The History of Tourette syndrome

By Nelson Tang

What is Tourette syndrome? How common is it and how does it impact the lives of those who live with it? This article will answer such questions and more. It will take a look at the causes of Tourette syndrome as well as the signs and symptoms that are associated with it. It will also talk about the link it has with other disorders as those with Tourette syndrome may have other disorders depending on the severity. Moreover, it will go over the different kinds of treatment for this disorder and who George Gilles De La Tourette was and his contributions to the field. Lastly, it will go over the history and what has changed since the discovery in terms of what we know now and the advancements that were made over the years.

Tourette syndrome is a neurological disorder that may cause sudden involuntary or unwanted and uncontrolled rapid and repeated movements or vocal sounds known as tics. It falls under the group of disorders involving the developing nervous system called tic disorders. There are roughly more than 200,000 cases of it per year in the United States Studies. Data shows that Tourette syndromes affects males more than females as they are more likely to get it out of the two. It mainly affects an individual’s motor and vocal functions, which is what causes the tics and varies from person to person ranging from mild to severe. The main causes with most cases of Tourette syndrome seem to be the results of multiple gene variations and environmental factors. Studies showed that a small percentage of people with Tourette syndrome have mutations involving the SLITRK1 gene, which affects how neurons grow and connect with one another. Furthermore, it shows that abnormalities in the NRXN1 and CNTN6 genes, which are responsible for regulating the normal formation of these nerve connections, are factors. Despite there being no clear cause of the disorder, current research indicates and points towards specific abnormalities. These abnormalities can be seen in certain sections of the brain such as the basal ganglia, frontal lobes, and cortex, the circuits that connect these parts and the neurotransmitters, which are responsible for the communication between nerve cells. [3].

The main symptom of Tourette syndrome are tics and typically involves a combination of physical and verbal tics. These symptoms usually manifest between the ages of 2 and 14 years old with the average age being 6 years old. Physical tics include actions such as blinking, eye rolling, grimacing, shoulder shrugging, the jerking of one’s head or limbs, jumping, twirling, or touching objects and other people. Furthermore,vocal tics include actions such as grunting, throat clearing, whistling, coughing, tongue clicking, animal sounds, saying random words or phrases, repeating a sound, word, or phrase, or swearing. Contrary to popular misconceptions, swearing is quite rare and only affects 1 in 10 people with Tourette syndrome. When it comes to the tics, it varies as it can be worse on some days or increase during periods of stress, anxiety or tiredness.  There also appears to be strong urges in individuals before a tic is triggered. People with this disorder have also shown to have behavioral and mood problems such as anxiety or depression as well as other disorders such as attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD). [2].

When it comes to diagnosing Tourette syndrome, there is no single test for it. There are a number of tests and methods in finding out such as MRI scans. Patients are usually diagnosed if they have consistently had tics for at least a year. They can also see specialists such as a neurologist who specialize in the brain and nervous system for further diagnosis, testing, and evaluation. There is currently no cure for Tourette syndrome and it appears that treatment is not really needed for most children. It is really more about controlling one’s tics. Treatment includes medicine and behavioral or speech therapy. There are two types of behavioral therapy that are used, which are habit reversal training and exposure with response prevention (ERP). Habit reversal training involves finding out the feelings that trigger tics and finding alternatives in relieving the urges. ERP involves controlling urges,which may help in reducing the frequency of one’s tics. [2]. In some cases, the symptoms seem to just go away over time. 

Tourette syndrome is named after George Gilles de la Tourette, who discovered the condition. He was born in the small town of Saint-Gervais-les- Trois-Clochers, France in 1857. Not much is known about his childhood and early life. Tourette began his medical studies from 1873-1876 in Poitiers and Paris, France. Later, he began training under Dr. Charcot’s guidance at the Salpêtrière hospital where he studied various medical conditions such as hysteria and ataxia just to name a few. These were of interests to Dr. Charcot and he would later have Tourette focus on paroxysmal movement disorders, which are neurological illnesses characterized by sudden outbursts of emotion and/or action. It is here where Tourette perhaps first encountered what we know as Tourette syndrome.

He would publish his most famous work based on his observations of 9 individuals in an article that was  published in the January 1885 issue of the medical journal Archives de Neurologie. These patients had a condition that had various features, including childhood-onset, heritability, waxing and waning, stereotyped movements, premonitory sensation, echolalia and coprolalia. Tourette referred to it  as “maladie des tics.’ Prior to this, there have been recordings throughout history that may have indicated the same thing. One such curious case was in 1498 entitled “Maleus maleficarum (Witches hammer) published by Jakob Sprenger and Heinrich Kraemer, which described a priest who had motor and vocal tics. It was believed to be a result of possession or an exorcism.

After Tourette, there seemed to be a lack of interest in studying this disorder as research into other neurological disorders such as Parkinsons was more popular. However, it changed with the establishment of the National Tourette Syndrome Association in the US in 1972. There was a greater degree of interest during this period and has continued its work since then.[1]. Since its discovery, we now have a better understanding of Tourette syndrome and how to treat it and improve the quality of life of those affected by it. Work and research continues as a cure is yet to be found.

References:

[1]. “125 Years of Tourette Syndrome: The Discovery, Early History and Future of the Disorder.” Tourette Association of America, 19 Apr. 2016, tourette.org/resource/125-years-tourette-syndrome-discovery-early-history-future-disorder

[2]. NHS Choices, NHS, www.nhs.uk/conditions/tourettes-syndrome/

[3]. “Tourette Syndrome.” National Institute of Neurological Disorders and Stroke, U.S. Department of Health and Human Services, www.ninds.nih.gov/health-information/disorders/tourette-syndrome