Tourette’s syndrome is a neurological disorder characterized by repetitive, involuntary movements and vocalizations called tics. Tics can include eye blinking, facial grimacing, shoulder shrugging, and throat clearing, among many others. People with Tourette’s often make sounds or words against their will during tics.
Tourette’s symptoms usually begin between the ages of 5 and 18 and occur in bouts. Tics tend to worsen during periods of stress or excitement and improve with relaxation or concentration on an engaging task. While there is no cure for Tourette’s, various treatments can help manage symptoms. A neurologist is a medical doctor who specializes in disorders of the nervous system, including Tourette’s, and can provide comprehensive care.
Diagnosing Tourette’s
A neurologist conducts a thorough evaluation to diagnose Tourette’s syndrome. They will perform a physical exam and take a detailed history of symptoms. Important aspects of the history include:
- Age of onset and progression of tics over time
- Location, frequency, and type of motor and vocal tics
- Triggers that worsen tics
- Whether tics disappear during sleep
- Presence of comorbid conditions like ADHD or OCD
- Family history of tics or related disorders
There are no blood tests or imaging studies to diagnose Tourette’s. The diagnosis is based on clinical criteria. To meet diagnostic criteria for Tourette’s, a person must have:
- Multiple motor tics and at least one vocal tic
- Tics that occur many times a day, nearly every day for more than one year
- Onset before age 18
- Tics not caused by medications or other medical conditions
Assessing Severity
After making a diagnosis, the neurologist will assess the severity of tics. Several rating scales exist to measure tic severity. These scales evaluate factors like:
- Frequency, intensity, complexity, and interference of tics
- Severity of associated behavioral symptoms
- Level of distress experienced by the patient
Tracking tic severity over time provides crucial information about whether treatment is working. The neurologist may periodically re-assess severity and adjust therapy accordingly.
Investigating Comorbidities
Many people with Tourette’s also have co-occurring psychiatric, behavioral, learning, or sleep disorders. Common comorbid conditions include:
- Attention deficit hyperactivity disorder (ADHD)
- Obsessive compulsive disorder (OCD)
- Anxiety and depression
- Autism spectrum disorder
- Sleep disturbances
The neurologist thoroughly investigates for any comorbidities, as treating them can improve quality of life. Treating ADHD and OCD, for example, may indirectly improve tics.
Ordering Additional Tests
In some cases, the neurologist may order imaging or laboratory tests to identify any underlying brain abnormalities causing tics. Tests can include:
- MRI of the brain
- EEG to measure brain wave activity
- Blood tests to check hormone, immune system, and metabolic function
- Genetic testing in specialized cases
- Neuropsychological testing to assess learning disorders
For most patients, tests are not necessary to make a Tourette’s diagnosis. But testing may provide clues about prognosis and guide treatment in complex cases.
Educating the Patient and Family
The neurologist plays a key role in educating patients and families about Tourette’s syndrome. They explain:
- The neurological basis of tics
- Why tics wax and wane over time
- How Tourette’s is manageable with proper treatment
- Potential medication side effects
Education reduces stigma and empowers patients to take an active role in care. Support groups and reputable websites can provide additional resources.
Exploring Medication Options
Medications may be appropriate for patients with moderate-to-severe tics or tic-related impairment. The neurologist has expertise in choosing and prescribing appropriate medications. Options include:
- Alpha-agonists like clonidine or guanfacine
- Antipsychotics like risperidone, aripiprazole, or haloperidol
- Botulinum toxin injections for localized tics
- ADHD or OCD medications if warranted
The neurologist monitors for medication side effects and efficacy using tic rating scales. Doses are adjusted to balance optimal tic control against side effects.
Considering Behavioral Interventions
The neurologist may recommend behavioral therapy to help patients manage tics. These interventions include:
- Comprehensive Behavioral Intervention for Tics (CBIT): In CBIT, patients learn to recognize tic triggers and substitute competing motor behaviors to voluntarily suppress tics. It also incorporates relaxation techniques.
- Exposure and Response Prevention (ERP): ERP is effective for OCD symptoms in some Tourette’s patients. It involves gradual exposure to OCD triggers to reduce compulsive behaviors.
- Cognitive Behavioral Therapy (CBT): CBT aims to improve coping strategies for Tourette’s symptoms.
The neurologist collaborates with mental health professionals like psychologists to facilitate behavioral treatment.
Ordering Physical and Occupational Therapy
For significant tic-related pain or physical impairment, the neurologist may prescribe physical or occupational therapy. Goals of therapy include:
- Strengthening and stretching exercises to improve mobility
- Relaxation techniques
- Strategies to prevent injury during forceful tics
- Ergonomic modifications at school or work
Therapy enhances physical functioning, safety, and quality of life for Tourette’s patients.
Coordinating Care and Follow-Up
Caring for Tourette’s patients involves a multidisciplinary approach. The neurologist coordinates care between the patient’s:
- Primary care doctor
- School and specialists like therapists or psychologists
- Other medical specialists if comorbidities exist
Ongoing follow-up is important to monitor tic severity, adjust treatment, and provide support. Follow-up frequency varies based on symptom severity. More frequent follow-up is needed during med changes. Periodic follow-up continues into adulthood, as tics often improve by early adulthood.
Improving Quality of Life
While there is no cure for Tourette’s, neurologists aim to help patients live full, enriching lives. Optimizing tic management improves overall wellbeing. With proper treatment, most Tourette’s patients can expect to:
- Achieve good control of tics and related symptoms
- Participate fully in school, work, and social activities
- Have strong self-esteem
- Find support through advocacy organizations
With the neurologist’s help, patients can learn to thrive with Tourette’s.
Conclusion
Neurologists play a vital role in managing Tourette’s syndrome. They accurately diagnose Tourette’s, assess symptom severity, investigate comorbidities, and initiate treatment. Treatment options overseen by a neurologist include medications, behavioral interventions, physical/occupational therapy, and comprehensive care coordination. With proper treatment tailored to the individual, neurologists can greatly improve quality of life for Tourette’s patients. Multidisciplinary care from a neurologist leads to better outcomes and helps Tourette’s patients live fulfilling, productive lives.
