Tourette Syndrome (TS) is a neurological disorder characterized by tics - "involuntary," rapid, sudden movements that occur repeatedly in the same way. To receive a diagnosis of TS a person must have both multiple motor and one or more vocal tics, not necessarily simultaneously, throughout a span of more than one year. The tics may occur many times a day (usually in bouts) nearly every day or intermittently. Tics periodically change in the number, frequency, type and location and wax and wane in their severity. Symptoms can sometimes disappear for weeks or months at a time. While most persons with TS have some control over their symptoms from seconds to hours at a time, suppressing them may merely postpone more severe outbursts. Tics are experienced as irresistible and (as the urge to sneeze) eventually must be expressed. Tics increase as a result of tension or stress and decrease with relaxation or concentration on an absorbing task.
Other symptoms include obsessions, compulsions, impulsions, and mood lability.
Co-morbid syndromes include Attention-deficit Hyperactivity Disorder, Anxiety Disorders including phobias, Separation Anxiety Disorder, Panic Disorder, and Mood Disorder including Unipolar (depression) and Bipolar (Manic Depression) Affective Disorder.
Attention-Deficit/Hyperactivity Disorder (ADHD)
Hyperactivity with or without Attention Deficit disorder (ADHD) occurs in many persons with TS, approximately 60%. Children may show signs of hyperactivity before TS symptoms appear. Adults may exhibit signs of ADHD such as overly impulsive behavior and concentration difficulties.
The cardinal features of ADHD include: poor concentration, impulsivity, and hyperactivity. Subtypes include: Predominately Inattentive Type, and the Predominately Hyperactive-Impulsive Type.
- Often fidgets with hands or feet or squirms in seat
- Has difficulty remaining seated when required to do so
- Is easily distracted
- Has difficulty waiting turn in games or group activities
- Often blurts out answers to questions before they have been completed
- Has difficulty following through on instructions from others
- Has difficulty sustaining attention in tasks or play activities
- Often shifts from one uncompleted activity to another
Movement and Psychological Definitions:
Tics: rapid, repetitive, stereotyped motor movements or vocalizations. Tics run the spectrum from involuntary to more compulsive-like (voluntary); tics can be suppressed, usually abate during sleep. A division occurs into simple and complex tics. There also seem to be "sensory tics."
Examples:
- Simple motor tics: eye blinking, grimacing, puckering
- Complex motor tics: touching, shouting, combinations of movements
- Simple vocal tics: barks, coughs, grunts, squeaks
- Complex vocal tics: words and phrases, coprolalia
Obsessions: are stereotyped, irresistible thoughts, ideas, images, that produce anxiety, and are "intrusive" into the patient's thinking. These obsessions are recognized as senseless; also recognized as the person's own thoughts. Attempts are made to suppress and control the obsessions.
Examples:
- contamination - obsessions about germs, chemicals, and other contaminants;
- disease - obsessions about a skin disorder or AIDS
- sexual - fears of aggressive sexual impulses towards others or self
- harm - obsessions about harming self, or others (typically children or spouse)
- doubting reality - fears of tainted perceptions that may lead to disaster
- or death, doubting one locked the doors or turned off the stove burners, or
- fearful one hit a pedestrian
- "just right" obsessions.
Compulsions: voluntary, often irresistible actions/behaviors usually in response to an obsession, that relieves stress or is meant to prevent something bad (like contamination) from happening. The patient recognizes these compulsions as excessive or unreasonable.
Examples:
- skin picking/hair pulling - response to itching or skin obsession;
- hand washing, wearing gloves - responses to contamination obsessions;
- touching self, others, or objects - haphemania;
- checking locks - response to "doubting" obsessions;
- hoarding objects
- perfectionistic obsessions.
Chorea: quick, irregular movements of extremities (mostly distal); not as stereotyped or repetitive as tics. Choreaform movements are associated with caudate degeneration or inflammation.
Examples:
- Sydenham's Chorea;
- Huntington's Chorea
Athetosis: writhing, twisting movements of extremities.
Examples:
- Huntington's Disease;
- Wilson's Disease (hepatocerebral degeneration).
Tremor: rapid rhythmic vacillating movements of limbs.
Examples:
- pill rolling tremor at rest (Parkinson's Disease);
- essential tremor; (also known as familial tremor)
Ballism: rapid thrusting of arm.
Example:
- hemiballism (due to countra-lateral subthalamic damage)
Dystonia: sustained spasm of muscle contractions; between spasms muscle tone is normal; acutely, often caused by medications: neuroleptics such as Haldol, even Reglan, or Compazine.
Example:
Myoclonus: sudden fast muscle movements; groups of muscles.
Example:
- myoclonic jerks during sleep; (caused by tricylic antidepressants)
Dyskinesias: generic term for abnormal movements.
Examples:
- Tardive Dyskinesia: oral-boccofacial movements seen with neuroleptic use (Haldol); can be tic-like, or produce tremors;
- Acute dyskinesias;
- Extrapyramidal movements such as torticollus, oculo-gyric crisis, Parkinsonian movements, akathesia (restlessness)
Self-injury (self-abuse): self inflicted injuries including lacerations, bruises (needle sticks, etc); range from wrist cutting, to skin/scab/nose picking; instrument injury; genital mutilation; head banging.
Examples:
- head banging (Autism, Tourette's, Mental Retardation);
- skin picking (OCD);
- self-inflicted infections (Personality Disorders, Factitious Disorder - Munchausen's - and Munchausen's by Proxy, malingering)
If you have questions or comments, you may contact 
Jim Eisenreich