Hello again, friends from the TS Chat Room! I will share some of my notes from the Medical Symposium....and they are JUST that... my notes, as I perceived the information... and therefore may be incomplete in some areas... please remember that and I do hope the info will be of some help to you.
BB
DR Jerry Erenberg, M.D. (chairman of the neuro. Advisory Board of the TSA
TS is affected by the following factors:
Genetic
Neurological
Psychological
Environmental
Phases in the "life" of TS
1885-Initially described by Gilles de la Tourette
1943-Rediscovered
1961-Use of Haloperidol began for TS
1960-psychiatric literature began to contain articles about TS
1970-Public press-neurologic literature and pediatric literature about TS
1980-Associated disorders-ADHD and OCD and Genetics were stressed
1977(prior to) CCF 2 reported cases Dxed with TS
1977 9 " " " " "
1978 50 " " " " "
1982 200 " " " " "
1997 1000 " " " " "
No objective way to diagnose----USE CRITERIA of DSM IV (see DSM IV for that criteria)
Incidence is aprox 1/2500 with a
Male/female 4/1 ratio
Less common in African Americans
Severity of TS = aprox 58% Mild , 36% Moderate and 5% Severe
ONSET is usually between 5 and 10 yrs. Of age and 90% or all Tser have had onset by 10 yrs of age.
Tourette's does NOT lead to Intellectual or Physical poor health....nor shortened life expectancy.
VERY IMPORTANT to make a Differential Diagnosis/ Movement disorders
Tics-
Tran. Simple
Chronic simple
Chronic motor or vocal
Chronic motor AND vocal
Genetics-
Autosomal dominant
Variable Expression
Sex specific transmission-manifestation of ticsM, F OCD manif
Etiology-
Dopamine
Too much
Too little
Hypersensitivity
Developmental Basal ganglia syndromes-
TIC disorders
OCD
ADHD
AUTISM/PDD
Sydenham's Chorea
TIC SEVERITY
1/3 to 1/2 of tsers from the age of 15 ys decline until age 22. Then at that age, the TIC SITUATION is more or less calculatable (It will usually remain at a comparable level from then on) BY THE END OF THE 4TH YEAR OF TIC-ING THE SEVERITY IS USUALLY A "MARKER" OF HOW SEVERE THE TICS WILL BE .
BEHAVIOUR DISORDERS = TS DR. John Walkup, M.D.-child psychiatrist
Comorbidity and Differential diagnosis of TS
Differential diagnosis can be approached in different ways....
LUMPERS or SPLITTERS...
Lumpers being those who believe that TS is central and the other comorbid disorders overlap
Splitters being those who believe that TS is just the motor =vocal tics and the others are separate
(COMPULSIONS, STEREOTYPIES, PERSEVERATIVE, SELF-INJURIOUS BEHAVIOUR-MANERISMS)
Sydenham's Chorea
Myoclonus
Tremor
Dystonia
Athetosis
Spasms
Dyskinesias
Genetic Disorders
TS
OCD
Some forms of ADHD (they speak of two types of adhd 1)onset after ts appeared 2)onset before the FIRST one appears TS related
DISORDERS COMMONLY SEEN COMORBID TO TS (depends where you are lumper or splitter?)
ADHD - OCD - LD's - Mood Disorders - Anxiety disorders
Tics + comorbid + MDD
Tics + comorbid + SAD
Tics + comorbid + PD + Agoraphobia
Tics + comorbid + BpolarAD
Tics + comorbid + PDD
Tics + comorbid + SA
Tics + comorbid +ODD/CD
Tics + Personality disorder
EXPLOSIVE ANGER
Easily conditioned behaviour
Associated with mood and anxiety
Cultural Factors (this was my impression at the moment ..as a mom of a Dr. Jeckyl and Mr. Hyde child...he hasn't experienced "rage" per se, yet...as did Dr.Cathy Budman, M.D. who is studying rage and views things more as we Parents may tend to view things relating to ragess or other explosive behaviours)
Secondary Behaviour Problems
CHILDREN with TS are more Dificult to Parent
Parents are uncertain
Children are less responsive to routien parenting interventions
"He can't control himself" is a common concept
TS as a Lifestyle
Emphasis on TS as a central identity
TS identity crisis
HISTORICAL COHORTS OF PEOPLE WITH TS
Undiagnosed = /or stigmatized adults with TS
Persons with TS from the neuroleptic era
Persons with TS who were told they could NOT Control themselves
It may be TS, but tics are not the Problem
Outcome is associated with severity of comorbid conditions and self control and the courage to Overcome adversity
