Tourette Syndrome

Tourette Syndrome
Presentation by:Samuel H. Zinner, M.D.

Overview
Take Home Points:
* TS is not rare
* Tics are usually mild, not catastrophic
* In most people with TS, tics are one of many related complications
* Address main problems, often not tics

Who cares about Tourette syndrome?
* TS is:
o common
o under-diagnosed
o misunderstood
o ripe with opportunity for management (and mismanagement)& research

Tic Disorders: Characteristics
* Tic Definition
o motor or phonic
o involuntary (unvoluntary?)
o sudden and rapid
o recurrent
o non-rhythmic and stereotyped

Tourette’s Disorder
* DSM-IV-TRTM Criteria
o Multiple motor + 1 or more vocal
o Many times/day & at least 1 year
o Onset before 18 years
o Not due to substance or medical condition

Epidemiology
Etiology
Differential Diagnosis of tics
* Compulsions
* Habits
* Stereotypies
* Allergies
* Sydenham chorea
* Various involuntary neuromuscular
Genetics
Genetics barriers to identifying genes
* Diagnosis based on behaviors
* Defining the TS phenotypic spectrum
o “endophenotypes”
* Family pedigree problems
* Environmental influences
* Combinations of genes may be involved
* Symptoms decrease with age
* Transient tics

Differential Diagnosis of tics
* Sydenham’s chorea
* Compulsions
* Blepharospasm
* Other hyperkinetic disorders
* Stereotypies
* Allergies

Diagnostic Pitfalls 101
Diagnostic Pitfalls 102
Assessment: co-morbid conditions
Clinical Course
Quality of Life?
Management
Identification
Identification – comorbid conditions
KEY POINT!
Always assess for non-tic comorbidity
Identification – comorbid conditions
TRICHOTILLOMANIA: moth-eaten appearance to hair and scalp excoriations
Clinical Course
A common sense guide to complementary/alternative medicine
Integrative Medicine websites

National Center for Complementary and Alternative Medicine
http://nccam.nih.gov
Consortium of Academic Health Centers for Integrative Medicine
www.imconsortium.org
Management: Advocacy and Legal Rights
Pharmacotherapy for Comorbid Conditions
KEY POINT!
Target the most troubling symptoms
Pharmacotherapy
KEY POINTS!
Take Home Points: Clarifying Common Misconceptions

Tourette Syndrome.ppt