None — Tourette Syndrome
Tourette Syndrome is a neurological condition characterized by involuntary movements or vocalizations, called tics. Examples of motor tics include eye blinking, shoulder shrugging and facial grimacing. Vocal tics can include sounds like throat clearing, tongue clicking, shouting or barking. Fewer than 15 percent of patients with Tourette syndrome have coprolalia, or uncontrolled utterances of ethnic slurs, cursing or profanity. Tics may be further classified as simple (sudden and brief, involving a small number of muscle groups) or complex (distinct patterns of movement that involve several muscle groups).
The Tourette Syndrome Association estimates about 200,000 people in the U.S. have the condition. Males are affected three to four times more often than females. It's ten times more common in children than in adults. The average age of onset of symptoms is between 7 and 10. Some patients say they experience an unusual urge or sensation before the onset of a tic, called a premonitory urge.
Treating Tourette Syndrome
The majority of patients with Tourette Syndrome have mild symptoms that don't require any specific treatment. Patients with more severe symptoms (those that interfere with daily function) may be treated with medications, most commonly neuroepileptics. There isn't one medication that works for everyone. In addition, the drugs can have side effects, like sedation, weight gain, tremor and Parkinson-like movements.
In many cases, the severity of Tourette symptoms decreases over time. By the third decade, symptoms are often greatly improved or may disappear.
Deep Brain Stimulation
Deep brain stimulation (DBS) is a technique that provides direct electrical stimulation to target areas of the brain to produce changes in abnormal brain activity. The technique is approved by the FDA for treatment of some patients with Parkinson's disease, essential tremor, dystonia and obsessive compulsive disorder.
Research suggests DBS may be helpful for patients with severe or disabling tics who don't respond to standard treatment. Alon Mogilner, M.D., Ph.D., Neurosurgeon with Harvey Cushing Institutes of Neuroscience in Great Neck, NY, says CT scans and MRI scans are used to develop a roadmap for the brain. Then, during surgery, an electrode is used to stimulate specific areas of the brain. Surgeons listen to the electrical activity coming from the target area and watch to see the effects of stimulation on the body. This process helps to ensure the probe is targeting the correct site, without producing any unwanted side effects.
The second component to the DBS system is a pulse generator, which is generally implanted beneath the skin in the area under the collarbone (or sometimes in the abdomen). A cable from the pulse generator is run under the skin up to the implanted electrode in the brain.
Mogilner says after surgery, doctors wait about two to four weeks to turn on the pulse generator. The settings can be adjusted and fine-tuned to provide optimal treatment results. Patients generally have follow-up visits every three to six months to make sure the treatment is working as planned and make any necessary adjustments in stimulation.
Currently, DBS is still an experimental treatment for Tourette syndrome. More research needs to be done because the treatment works for some people, but not others. Implantation of the DBS components can increase the risk for infection, bleeding or stroke. If there is any malfunction or breakage of the equipment, more surgery may be required to remove or replace the system.
For information on Deep Brain Stimulation (DBS) for Tourette syndrome, visit the registry page.
For general information on Tourette Syndrome: National Institute of Neurological Disorders and Stroke Tourette Syndrome Association
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