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Tourette Syndrome





Tourette's Syndrome:
A review of Biological, Biochemical, Neurological
and Environmental Factors

Symptoms of Tourette's Syndrome:

Eyes/face/mouth: blinking, eye rolling, facial twitching, grimacing, head turning, jerking chin, snapping jaw, clenching jaw, pushing jaw, spitting, teeth grinding, tongue protrusion

Words/sounds: coprolalia/swearing, echolalia, grunting, humming, laughing, screaming, shrieking, snorting, squeals, speech arrest

Limb/trunk movements: echopraxia/mimicry, flailing arms/flapping arms, fingers touch lips, hand goes to mouth, hand clapping, hand rubbing, head nodding, head thrusting backward, arching head & back, jumping, kicking, rocking, stamping, throwing self on floors/walls, twirling/rotation

self-injurious & aggressive movements: head thrust back/extending neck, head thrust forward/neck flexion, head banging, hitting self, picking own skin, scratching self, self-mutilation, slapping chest, tongue biting, aggression, hitting others

autonomic changes: crying, drooling, face turns blue, blowing air, whistling, great difficulty breathing/gasping, noisy breathing/hyperventilation, ictal urinary, incontinence/enuresis

other: temporarily suppress movements, unsuccessful at suppressing, pattern of involuntary movement changes over time, epigastric or umbilical sensation, feeling weird, feel nervous right before episode, tingling sensations

Areas of the Brain Involved:

-frontal lobe(s)
-middle and inferior portions of the frontal lobe bilaterally
-coprolalia correlated with hypometabolism in the left parasylvian region near the speech area in the frontal lobes
-repetitive utterances - the midbrain and diencephalon
-a midsagittal cross-sectional head area - the overall length of the corpus callosum was reduced in TS patients - the corpus callosum were less rounded than those of normal controls
-basal ganglia -a significant difference was found for measures of symmetry in the putamen and lenticular region
-significant differences for the volume of the left globus pallidus and for lenticular asymmetry were also found
-ventrical dilation
-prominent sylvian fissures or cortical sulci
-enlarged occipital horns of the lateral ventricles bilaterally
-large porencephalic cyst in right hemisphere involving right basal ganglia
-a small arachnoid cyst in the occipital region
-slight cortical atrophy

Neurochemical Systems Involved:

-lower serotonin (5-HT) and lower glutamate - three major areas of subthalamic nucleus
-major metabolite of serotonin
-5-hydroxyindoleacetic acid was abnormally low
-dopaminergic activity - low
-excessive dopamine






Diagnostic criteria for Tourette Syundrome

For a person to be diagnosed with TS, he or she must meet the following criteria: A.The person must have both motor tics (for example, blinking or shrugging the shoulders) and vocal tics (for example, humming, clearing the throat, or yelling out a word or phrase), although they might not always happen at the same time.

B.The person must have had tics for at least a year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on, but there must not be a single tic-free period of more than 3 months.

C.The personís tics must begin before he or she is 18 years of age.

D.The personís symptoms must not be due to taking medicine or other drugs or to having another medical condition (for example, seizures, Huntington disease, or postviral encephalitis).

Chronic Motor or Vocal Tic Disorder
For a person to be diagnosed with a chronic tic disorder, he or she must meet the following criteria: A.The person must have one or more motor tics (for example, blinking or shrugging the shoulders) or vocal tics (for example, humming, clearing the throat, or yelling out a word or phrase), but not both.

B.The person must have tics that occur many times a day nearly every day or on and off throughout a period of more than a year. During this period, there must not be a single tic-free period of more than 3 months.

C.The personís tics must start before he or she is 18 years of age.

D.The personís symptoms must not be due to taking medicine or other drugs or to having a another medical condition (for example, seizures, Huntington disease, or postviral encephalitis).

E.The person must not have been diagnosed with TS.

Transient Tic Disorder
For a person to be diagnosed with this disorder, he or she must meet the following criteria: A.The person must have one or more motor tics (for example, blinking or shrugging the shoulders) or vocal tics (for example, humming, clearing the throat, or yelling out a word or phrase).

B.The person must have tics that occur many times a day, nearly every day or at least 4 weeks, but for no longer than 12 months in a row.

C.The personís tics must start before he or she is 18 years of age.

D.The personís symptoms must not be due to taking medicine or other drugs or to having another medical condition (for example, Huntington disease or postviral encephalitis).

E.The person must not have been diagnosed with TS or chronic motor or vocal tic disorder.




American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington, DC; 2000.


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