Tourette's disorder is a neuropsychiatric disorder characterised by motor and vocal tics, which may be associated with obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD). Tourette syndrome is a neurological disorder that develops in childhood or adolescence in which patients have involuntary tics involving sudden movements or vocalizations that are rapidly repeated. The symptoms usually occur several times a day, every day or intermittently and are usually mild, but can be severe. The condition is believed be to associated with many genetic and environmental factors.
Tourette's Syndrome Treatment
Although the neurochemistry of Tourette's disorder is not well known,
there are some effective therapies for tics, OCD and ADHD. However, these are
not devoid of adverse effects. Tics only require treatment when they interfere
with the functioning of the patient. If therapy is needed, monotherapy at the
minimal effective dose is desirable, but some patients may require two or more
drugs. The most frequently used drugs for tics are antipsychotics (mainly
pimozide and haloperidol) and clonidine.
Additional drugs that may be looked at include atypical
antipsychotic drugs (risperidone, olanzapine, clozapine, ziprasidone) and other
dopaminergic drugs (fluphenazine, sulpiride, tiapride, metoclopramide,
piquindone, tetrabenazine), clonazepam, calcium channel antagonists, botulinum
toxin, dopamine agonists, selegiline, and other drugs. The drugs of choice for
OCD in patients with Tourette's disorder are the selective serotonin reuptake
inhibitors (SSRIs), although the tricyclic antidepressant clomiplamine, which
inhibits both serotonin and noradrenaline uptake, has also been found to be
useful. ADHD can be treated with some psychostimulants, mainly methylphenidate,
although these drugs must be used with caution. Other potentially useful drugs
for the treatment of ADHD in patients with Tourette's disorder are clonidine,
guanfacine, selegiline, some tricyclic antidepressants, sertraline, pimozide and
clonazepam.
Additional Tourette's Syndrome Treatment options
More research is needed on nonpharmacological therapies (hypnotherapy,
biofeedback, conductual therapies, electroconvulsive therapy, acupuncture and
surgery).
Tourette's Syndrome Symptoms
The most common Tourette's syndrome symptoms are motor tics such as forceful eye
blinking. Vocal tics, which are repetitive involuntary stereotyped
vocalizations, are usually unintelligible sounds, such as sniffing, grunting or
throat clearing, but they can also be complex, such as uttering whole phrases.
Complex motor tics can occur, such as bending over and touching the ground.
Many people have come across in a public situation where they
noticed someone swearing in an inappropriate way that seemed to be out of their
control. This is called coprolalia. Other involuntary motor or vocal tics
include copropraxia (involuntary obscene gestures), echolalia (involuntary
repetition of speech of others), and echopraxia (involuntary imitation of the
actions of others).
Cause of Tourette's Syndrome
Women who smoke during pregnancy appear to have a very strong risk of
having a child with severe symptoms of Tourette's syndrome and the risk of
having obsessive-compulsive disorder is also increased in these children.
Reductions in oxygen in the womb, a known effect of smoking, could increase the
risk of developing Tourette's syndrome in those with a genetic susceptibility.
Tourette's Syndrome Research
Update
Nutritional supplements and complementary/alternative medicine in Tourette
syndrome.
J Child Adolesc Psychopharmacol. 2004 Winter;14(4):582-9.
Tourette syndrome (TS) is a neuropsychiatric disorder associated with
motor and vocal tics. Some people with TS have reported using alternative or
complementary medicine (CAM), including nutritional supplements to control their
tics. In a recent national survey, approximately 40% of people reported having
used CAM in the prior year. We attempted to explore the use of supplements and
other CAM among TS patients. METHOD: We developed a survey instrument based on
anecdotal accounts of CAM use and distributed it to the mailing list of the New
York Chapter of the Tourette Syndrome Association (n=500) and the subscription
list of Latitudes, a newsletter exploring CAM treatments for neurological
conditions (n=750). Responses were entered in a database and analyzed using SPSS
version 10. Of 115 respondents, 87.8% reported using 1 or more of 29
nutritional supplements to control symptoms. Many also reported using other CAM.
Most supplement users reported an improvement in tics. CONCLUSIONS: Although
these results are not generalizable, they provide no evidence that use of
supplements and other CAM is rarer among TS patients than in the general
population. Given that most of our respondents were also using conventional
medication, further study of the use of supplements and other CAM therapies by
people with Tourette Syndrome, the safety and efficacy of such therapies in this population,
and possible interactions of such therapies with conventional treatment seems
warranted.
Cannabinoids reduce symptoms of Tourette's syndrome.
Expert Opin Pharmacother. 2003 Oct;4(10):1717-25.
Currently, the treatment of Tourette's syndrome is unsatisfactory.
Therefore, there is expanding interest in new therapeutical strategies.
Anecdotal reports suggested that the use of cannabis might improve not only
tics, but also behavioural problems in patients with Tourette Syndrome. A single-dose,
cross-over study in 12 patients, as well as a 6-week, randomised trial in 24
patients, demonstrated that Delta9-tetrahydrocannabinol (THC), the most
psychoactive ingredient of cannabis, reduces tics in Tourette Syndrome patients. No serious
adverse effects occurred and no impairment on neuropsychological performance was
observed. If well-established drugs either fail to improve tics or cause
significant adverse effects, in adult patients, therapy with Delta9-THC should
be tried. At present, it remains unclear whether herbal cannabis, different
natural or synthetic cannabinoid CB1-receptor agonists or agents that interfere
with the inactivation of endocannabinoids, may have the best adverse effect
profile in Tourette Syndrome.
Tourette's Syndrome questions
Q. I have a grandson that just turned 10 years old. About two years ago, he
started this uncontrollable eye blinking from time to time. His mom & dad
thought it was just from him playing video games on the computer too much. Since
then, about a year ago he started making throat clearing and grunting sounds
from time to time. His dad did some research and talked to some people and they
suggested that he had tics, or tourettes syndrome. Since school has started (two
months ago) he has wet his pants at school on a regular basis and not having any
idea he's doing this. I feel reasonably certain he has tourettes also and it
seems to me that it's getting worse. I have read that serotonin and dopamine
deficiencies may contribute to this disease. Can you tell me what I need to get
for this little boy to see if we can increase his serotonin and dopamine levels
and also if you may be able to tell me if sugar and a diet high in carbohydrates
can affect this. He eats sugar and bread like it's going out of style and is
skinny and has too much energy. I, like his dad, am very worried about him. Many
of the doctors nowadays want to cripple people with the psychiatric and
psychotic drugs and I don't want that for this boy. Can you help me?
A. We don't have much experience with Tourette's
syndrome and natural supplements at this point to make any recommendations.
Q. I wanted to share my experience with Tourette's Syndrome. At 5, our son began displaying typical Tourette's Syndrome symptoms - head bobbing, licking, smelling everything, throat noises, humming, etc. Of course we were devastated, but didn't want to rush into drugs, as the options were not good. My husband started to remember incidents from his childhood, and came to realize that he and his brother had displayed many of the same symptoms, but no longer did. We began to notice that our son's symptoms became worse at particular times of year, and suspected that seasonal allergies played a role. We discussed this with our wonderful pediatrician, who advised us that Tourette's Syndrome is a description of a collection of symptoms, not a disease, and that allergies was as good an explanation as any. We treated the allergies, and the symptoms all but disappeared. As a teen, he still has small compulsions - jumping up and touching the ceiling, bouncing his leg - but nothing seriously detracting from his life. We've sense discovered that other doctors aren't nearly so imaginative or open minded.
Q. Does
5-htp treat Tourette's Syndrome?
A. I don't have any experience with this supplement and Tourette's syndrome.
Q. I am very curious if you have any testimonials, or
opinions, on the product
tryptophan on helping with Tourette's syndrome.
A. We have not had any testimonials regarding the effectiveness of
tryptophan for Tourette's syndrome.
Q. I recently read where Carnitine may help Tourette
Syndrome children. Do you know anything about this? Any data at all? Would it be
just Carnitine or the Acetyl-Carnitine Supplement?
A. We did a Medline search in Nov 2007 and did not find any
research regarding carnitine, acetyl-l carnitine, and Tourette syndrome.
Q. My son was cured of Tourette's nearly two years ago.
He was severely affected, having motor tics from head to toe, echolalia,
screams, barks, throat sounds, squeaks, you name it. He became symptomatic at
age 6. He is now 8 1/2. He was treated with nystatin and diet change. We
attribute the explosion of symptoms to repeated long term antibiotic use as well
as use of steroid medication around the same time. He again became symptomatic
during treatment with antibiotics one year later, but symptoms resolved with
nystatin treatment entirely. Here is a full report:
My son is not the only child to be successfully treated this way.
Another mom in Canada had a son with Tourette's syndrome who recovered without
other meds. Another mom in NY has just started nystatin on her son, as well as
diet, and for the first time in years he has gone days at a time with few or no
tics. He has only been on treatment for less than one week! Here is my son's
full history:
CM, now 8 years of age, had initial onset of motor tics in June, 2004. He was
being aggressively treated for chronic allergic sinusitis and tonsillitis (since
age 2) with repeated courses of antibiotics as well as steroid medications
including prednisone. Motor tics included severe and painful trunk-twisting and
shoulder shrugging. Motor tics gradually subsided within three weeks. Cory's
second onset of motor tics was in April, 2005 when he was dealing with severe
allergies and tonsillitis again. For months previous to this, he was treated
aggressively with antibiotics and steroid medications. Motor tics began in his
face, then spread to shoulders, torso, and legs. About four weeks after motor
tics began, vocal tics began. Vocal tics included throat noises, squeaks, barks,
screams. Echolalia was severe. Cory had developed comorbid symptoms including
severe rage attacks, severe OCD, and extreme anxiety. Cory had a lifelong
history of sinusitis, ear infections, tonsillitis, eczema, unexplained rashes,
unexplained very high fevers. He also had a lifelong history of night sweats. By
July, 2005 Cory had been diagnosed with Tourette's syndrome and we were informed
that due to the severity of motor and vocal tics he would require medication in
order to function at school. His tics and OCD were so severe that he was a
danger to himself out in public, as he would impulsively jump into traffic if
walking near a street or in a parking lot. His screams prevented him from
socializing at all. We were advised to look for an alternative educational
setting for Cory to attend third grade. On July 1, 2005 we took Cory to Bruce
Semon, M.D. who has a private practice in Wisconsin. Dr. Bruce Semon confirmed
what I suspected since my son was two years old, namely that he had yeast
overgrowth from constant antibiotic use. Dr. Semon prescribed nystatin, provided
a careful dosing schedule, and instructed us to begin a yeast elimination diet.
This diet involved removing all products containing malt, all products of
fermentation, certain fruits, white bread and cheddar cheese. His complete diet
is outlined in a book he published titled Feast Without Yeast and his dietary
recommendations are based on his own research as well as other published
research. This research and references are published in his first book, An
Extraordinary Power to Heal. We feel that dietary changes were crucial to
beating this, but also feel that nystatin made it possible. Cory's motor tics
are described as:
repetitive eye movements that resembled looking to the side of the head and then
upward
cranking head back and sideways simultaneously
lifting shoulders one at a time to ears, or together
repetitive touching of opposite shoulders with the hands (every 3 seconds)
twisting the torso in one direction while shrugging shoulder
repeatedly arching his back
repeatedly stepping backward with one foot, or hopping backward with both feet
while walking (every four to ten steps taken)
Vocal tics are described as:
loud bark or scream lasting 1/4 second, in one pitch (every minute or less)
repeated words that were heard on t.v. or heard in a crowd (every few seconds)
repeated throat clearing or grunting noise (every few seconds)
repeated humming sound that would rise in pitch and drop again ( every four
seconds)
Treatment and outcome:
Cory was treated with oral nystatin starting in mid July, 2005. Elimination diet
was started immediately. Within two weeks many of Cory's vocal tics were gone,
having gradually subsided in volume and frequency. Within four weeks most of
Cory's motor tics had subsided. By the middle of August Cory had motor tics that
were barely noticeable and no vocal tics. Cory was enrolled in the public school
we intended to send him to before his illness, and by the start of school
September 7th all symptoms had resolved. A few related conditions took a bit
longer to clear up, namely constipation and encopresis, anxiety, and some signs
of OCD. By December, 2005 he had none of anxiety or OCD seen before. Related
chronic illnesses that also resolved simultaneously:
tonsillitis (became life threatening at one point) but they advised against
surgical removal
chronic sinus infection
eczema
frequent stomach pain and nausea (after nearly every meal!)
night sweats (these he had without a break from the age of about two years)
night terrors (almost nightly, since the age of three years)
Recent episode:
in April, 2006 following a course of broad spectrum antibiotics, some mild motor
tics started up again oral nystatin was started immediately all symptoms
resolved after about four weeks of nystatin and dietary restriction of sugar and
complex carbohydrates treatment was continued as precaution for another few
weeks no symptoms since treatment
A. Very interesting, we find it difficult to believe that nystatin
would cure Tourette's, but we will await other reports.