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Tourette syndrome (also called Tourette’s syndrome, Tourette’s disorder, Gilles de la Tourette syndrome, GTS or, more commonly, simply Tourette’s or TS) is an inherited neuropsychiatric disorder with onset in childhood, characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic; these tics characteristically wax and wane. Tourette’s is defined as part of a spectrum of tic disorders, which includes transient and chronic tics.
Tourette’s was once considered a rare and bizarre syndrome, most often associated with the exclamation of obscene words or socially inappropriate and derogatory remarks (coprolalia). However, this symptom is present in only a small minority of people with Tourette’s.[1] Tourette’s is no longer considered a rare condition, but it may not always be correctly identified because most cases are classified as mild. Between 1 and 10 children per 1,000 have Tourette’s;[2] as many as 10 per 1,000 people may have tic disorders,[3][4] with the more common tics of eye blinking, coughing, throat clearing, sniffing, and facial movements. People with Tourette’s have normal life expectancy and intelligence. The severity of the tics decreases for most children as they pass through adolescence, and extreme Tourette’s in adulthood is a rarity. Notable individuals with Tourette’s are found in all walks of life.[5]
Genetic and environmental factors each play a role in the etiology of Tourette’s, but the exact causes are unknown. In most cases, medication is unnecessary. There is no effective medication for every case of tics, but there are medications and therapies that can help when their use is warranted. Explanation and reassurance alone are often sufficient treatment;[6] education is an important part of any treatment plan.[7]
The eponym was bestowed by Jean-Martin Charcot (1825–93) on behalf of his resident, Georges Albert Édouard Brutus Gilles de la Tourette (1859–1904), a French physician and neurologist, who published an account of nine patients with Tourette’s in 1885.
Tics are sudden, repetitive, stereotyped, nonrhythmic movements (motor tics) and utterances (phonic tics) that involve discrete muscle groups.[8] Motor tics are movement-based tics, while phonic tics are involuntary sounds produced by moving air through the nose, mouth, or throat.
Tourette’s is one of several tic disorders, which are classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM) according to type (motor or phonic tics) and duration (transient or chronic). Transient tic disorder consists of multiple motor tics, phonic tics or both, with a duration between four weeks and twelve months. Chronic tic disorder is either single or multiple, motor or phonic tics (but not both), which are present for more than a year.[8] Tourette’s is diagnosed when multiple motor tics, and at least one phonic tic, are present for more than a year.[9] Tic disorders are defined similarly by the World Health Organization (International Statistical Classification of Diseases and Related Health Problems, ICD-10 codes).[10]
Although Tourette’s is the more severe expression of the spectrum of tic disorders,[11] most cases are mild.[12] The severity of symptoms varies widely among people with Tourette’s, and mild cases may be undetected.[8]
Tics are movements or sounds “that occur intermittently and unpredictably out of a background of normal motor activity”,[13] having the appearance of “normal behaviors gone wrong”.[14] The tics associated with Tourette’s constantly change in number, frequency, severity and anatomical location. Waxing and waning—the ongoing increase and decrease in severity and frequency of tics—occurs differently in each individual. Tics also occur in “bouts of bouts”, which vary for each person.[8]
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