Tics and Tourette’s syndrome: diagnosis, symptoms and treatment

It seems that Mozart also suffered from Tourette’s syndrome. And although it is not very widespread, it has become the theme of some films that have made it known to the general public. Recently, the actor Alessandro Borghi talked about it, out of his teeth, who told how he lives with the disease.

Tourette’s syndrome affects 1% of the world population, manifests itself with motor or vocal ticsin childhood (between 5 and 12 years, with a 4 to 1 higher incidence on males than females) and it tends to disappear in adulthood but, where it persists, it can also create disabling problems.

For this reason, the most effective therapies are psychological ones, which teach us to live with what director Peter Werner in his film called “the faithful companion”. «For a long time I thought I had tics but it was Tourette, a neurological syndrome that presents various symptoms. I have spasms and I blow on my fingers. When I act it passes, and I have given myself a poetic explanation: my job is to put myself in someone else’s shoes; the other the Tourette does not have it and therefore, at that moment, neither do I ». With these few words, Borghi summarized a complex situation and still shrouded in an aura of mystery, since the cause is still unknown even if numerous hypotheses are made.

But where are the therapies? Does it heal? We turned the questions to a profound scholar and connoisseur of this syndrome, the neurologist of the Bambino Gesù Children’s Hospital in Rome, Alessandro Capuano.

Should a parent worry if he sees his child having tics?

Absolutely no. Tics are a pathology very frequent in childhood. An important element needs to be clarified. We can speak of Tourette’s syndrome when multiple motor tics and at least one vocal tic are present for more than a year. These may be associated with neuropsychiatric disorders such as attention deficit hyperactivity disorder, or an obsessive-compulsive disorder. Tourette’s syndrome is very multifaceted in its clinical expression. I would also like to emphasize that parents do not have to worry about the intellectual abilities of children, who can lead a normal life.


Do the manifestations persist into adulthood?

In 70% of cases the disorder passes. When the tics persist they are mild, easily manageable and do not represent a problem for carrying out daily activities. Only in a small percentage of cases the syndrome continues to live in severe form. This also happens because, when it was diagnosed in developmental age, the comorbidities (ie the parallel presence of several disorders) were not recognized and adequately addressed, which are then those that have the most impact in adulthood.


So the main problem is not tics but what accompanies them?

Exactly. Tics can be controlled. The more the child grows, the more he is aware of the syndrome, and develops control strategies that improve the situation.


Does this mean that action must be taken immediately?

It is essential to characterize the various disturbances that must be monitored over time as soon as possible. Tics have a fluctuating course, they come and go, they change and are influenced by many factors that can aggravate them. But the focus is on managing the rest, of what is under the tip of the iceberg. I repeat: Tourette is a complex syndrome that involves the development of many functions.


Are there any warning signs of tics coming? What does the subject perceive?

Often there is a premonitory sensation, like a kind of discomfort, pain, like an energy that must come out, which is helped through tics or a vocalization such as a cough or a scream. The blinking of the eye, facial grimaces, kicks, jumps, a bizarre gait often occur. The premonitory sensation is important for therapy.


Are there any laboratory tests for diagnosis?

It is the doctor who makes the diagnosis based on a series of clinical diagnostic criteria. It should be noted that tics are quite frequent in developmental age. Up to 40% of children who come to a specialist movement disorder clinic have tics. Some are transient and do not involve Tourette’s syndrome.


Let’s talk about therapies: what are the news?

Type therapy cognitive behavioral remains the most valid route for both tics and comorbidities. Only in severe cases, when symptoms interfere with the activity of daily living and cause discomfort or pain, are drugs used. But these are infrequent cases. Specific techniques have been tested to train the ability to control tics. A widely used one is thehabit reversal, or the habit reversal technique. This makes the patient aware of the tic and warning signs and teaches him to perform an alternative voluntary movement that is incompatible with that produced by the tic.


Can we give a concrete example of habit reversal?

When the patient feels that a vocalization phenomenon is coming, which can be annoying at the level of social interaction, he replaces it with a movement of the hand, perhaps clenching his fist. Cognitive behavioral therapies act on the obsession-compulsion circuit, they help to improve attention. Also, lowering the patient’s stress and anxiety levels can reduce tics.

At what age of the child should we intervene?

It is preferable around 8-10 years. But first you can act through the parents with the so-called parent training. The child is not interested in tics. He tends to be impulsive, hyperactive with little attention. There are behavioral strategies to improve hyperactivity. It is also essential to lower family stress. The little one perceives the concern of the parents and gets in tension, while it is essential that there is a calm atmosphere in the family.


What advice can you give parents?

Repressive behaviors should be avoided, especially reprimands when the syndrome occurs. It is a mistake to say “no, you must not do this”, it only generates anxiety. We must live it in a serene way. It is certainly not Tourette who will hinder a successful working life or romantic relationships in adulthood. It is good for parents to have this awareness that they can pass on to their children. If there is serenity, the path becomes simpler.


Tourette’s syndrome does not arise from psychological causes

Scientists are still studying the causes of this syndrome. “It is believed to be the result of a complex interaction between environmental factors and genetic abnormalities in the development, in developmental age, of certain areas of the brain that control movement,” explains our expert. “And there is often a familiarity. So many genes contribute to brain development, and when something goes wrong this can result in the inability to control involuntary movements. However, there are no psychological causes. Some parents explain tics as a child’s strategy to get attention: wrong. ‘