Diagnosis of Tourette's Syndrome

Tourette's disorder is named after Gilles de la Tourette, a french neurologist who was a student of Charcot. He worked as his resident in Salpetriere, Paris. Charcot named this disease for his resident when Tourette published a case series of nine patients with Tourette's syndrome. Previously thought to be rare, it is now thought to be a spectrum disorder with neuropsychological sequelae. Incidence ranging from 1-10 per 1000. Tourette's is a disorder which poses as many different things and is usually misdiagnosed with many things before it is correctly diagnosed. The DSM IV TR criteria for Tourette's are:

A. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently. (A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.)

B. The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.

C. The onset is before age 18 years.

D. The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington's disease or post viral encephalitis).

As per criteria it is useful to screen patient's for tics but sometimes it is also useful to keep a flexibility to go the opposite way, i.e, look for a particular type of a personality and then look for tics. The typical tourette's personality reflects the development of individuals in a certain way. Individuals with Tourette's have problems with inattention, hyperactivity, anxiety symptoms, obsessive thoughts, compulsive actions, stubbornness, mood swings and tics. The development of Tourette's children is probably parallel to the development of a child without Tourette's because of the fact that people with Tourette's can be found in all walks of life.

Some people call the associated features of Tourette's as co morbid diagnoses. Anxiety disorders, ADHD especially inattentive type and Cyclothymia vs Bipolar can be seen. So searching for tics once seeing a constellation of symptoms as above can be helpful.