I’m still not sure what happened last week but the past is the past and now is the post.
Although I have made two references to the common association between Tourette’s syndrome and spewing forth a stream of expletives before I have even written the first paragraph it appears this association is for the most part just Hollywood glitz and glamour. Tourette’s Syndrome actually has the much broader definition of ‘the presence of multiple physical tics and at least one vocal tic’. In fact this is only the most recent definition I could find, it seems that what we call Tourette’s changes with every new edition of the DSM. Tourette’s also has a fairly unique property amongst tic disorders; its onset is transient and its severity variable. Sometime you got it bad, other times its not even noticeable. Taking it from ‘fairly unique’ to ‘right out there on its own’ is the length of time between episodes, with onset being close to impossible to predict and the length of an episode or period of non-episodes also varying greatly. This syndrome sneaks up on you and you can’t do anything about it till it’s gone. That blows.
Tourette’s was once considered to be a rare and unusual disorder but more recently has become for more common, although it probably has something to do with the widening of the definition of the syndrome. Some estimates have put diagnosis rates at 10 in every 1,000 children but it is also acknowledged that many ‘sufferers’ may not be aware of the syndrome as the vast majority of cases are mild to sub-clinical.
The characteristic ‘tic’ of Tourette’s sufferers can take many different forms. Tourette’s is diagnosed when there is both a vocal and physical tic with the most common being throat clearing and eye blinking respectively. More serious but significantly rarer are the more obvious vocal tics including Coprolalia (the swearing one), Echolalia (repeating others words, also a very good Something for Kate album), Palilalia (repeating your own words). Physical tics are usually mild but some cases of chorea and dystonia associated with tics has been observed.
Whilst medications are available to Tourette’s sufferers they can only treat symptoms and due to the sporadic nature of both onset and severity this makes effective treatment almost impossible. It seems that many sufferers don’t use these medications however as the tics associated with Tourette’s appear to be temporarily suppressible. That one time you see a sufferer let loose with a string of curses, rapidly blinks their eyes for a period of time or clears their throat continuously may be the result of a whole day of suppressed tics. Many describe the sensation like trying to ignore an itch, you can suppress the urge to scratch and achieve sweet release or you can consciously control your response, eventually you will have to scratch that itch though.
Now, I wouldn’t be a very good microbiologist if I didn’t find some way to talk about bacteria when considering a neurological disorder would I?
Whilst it is generally accepted that Tourette’s is inherited some people are claiming that Tourette’s and other related disorders including OCB may exaggerated or indeed caused by a Streptococcal infection early in life. What is this syndrome called you ask? Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections or, and I’m not even kidding, (PANDAS)
Leckman, J. F., et al. (2006). “Phenomenology of tics and natural history of tic disorders.” Adv Neurol 99: 1-16.
Scahill, L., et al. (2006). “Disruptive behavior problems in a community sample of children with tic disorders.” Adv Neurol 99: 184-190.
Swedo, S. E., et al. (1998). “Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases.” Am J Psychiatry 155(2): 264-271.