Stimulants and other medications may be useful in treating ADHD when it co-occurs with tic disorders. Drugs from several other classes of medications can be used when stimulant trials fail, including guanfacine (trade name Tenex), atomoxetine (Strattera) and tricyclic antidepressants. Clomipramine (Anafranil), a tricyclic, and SSRIs—a class of antidepressants including fluoxetine (Prozac), sertraline (Zoloft), and fluvoxamine (Luvox)—may be prescribed when a Tourette's patient also has symptoms of obsessive–compulsive disorder. Several other medications have been tried, but evidence to support their use is unconvincing.
Tic disorder
As many as 1 in 100 people may experience some form of tic disorder, usually before the onset of puberty. Tourette syndrome is the more severe expression of a spectrum of tic disorders, which are thought to be due to the same genetic vulnerability. Nevertheless, most cases of Tourette syndrome are not severe. Although a significant amount of investigative work indicates genetic linkage of the various tic disorders, further study is needed to confirm the relationship.
Chris Crewther
In a speech to parliament in late 2016, Crewther revealed he has Tourette syndrome. He further discussed his condition during an interview on the Lateline program on 2 March 2017. He is the patron for the Tourette Syndrome Association of Australia and established the Parliamentary Friendship Group for Tourette Syndrome.
Tourette syndrome
Several studies have demonstrated that the condition in most children improves with maturity. Tics may be at their highest severity at the time that they are diagnosed, and often improve with understanding of the condition by individuals and their families and friends. The statistical age of highest tic severity is typically between eight and twelve, with most individuals experiencing steadily declining tic severity as they pass through adolescence. One study showed no correlation with tic severity and the onset of puberty, in contrast with the popular belief that tics increase at puberty. In many cases, a complete remission of tic symptoms occurs after adolescence. However, a study using videotape to record tics in adults found that, although tics diminished in comparison with childhood, and all measures of tic severity improved by adulthood, 90% of adults still had tics. Half of the adults who considered themselves tic-free still displayed evidence of tics.
Many people with TS may not realize they have tics; because tics are more commonly expressed in private, TS may go unrecognized or undetected. It is not uncommon for the parents of affected children to be unaware that they, too, may have had tics as children. Because Tourette's tends to subside with maturity, and because milder cases of Tourette's are now more likely to be recognized, the first realization that a parent had tics as a child may not come until their offspring is diagnosed. It is not uncommon for several members of a family to be diagnosed together, as parents bringing children to a physician for an evaluation of tics become aware that they, too, had tics as a child.
I Have Tourette's but Tourette's Doesn't Have Me
Children with Tourette's Syndrome discuss the challenges of living with Tourette's, a misunderstood and often stigmatizing condition. They demonstrate some of their tics, and talk about their lives with tics including embarrassing and isolating situations at school and among friends. Professionals and experts offer further information about Tourette's on the DVD.
Obsessive–compulsive spectrum
Tourette’s syndrome is a neurological disorder characterized by recurrent involuntary movements (motor tics) and involuntary noises (vocal tics). The reason Tourette’s syndrome and other tic disorders are being considered for placement in the obsessive compulsive spectrum is because of the phenomenology and co-morbidity of the disorders with obsessive compulsive disorder. Within the population of patients with OCD up to 40% have a history of a tic disorder and 60% of people with Tourette’s syndrome have obsessions and/or compulsions. Plus 30% of people with Tourette’s syndrome have clinically diagnosable OCD. Course of illness is another factor that suggests correlation because it has been found that tics displayed in childhood are a predictor of obsessive and compulsive symptoms in late adolescence and early adulthood. However, the association of Tourette’s and tic disorders with OCD is challenged by neuropsychology and pharmaceutical treatment. Whereas OCD is treated with SSRI, tics are treated with dopamine blockers and alpha-2 agonists.
Cure Cottages of Saranac Lake
Dr. Edward Livingston Trudeau (1848–1915), as a young man, watched his elder brother die of tuberculosis over a period of three months– at the time, the disease was incurable. He subsequently trained as a doctor, and, three years after completing his studies, was himself diagnosed with tuberculosis. Conventional thinking of the time called for a change of climate, and he went to live in the Adirondack Mountains, initially at Paul Smith's Hotel, spending as much time as possible in the open, and he subsequently regained his health. In 1876 he moved to Saranac Lake and established a medical practice among the sportsmen, guides and lumber camps of the region. In 1882, Trudeau read about Prussian Dr. Hermann Brehmer's success treating tuberculosis with the "rest cure" in cold, clear mountain air. Following this example, Trudeau founded the Adirondack Cottage Sanitarium in February, 1885. The first patients were two sisters who had been factory workers in New York City. They were treated in a one-room cottage named "Little Red", built for $350 on land donated by the guides and residents of the village. As the sanitorium grew, it would be supported at first by wealthy sportsmen that Trudeau had met at Paul Smith's, several of whom had built great camps on the nearby St. Regis Lakes.
Tobias Picker
Picker has been diagnosed with Tourette's syndrome. He has mentioned that there are "tourettic" elements to his music. He appeared in a BBC Horizon television documentary, titled "Mad But Glad", about the link between Tourette's syndrome and creativity. He has been involved in mentoring programs for children with Tourette's.
Tourette syndrome
Findings since 1999 have advanced TS science in the areas of genetics, neuroimaging, neurophysiology, and neuropathology. Questions remain regarding how best to classify Tourette syndrome, and how closely Tourette's is related to other movement disorders or psychiatric disorders. Good epidemiologic data is still lacking, and available treatments are not risk free and not always well tolerated. High-profile media coverage focuses on treatments that do not have established safety or efficacy, such as deep brain stimulation, and alternative therapies involving unstudied efficacy and side effects are pursued by many parents.
Creosote
Creosote was suggested as a treatment for tuberculosis by Reichenbach as soon as 1833. Following Reichenbach, it was argued for by John Elliotson and Sir John Rose Cormack. Elliotson, inspired by the use of creosote to arrest vomiting during an outbreak of cholera, suggested its use for tuberculosis through inhalation. He also suggested it for epilepsy, neuralgia, diabetes and chronic glanders. The idea of using it for tuberculosis failed to take hold, and use of this purpose was dropped, until the idea was revived later in 1876 by the British doctor G. Anderson Imlay, who suggested it be applied locally in spray to the bronchial mucous membrane. This was followed up in 1877 when it was argued for in a clinical paper by Charles Bouchard and Henri Gimbert. Germ theory had been established by Pasteur in 1860, and Bouchard, arguing that a bacillus was responsible for the disease, sought to rehabilitate creosote for its use as an antiseptic to treat it. He began a series of trials with Gimbert to convince the scientific community, and claimed a promising cure rate. A number of publications in Germany confirmed his results in the following years.
Tourette syndrome
Non-genetic, environmental, post-infectious, or psychosocial factors—while not causing Tourette's—can influence its severity. Autoimmune processes may affect tic onset and exacerbation in some cases. In 1998, a team at the US National Institute of Mental Health proposed a hypothesis based on observation of 50 children that both obsessive–compulsive disorder (OCD) and tic disorders may arise in a subset of children as a result of a poststreptococcal autoimmune process. Children who meet five diagnostic criteria are classified, according to the hypothesis, as having Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS). This contentious hypothesis is the focus of clinical and laboratory research, but remains unproven.
Tourette syndrome
Although it has been speculated that Mozart had Tourette's, no Tourette's expert or organization has presented credible evidence to support such a conclusion, and there are problems with the arguments supporting the diagnosis: tics are not transferred to the written form, as is supposed with Mozart's scatological writings; the medical history in retrospect is not thorough; side effects due to other conditions may be misinterpreted; "it is not proven whether written documents can account for the existence of a vocal tic" and "the evidence of motor tics in Mozart's life is doubtful."
Pre-dating Gilles de la Tourette's 1885 publication, likely portrayals of TS or tic disorders in fictional literature are Mr. Pancks in "Little Dorrit" by Charles Dickens and Nikolai Levin in "Anna Karenina" by Leo Tolstoy. The entertainment industry has been criticized for depicting those with Tourette syndrome as social misfits whose only tic is coprolalia, which has furthered stigmatization and the public's misunderstanding of those with Tourette's. The coprolalic symptoms of Tourette's are also fodder for radio and television talk shows in the US and in the British media.
Turpentine
Turpentine was a common medicine among seamen during the Age of Discovery. It is one of several products carried aboard Ferdinand Magellan's fleet in his first circumnavigation of the globe. Taken internally it was used as a treatment for intestinal parasites, but because of its toxicity, it should never be taken internally.As an organic solvent, its vapour can irritate the skin and eyes, damage the lungs and respiratory system, as well as the central nervous system when inhaled, and cause damage to the renal system when ingested, among other things. Being combustible, it also poses a fire hazard. Ingestion can cause burning sensations, abdominal pain, nausea, vomiting, confusion, convulsions, diarrhea, and unconsciousness. Because turpentine can cause spasms of the airways particularly in people with asthma and whooping cough, it can contribute to a worsening of breathing issues in persons with these diseases if inhaled.
History of Tourette syndrome
The European Society for the Study of Tourette syndrome (ESSTS) held its first meeting in 2000, with the goal of increasing awareness about Tourette syndrome in Europe. In 2009, working groups started to formulate the first European guidelines for TS, which were published in 2011.
Societal and cultural aspects of Tourette syndrome
Tourette syndrome is an inherited neurological disorder with onset in childhood, characterized by the presence of motor and phonic tics. Tourette's is a misunderstood and stigmatizing condition, often mentioned in the popular media. Tourette syndrome was once considered a rare and bizarre syndrome. It is no longer considered rare, but is often undetected because of the wide range of severity, with most cases classified as mild. Tourette's is defined as part of a spectrum of tic disorders, which includes provisional and chronic tics. With increased knowledge of the full range of severity of Tourette syndrome—including milder cases—it has shifted from a condition only recognized in its most severe and impairing forms, to one recognized as a condition which is often mild, and which may be associated with some advantages and some disadvantages.
Tourette syndrome
Coprolalia (the spontaneous utterance of socially objectionable or taboo words or phrases) is the most publicized symptom of Tourette's, but it is not required for a diagnosis of Tourette's and only about 10% of Tourette's patients exhibit it. Echolalia (repeating the words of others) and palilalia (repeating one's own words) occur in a minority of cases, while the most common initial motor and vocal tics are, respectively, eye blinking and throat clearing.
Icy Sparks
After her return home, the atmosphere is tense. After her grandfather dies, Icy and her grandmother turn to religion for solace. Inspired by a tent-meeting revival where she observes that people touched by the Holy Spirit behave as if they have Tourette's syndrome, Icy discovers she has a gift for music. She proceeds to attend university, where her disorder is diagnosed officially. Later, she becomes a therapist, working with children with Tourette's syndrome and with selective mutes.
Neurocrine Biosciences
Neurocrine announced it filed a new drug application (NDA) for its once-daily valbenazine drug treating TD on August 29, 2016. Valbenazine received a priority review designation, fast track status and a breakthrough designation from the FDA. In April 2017, the FDA approved INGREZZA (valbenazine) for the treatment of TD. At the time of approval, it was the first and only drug approved for adults with TD. Neurocrine is also studying valbenazine in clinical trials for the treatment of Tourette Syndrome. In October 2017, Neurocrine announced that it had been granted orphan drug designation status from the FDA for valbenazine for the treatment of pediatric patients with Tourette syndrome.
Societal and cultural aspects of Tourette syndrome
Other television and film productions depicting persons with TS, or using coprolalia as a plot device, include an episode of "Ally McBeal", in which Anne Heche portrays a woman with Tourette's whose leg tic causes her to run over and kill her boyfriend; "An Angel on my Tree", an episode of "Touched by an Angel" in which a father commits manslaughter in reaction to an event that involved his son who had Tourette's; an episode of "The Simpsons", in which Bart Simpson is mentioned to claimed to have Tourette's to excuse himself from a test; and an episode of "South Park", "Le Petit Tourette", in which Eric Cartman pretends to have Tourette's to get away with saying offensive things. The episode received a mixed reaction from the Tourette Syndrome Association, which commented that it provided useful information while at the same time perpetuating outright myths about coprolalia and Tourette syndrome.
Maggot therapy
The use of maggots to clean dead tissue from animal wounds is part of folk medicine in many parts of the world. It is particularly helpful with chronic osteomyelitis, chronic ulcers, and other pus-producing infections that are frequently caused by chafing due to work equipment. Maggot therapy for horses in the United States was re-introduced after a study published in 2003 by veterinarian Dr. Scott Morrison. This therapy is used in horses for conditions such as osteomyelitis secondary to laminitis, sub-solar abscesses leading to osteomyelitis, post-surgical treatment of street-nail procedure for puncture wounds infecting the navicular bursa, canker, non-healing ulcers on the frog, and post-surgical site cleaning for keratoma removal.
Tourette syndrome
Although not all people with Tourette's have comorbid conditions, most Tourette's patients presenting for clinical care at specialty referral centers may exhibit symptoms of other conditions along with their motor and phonic tics. Associated conditions include attention-deficit hyperactivity disorder (ADD or ADHD), obsessive–compulsive disorder (OCD), learning disabilities and sleep disorders. Disruptive behaviors, impaired functioning, or cognitive impairment in patients with comorbid Tourette's and ADHD may be accounted for by the comorbid ADHD, highlighting the importance of identifying and treating comorbid conditions. Disruption from tics is commonly overshadowed by comorbid conditions that present greater interference to the child. Tic disorders in the absence of ADHD do not appear to be associated with disruptive behavior or functional impairment, while impairment in school, family, or peer relations is greater in patients who have more comorbid conditions and often determines whether therapy is needed.
Tourette syndrome
Tourette's was classified by the fourth version of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-IV-TR) as one of several tic disorders "usually first diagnosed in infancy, childhood, or adolescence" according to type (motor or phonic tics) and duration (transient or chronic). Transient tic disorders consisted of multiple motor tics, phonic tics or both, with a duration between four weeks and twelve months. Chronic tic disorder was either single or multiple, motor or phonic tics (but not both), which were present for more than a year. Tourette's is diagnosed when multiple motor tics, and at least one phonic tic, are present for more than a year. The fifth version of the DSM (DSM-5), published in May 2013, reclassified Tourette's and tic disorders as motor disorders listed in the neurodevelopmental disorder category, and replaced transient tic disorder with provisional tic disorder, but made few other significant changes.
Tourette syndrome
Singer (2011) states the prevalence of TS in the overall population at any time is .1% for impairing cases and .6% for all cases, while Bloch and colleagues (2011) state the overall prevalence as between .3 and 1%. Robertson (2011) also suggests that the rate of Tourette's in the general population is 1%. Using year 2000 census data, a prevalence range of .1 to 1% yields an estimate of 53,000–530,000 school-age children with Tourette's in the US, and a prevalence estimate of .1% means that in 2001 about 553,000 people in the UK age 5 or older would have Tourette's.
Tourette syndrome
According to the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), Tourette’s may be diagnosed when a person exhibits both multiple motor and one or more vocal tics over the period of a year; the motor and vocal tics need not be concurrent. The onset must have occurred before the age of 18, and cannot be attributed to the effects of another condition or substance (such as cocaine). Hence, other medical conditions that include tics or tic-like movements—such as autism or other causes of tourettism—must be ruled out before conferring a Tourette's diagnosis. Since 2000, the DSM has recognized that clinicians see patients who meet all the other criteria for Tourette's, but do not have distress or impairment.
Tourette syndrome
A person with Tourette's has about a 50% chance of passing the gene(s) to one of his or her children, but Tourette's is a condition of variable expression and incomplete penetrance. Thus, not everyone who inherits the genetic vulnerability will show symptoms; even close family members may show different severities of symptoms, or no symptoms at all. The gene(s) may express as Tourette's, as a milder tic disorder (provisional or chronic tics), or as obsessive–compulsive symptoms without tics. Only a minority of the children who inherit the gene(s) have symptoms severe enough to require medical attention. Gender appears to have a role in the expression of the genetic vulnerability: males are more likely than females to express tics.
Tourette syndrome
Although Tourette's is the more severe expression of the spectrum of tic disorders, most cases are mild and many individuals with TS do not come to clinical attention. The severity of symptoms varies widely among people with Tourette's, and mild cases may be undetected.
Tic
Tic disorders occur along a spectrum, ranging from mild (transient or chronic tics) to more severe; Tourette syndrome is the more severe expression of a spectrum of tic disorders, which are thought to be due to the same genetic vulnerability. Nevertheless, most cases of Tourette syndrome are not severe. The treatment for the spectrum of tic disorders is similar to the treatment of Tourette syndrome.
Tourette syndrome
Tourette's is associated with several comorbid conditions, or co-occurring diagnoses, which are often the major source of impairment for an affected child. Most individuals with tics do not seek medical attention, so epidemiological studies of TS "reflect a strong ascertainment bias", but among those who do warrant medical attention, the majority have other conditions, and up to 50% have ADHD or OCD.
Societal and cultural aspects of Tourette syndrome
An incident of disinformation about coprolalia and Tourette's involved Dr. Laura Schlessinger. According to the former Tourette Syndrome Association (name changed to Tourette Association of America in 2015), she berated a caller inquiring whether a child with TS should attend a family wedding, declaring that a majority of those with the condition exhibited coprolalia and should be excluded from many social situations, provoking an avalanche of angry calls about the misinformation. Garrison Keillor, radio show host of NPR's "A Prairie Home Companion", produced a segment in 2006, titled "Broadway Tourette's", about segregating people with stereotypical TS from other passengers on a cruise ship, prompting a press release from the Tourette Syndrome Association.
Treatment of Tourette syndrome
Newer neuroleptics, the atypical neuroleptics, are an alternative to the traditional medications used for treating tics. These medications have more selective dopamine blocking effects, or block serotonin with some blocking of dopamine. The medications in this class used to treat tics include risperidone (brand name Risperdal), olanzapine (brand name Zyprexa), ziprasidone (brand name Geodon), quetiapine (brand name Seroquel), clozapine (brand name Clozaril), tiapride, and sulpiride. They seem to have lower risks of neurological side effects (such as tardive dyskinesia) when used short-term, but longer trials are needed to confirm this. Some of the side effects associated with these medications are insomnia, weight gain, and school phobia. Abnormalities in metabolism, cardiac conduction times, and increased risk of diabetes are concerns with these medications. There is good empirical support for the use of risperidone, and less support for the others.
The α-adrenergic receptor agonists (antihypertensive agents) show some efficacy in reducing tics, as well as other comorbid features of some people with Tourette's. Originally developed to treat high blood pressure, these medications are a safer alternative to neuroleptic medications for the people with TS that respond to them. This class of medication is often the first tried for tics, as the antihypertensives have a lower side effect profile than some of the medications which more proven efficacy. The evidence for their safety and efficacy is not as strong as the evidence for some of the standard and atypical neuroleptics, but there is fair supportive evidence for their use, nonetheless. This class of medication takes about six weeks to begin to work on tics, so sustained trials are warranted. Because of the blood pressure effects, antihypertensive agents should not be discontinued suddenly. Clonidine (brand name Catapres) works on tics for about half of people with TS. Maximal benefit may not be achieved for 4–6 months. A small number of patients may worsen on clonidine. Guanfacine (brand name Tenex) is another antihypertensive that is used in treating TS. Side effects can include sedation, dry mouth, fatigue, headaches and dizziness. Sedation can be problematic when treatment is first initiated, but may wear off as the patient adjusts to the medication.
David Begnaud
Begnaud was diagnosed with Tourette Syndrome at age 6. On December 16 2018 he revealed this fact to his audience and the public outside his personal life. He said his parents never allowed him to use it as an excuse for not succeeding, and that Tourette's was one of the primary motivators for him to persevere and succeed in journalism. His tics are mainly nonvocal.
Treatment of Tourette syndrome
Treatment of Tourette syndrome can be divided into treatment of tics, and treatment of co-occurring conditions, which, when present, are often a larger source of functional impairment than the tics themselves.
Le Curé de Tours
Le Curé de Tours is a long short story (or, more properly, a novella) by Honoré de Balzac, written in 1832. Originally entitled "Les Célibataires" (The Celibates), it was published in that year in volume III of the 2nd edition of "Scènes de la vie privée", then republished in 1833 and again in 1839, still with the same title but as one of the "Scènes de la vie de province". Not until 1843 did it take on its present title of "Le Curé de Tours" when it appeared in volume II of "Scènes de la vie de province" (volume VI of his vast narrative series "La Comédie humaine").
IMMP2L
Gilles de la Tourette syndrome (GTS) is a complex neuropsychiatric disorder characterized by multiple motor and phonic tics. In the clinical characterization of a patient with GTS, Petek et al discovered a breakpoint in chromosome region 7q31. Additional characterization identified that IMMP2L, a novel gene coding for the apparent human homologue of the yeast mitochondrial inner membrane peptidase subunit 2, was found to be disrupted by both the breakpoint in the duplicated fragment and the insertion site in 7q31. It is the first association of IMMP2L gene to Tourette syndrome. 
Recent investigation by Bertelsen et al. further indicated that IMMP2L was one of the genes as a susceptibility factor in disease pathogenesis. Tourette syndrome is often accompanied by comorbidities such as attention-deficit hyperactivity-disorder and obsessive compulsive disorder. Tourette syndrome has a complex etiology and the underlying environmental and genetic factors responsible for this disease are still largely unknown.
Tourette syndrome
Secondary causes of tics (not related to inherited Tourette syndrome) are commonly referred to as tourettism. Dystonias, choreas, other genetic conditions, and secondary causes of tics should be ruled out in the differential diagnosis for Tourette syndrome. Other conditions that may manifest tics or stereotyped movements include developmental disorders, autism spectrum disorders, and stereotypic movement disorder; Sydenham's chorea; idiopathic dystonia; and genetic conditions such as Huntington's disease, neuroacanthocytosis, pantothenate kinase-associated neurodegeneration, Duchenne muscular dystrophy, Wilson's disease, and tuberous sclerosis. Other possibilities include chromosomal disorders such as Down syndrome, Klinefelter syndrome, XYY syndrome and fragile X syndrome. Acquired causes of tics include drug-induced tics, head trauma, encephalitis, stroke, and carbon monoxide poisoning. The symptoms of Lesch-Nyhan syndrome may also be confused with Tourette syndrome. Most of these conditions are rarer than tic disorders, and a thorough history and examination may be enough to rule them out, without medical or screening tests.
Treatment of Tourette syndrome
Habit reversal training (HRT), massed negative practice, biofeedback, relaxation, hypnosis and other behavioral approaches are proposed as alternative treatments of tics, but few have been well assessed. Relaxation techniques, such as exercise, yoga or meditation, may be useful in relieving stress that may aggravate tics, but the majority of behavioral interventions (such as relaxation training and biofeedback, with the exception of habit reversal) have not been systematically evaluated and are not proven therapies for Tourette's.
Quit It
Quit It is a 2002 novel by Marcia Byalick about a young girl living with Tourette syndrome (TS). It was her first novel for Delacorte Press. The book centers on Carrie, a seventh-grade girl who has just been diagnosed with TS. Targeted to early teens, "Quit It" explores Carrie's struggles to cope with TS while trying to fit in with her peers.
Tourette syndrome
Although there is no such thing as a "typical" case of Tourette syndrome, the condition follows a fairly reliable course in terms of the age of onset and the history of the severity of symptoms. Tics may appear up to the age of eighteen, but the most typical age of onset is from five to seven. A 1998 study published by Leckman and colleagues from the Yale Child Study Center showed that the ages of highest tic severity are eight to twelve (average ten), with tics steadily declining for most patients as they pass through adolescence. The most common, first-presenting tics are eye blinking, facial movements, sniffing and throat clearing. Initial tics present most frequently in midline body regions where there are many muscles, usually the head, neck and facial region. This can be contrasted with the stereotyped movements of other disorders (such as stims and stereotypies of the autism spectrum disorders), which typically have an earlier age of onset, are more symmetrical, rhythmical and bilateral, and involve the extremities (e.g., flapping the hands). Tics that appear early in the course of the condition are frequently confused with other conditions, such as allergies, asthma, and vision problems: pediatricians, allergists and ophthalmologists are typically the first to see a child with tics.
Louis Dubertret
This quantitative and dynamic approach to the in vivo inflammation in humans contributed to a better understanding of psoriasis. In therapeutic research, Dubertret coordinated several studies to evaluate anti-psoriatic drugs. 
In 2005, the René Touraine Foundation (fr: Fondation René Touraine), under the leadership of Dubertret, initiated—in collaboration with eleven European countries—the Psoriasis International Network, a network aimed to develop clinical and therapeutic research for psoriatic patients.
Jumping Frenchmen of Maine
According to Kushner, the French physician Jean-Martin Charcot chose his resident, Georges Gilles de la Tourette, to investigate the "relationship between tic disorders and jumping and startle behaviors reported in Malaysia, Siberia, and Maine"; Gilles de la Tourette translated Beard's descriptions and published them one year after Beard's papers. In 1885, Tourette published "Study of a Nervous Affliction" where he included the startle disorders in the typology of what he called "convulsive tic illness", that included what later came to be known as Tourette syndrome. Kushner argues that none of the patients studied by Tourette supported this assertion, and says that "many of his contemporaries refuted Gilles de la Tourette's typology".
Tourette syndrome
Tics are movements or sounds "that occur intermittently and unpredictably out of a background of normal motor activity", having the appearance of "normal behaviors gone wrong". The tics associated with Tourette's change in number, frequency, severity and anatomical location. Waxing and waning—the ongoing increase and decrease in severity and frequency of tics—occurs differently in each individual. Tics may also occur in "bouts of bouts", which vary for each person.
Tourette syndrome
There is no requirement that other comorbid conditions (such as ADHD or OCD) be present, but if a physician believes that there may be another condition present that could explain tics, tests may be ordered as necessary to rule out that condition. An example of this is when diagnostic confusion between tics and seizure activity exists, which would call for an EEG, or if there are symptoms that indicate an MRI to rule out brain abnormalities. TSH levels can be measured to rule out hypothyroidism, which can be a cause of tics. Brain imaging studies are not usually warranted. In teenagers and adults presenting with a sudden onset of tics and other behavioral symptoms, a urine drug screen for cocaine and stimulants might be necessary. If a family history of liver disease is present, serum copper and ceruloplasmin levels can rule out Wilson's disease. Most cases are diagnosed by merely observing a history of tics.
History of Tourette syndrome
The U.S. National Institutes of Health (NIH) turned down a 1972 grant proposal from the TSA because "the reviewers believed there were probably no more than 100 cases of TS in the entire nation", and a 1973 registry reported only 485 cases worldwide. Subsequent articles on Tourette's in "Good Housekeeping", "The New York Times" and "Ann Landers" produced an "enormous response, proving that there were many undiagnosed cases of TS across the United States". TS was listed as a rare disorder in the United States Orphan Drug Act of 1983, a law enacted to increase development of medications for conditions which affect small numbers of people. In 1985 pimozide was approved by the U.S. Food and Drug Administration for the treatment of the condition.
Tourette syndrome
The treatment of Tourette's focuses on identifying and helping the individual manage the most troubling or impairing symptoms. Most cases of Tourette's are mild, and do not require pharmacological treatment; instead, psychobehavioral therapy, education, and reassurance may be sufficient. Treatments, where warranted, can be divided into those that target tics and comorbid conditions, which, when present, are often a larger source of impairment than the tics themselves. Not all people with tics have comorbid conditions, but when those conditions are present, they often take treatment priority.
Ulcerative colitis
Helminthic therapy using the whipworm "Trichuris suis" has been shown in a randomized control trial from Iowa to show benefit in patients with ulcerative colitis. The therapy tests the hygiene hypothesis which argues that the absence of helminths in the colons of patients in the developed world may lead to inflammation. Both helminthic therapy and fecal bacteriotherapy induce a characteristic Th2 white cell response in the diseased areas, which was unexpected given that ulcerative colitis was thought to involve Th2 overproduction.
Immune thrombocytopenic purpura
After initial reports by the Portuguese physician Amato Lusitano in 1556 and Lazarus de la Rivière (physician to the King of France) in 1658, it was the German physician and poet Paul Gottlieb Werlhof who in 1735 wrote the most complete initial report of the purpura of ITP. Platelets were unknown at the time. The name "Werlhof's disease" was used more widely before the current descriptive name became more popular. Platelets were described in the early 19th century, and in the 1880s several investigators linked the purpura with abnormalities in the platelet count. The first report of a successful therapy for ITP was in 1916, when a young Polish medical student, Paul Kaznelson, described a female patient's response to a splenectomy. Splenectomy remained a first-line remedy until the introduction of steroid therapy in the 1950s.
History of Tourette syndrome
Questions remain regarding how best to classify Tourette syndrome, and how closely Tourette's is related to other movement disorders or psychiatric disorders. Good epidemiologic data is still lacking, and available treatments are not risk free and not always well tolerated.
Craig Carton
On June 6, 2013, Carton launched the Tic Toc Stop Foundation, aimed at wiping out Tourette syndrome. Fundraising includes a bowling event known as "Strike Out Tourettes".
Deep brain stimulation
The procedure is invasive and expensive, and requires long-term expert care. Benefits for severe Tourette's are not conclusive, considering less robust effects of this surgery seen in the Netherlands. Tourette's is more common in pediatric populations, tending to remit in adulthood, so in general this would not be a recommended procedure for use on children. Because diagnosis of Tourette's is made based on a history of symptoms rather than analysis of neurological activity, it may not always be clear how to apply DBS for a particular person. Due to concern over the use of DBS in Tourette syndrome treatment, the Tourette Association of America convened a group of experts to develop recommendations guiding the use and potential clinical trials of DBS for TS.
History of Tourette syndrome
The eponym was bestowed by Jean-Martin Charcot (1825–93) on behalf of his resident, Georges Albert Édouard Brutus Gilles de la Tourette (1859–1904), a French physician and neurologist, who published an account of nine patients with Tourette's in 1885. The possibility that movement disorders, including Tourette syndrome, might have an organic origin was raised when an encephalitis epidemic from 1918–1926 led to a subsequent epidemic of tic disorders. Research in 1972 advanced the argument that Tourette's is a neurological, rather than psychological, disorder; since the 1990s, a more neutral view of Tourette's has emerged, in which biological vulnerability and adverse environmental events are seen to interact.
Societal and cultural aspects of Tourette syndrome
A German psychiatrist examined the question of Mozart's diagnoses and concluded that "Tourette’s syndrome is an inventive but implausible diagnosis in the medical history of Mozart". Evidence of motor tics was found lacking and the notion that involuntary vocal tics are transferred to the written form was labeled "problematic". Neurologist and author Oliver Sacks published an editorial disputing Simkin's claim, and the Tourette Syndrome Association pointed out the speculative nature of this information. No Tourette's syndrome expert or organization has voiced concurrence that there is credible evidence to conclude that Mozart had Tourette's. One TS specialist stated that, "although some web sites list Mozart as an individual who had Tourette's and/or OCD, it's not clear from the descriptions of his behavior that he actually had either."
Societal and cultural aspects of Tourette syndrome
"Quit It" is a 2002 novel by Marcia Byalic, targeted at teens, about a seventh-grade girl recently diagnosed with TS. A protagonist with Tourette's is presented in Jonathan Lethem's detective novel, "Motherless Brooklyn". The Gwyn Hyman Rubio novel "Icy Sparks" was an Oprah Book Club selection about a teenage girl who may have TS.
Tumid lupus erythematosus
Lupus erythematosus tumidus (LET) was reported by Henri Gougerot and Burnier R. in 1930. It is a photosensitive skin disorder, a different subtype of cutaneous lupus erythematosus (CLE) from discoid lupus erythematosus (DLE) or subacute CLE (SCLE). LET is usually found on sun-exposed areas of the body. Skin lesions are edematous, urticarialike annular papules and plaques. Topical corticosteroids are not effective as treatment for LET, but many will respond to chloroquine. LET resolves with normal skin, no residual scarring, no hyperpigmentation or hypopigmentation. Cigarette smokers who have LET may not respond very well to chloroquine.
History of Tourette syndrome
According to Swerdlow, "the 'core' TS conundrum" is a lack of consensus about the definition of Tourette syndrome. Since vocal tics result from a "motor event (ie, a contracting diaphragm moving air through the upper airways)", TS could be defined as a disorder of motor tics, eliminating the distinction between TS and the other tic disorders. Individuals who have only tics may not be functionally impaired, raising the question of whether Tourette's as currently defined should be a DSM diagnosis. Swerdlow highlights the importance of studies in new areas such as behavioral techniques, and says that "the whole-cloth dismissal of psychologic forces in the pathobiology of TS was a strategic error". Questions remain about whether co-occurring (comorbid) conditions should be part of the core definition, and why sensory phenomena, which are a core part of Tourette's, are not part of the diagnostic criteria.
Klazomania
Jankovic and Mejia describe klazomania as due to tourettism (tics having Tourette syndrome-like features but not due to TS). According to the revised fourth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-IV-TR), Tourette's may be diagnosed when the other diagnostic criteria are met and symptoms cannot be attributed to another general medical condition. Hence, other medical conditions that include tics or tic-like movements—such as tourettism—must be ruled out before a TS diagnosis can be conferred. There are no specific tests; the diagnosis is based on history and symptoms.
Deep brain stimulation
DBS has been used experimentally in treating adults with severe Tourette syndrome that does not respond to conventional treatment. Despite widely publicized early successes, DBS remains a highly experimental procedure for the treatment of Tourette's, and more study is needed to determine whether long-term benefits outweigh the risks. The procedure is well tolerated, but complications include "short battery life, abrupt symptom worsening upon cessation of stimulation, hypomanic or manic conversion, and the significant time and effort involved in optimizing stimulation parameters". As of 2006, five people with TS had been reported on; all experienced reduction in tics and the disappearance of obsessive-compulsive behaviors.
History of Tourette syndrome
Findings since 1999 have advanced TS science in the areas of genetics, neuroimaging, neurophysiology, and neuropathology. Questions remain regarding how best to classify Tourette syndrome, and how closely Tourette's is related to other movement disorders or psychiatric disorders. Good epidemiologic data is still lacking, and available treatments are not risk free and not always well tolerated.
Le Roy, New York
Eventually, as doctors encouraged their patients to stay away from the media and the media attention died down, many of the girls' symptoms improved. By the end of the school year in June, one girl was diagnosed with Tourette syndrome, likely the source of the mass psychogenic illness, and most of the girls who received treatment for conversion disorder were back to normal in time for graduation. No environmental causes were found after repeated testing around the school and surrounding areas of town.
Treatment of Tourette syndrome
The majority of people with TS require no medication, but medication is available to help when symptoms interfere with functioning. Because children with tics often present to physicians when their tics are at their highest severity, and because of the waxing and waning nature of tics, medication is not usually started immediately or changed often. Frequently, the tics subside with understanding of the condition and a supportive environment. When medication is necessary, pharmaceutical intervention should be targeted at the most impairing symptoms, taking into account co-occurring conditions such as ADHD or OCD, which when present, may warrant treatment even when tics are mild.
Causes and origins of Tourette syndrome
Causes and origins of tinnys Tourette syndrome have not been fully elucidated. Tourette syndrome (also called "Tourette's syndrome", "Tourette's disorder", "Gilles de la Tourette syndrome", "GTS" or "TS") is an inherited neurological disorder with onset in childhood, characterized by the presence of multiple motor tics and at least one phonic tic, which characteristically wax and wane. Tourette's syndrome occurs along a spectrum of tic disorders, which includes transient tics and chronic tics.
The exact cause of Tourette's is unknown, but it is well established that both genetic and environmental factors are involved. The overwhelming majority of cases of Tourette's are inherited, although the exact mode of inheritance is not yet known, and no gene has been identified. Tics are believed to result from dysfunction in the thalamus, basal ganglia, and frontal cortex of the brain, involving abnormal activity of the brain chemical, or neurotransmitter, dopamine. In addition to dopamine, multiple neurotransmitters, like serotonin, GABA, glutamate, and histamine (H3-receptor), are involved.
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SLITRK1 (gene)
A subsequent examination of the region of the SLITRK1 gene found the mutation in none of 82 patients with Tourette syndrome. The authors concluded that tests to detect variant(s) in the gene probably would have little diagnostic utility. An experiment in the effects of a microdeletion in chromosome 13q31.1 was done in a fetus, the mother had passed the microdeletion to the child and both did not have tourettes or any other OCD symptoms, showing that it may not be a direct cause of tourettes. Further attempts to replicate the study were done in multiple studies. In a Japanese study, next-gen sequencing was used to screen 92 TS patients and 361 healthy controls, none of TS patients were found to have mutations at either variant or any new mutations in the gene. In a European study it was found that the 2 original variations were not found in any of the 222 trios that were studied. However, tests were also done on SNPs in the groups and 3 were found to have variations. Two of the three variations were found to be associated with the formation of Tourette syndrome. In a different study of 381 Caucasians with some form of OCD with 356 non-OCD control patients, 3 genetic changes were found after genetic screening. Of the 3, 2 were identified only once each and the third was found in 4 OCD patients but also in a non-OCD patient. The non-OCD patient did have compulsive nail biting, but these studies show that a genetic link between SLITRK1 and patients with TS may exist they are more complex in nature than previously understood.
Tourettes Action
According to their website, Tourettes Action's goal is to help individuals with TS receive the practical support and social acceptance they need to help them live their lives to the fullest. It also funds research into treatment and diagnosis of TS.