GILLES DE LA TOURETTE SYNDROME
Gilles de la Tourette syndrome is a disease in which simple tics occur transiently in up to 25% of children, remit within week to months and does not required treatment.
Motor tics are the initial manifestation in 80% of cases and commonly involve the face and 20% have initial symptoms of phonic tics. Tics are preceded by an urge that is relieved by doing movement or vocalization, they are temporarily supressed but eventually the urge becomes overwhelming.
Motor tics are occur likely in head, face, and shoulders (blinking, sniffing, frowning). Phonic tics consist of hisses, barks, grunts, throat clearing, coughs. But sometimes verbal utterances in which coprolalia or obscene speech are also occur.
There may also a echolalia (repetitions of speech of others), palialia (repetitions of words and phrases), echopraxia (imitation of movement of others). Some tics are self mutilating such as hair pulling, nail biting, and biting of tongue and lips. The disorder is chronic and but course may be punctuated by relapse and remissions.
Attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD) are commonly associated.
Examination reveals no abnormalities other than the tics. The diagnosis of disorder is delayed for many years, the tics interpreted as psychiatric illness or in some form of abnormal movement.
TREATMENT
Gilles de la Tourette syndrome treatment is symptomatic and need to be continued indefinitely. Behavioral therapy and habit reversal therapy can be effective alone or in combination with pharmacotherapy.
Alpha adrenergic agonists such as clonidine, guanfacine, are the first line therapy because of favorable side effects as compared to typical antipsychotics. They also have advantages of improving the symptoms of Attention deficit hyperactivity disorder (ADHD).
The atypical antipsychotic risperidone is more effective than placebo to control tics and more effective in improving symptoms of comorbid Obsessive compulsive disorder (OCD).
When typical antipsychotics is required in cases of severe tics, haloperidol is the drug of choice.
Injection of botulinum toxin type A at the site of most distressing tics is sometimes worthwhile and negligible side effects than systemic antipsychotic drugs therapy.
For Informational purpose only. Consult your Physician for advice.
