Considered syndrome belongs to neuropsychiatric disorders, which is widely researched in order to facilitate day-to-day lives of those, who suffer from it.
This essay concentrates on the history of Tourette’s syndrome, with detailed analysis of causes of its origin, especially stressing epigenetic causes. Main symptoms are briefly, but exhaustively listed, with the highlighting of unexpected, waxing and waning nature of Tourette’s syndrome. Special attention is paid to widespread ways of its treatment, defining their positive aspects and side effects. Furthermore, an analysis of contemporary scientific articles in this field is included in the work. Their critical summation gives an opportunity to estimate the level of development of modern scientific thought.
The wise balance between academic theory and practical reality is strictly preserved here, so essay is easy to read and informative to memorize. It may be useful for wide spectrum of people – from students to professors, from neuroscientists to those, who have common interest in different aspects of neuropsychiatric disorders.
Among various neuropsychiatric disorders the one, which is called Tourette’s Syndrome, takes special place. Its symptoms were estimates as signs of devil in times of scientific ignorance. Fortunately, nowadays numerous medical researches and psychological accomplishments allow explaining its origin from scientific point of view, presenting people with such syndrome a chance to cope with it.
The name of disorder itself has a narrative role, as it indicates on the clinical scientist – Georges Gilles de la Tourette, whose researches were the first one in such field. Briefly, Tourettes’ syndrome is a neurological condition, caused by malfunctioning of the brain, with genetic origin (it is commonly accepted, however, not absolutely proven), which is expressed in repeated display of vocal and motor tics (Olive & Levitt, 2010)
The possibility and role of such brain’s malfunctioning are explained by the scientific fact that every special brain area is responsible for accomplishment of a specific role, simultaneously “communicating” effectively with other, otherwise - any of a huge scientific list of disorders may easily affect a person. One of most known examples is Tourette’s Syndrome, which is displayed externally in a bit unpleasant way, however, does not usually cause irreversible changes.
Unfortunately, any mimic tics are sometimes misdiagnosed as Tourette’s syndrome, and vice versa – symptoms of this disorder may be interpreted as asthma’s symptoms, which, undoubtedly will tangle and complicate the treatment process. That is why, all main features of Tourette’s syndrome should be clarified in a proper way. It is accepted that Tourette’s syndrome is characterized by following criteria: 1) the presence of vocal, motor tics; 2) frequent exhibition of tics for more than a year; 3) shift of motor tic between parts of body over time; 4) the occurrence of symptoms before 18-year age; 5) there is no other medical explanation of tic (Olive & Levitt, 2010).
Returning back to the history, it is necessary to point out that Tourette’s syndrome does not belong to disorders, which emerged in last decades as inevitable conclusion of unfavorable ecologic situation, vicious behavior etc. In fact, such disorder has existed from the dawn of civilization, but its appropriate scientific and clinical evaluation has firstly taken place in the 20th century. Actually, two traditions – the neurological view of Gilles de la Tourette and the psychological one of Freud – have defined key directions of development of a thought in this field almost till nowadays (Leckman & Cohen, 1998).
However there is no absolute statement, which is understandable in the same way by the whole world and may explain the nature of Tourette’s syndrome, there is still the most widespread version that underlying cause of its emergence refers to epigenetic ones. This term means that disease is triggered by changes in the functioning of genome. The credibility of this particular theory is developed due to well-known twin studies, under which the deciding role of epigenetic factors is almost indisputable.
Having clarified its epigenetic nature, it is a high time to define main symptoms and external displays. It is the wisest to begin from the most easily interpreted symptom – a tic, which means that it is an isolated fragment of normal motor, vocal behaviors; or sudden, repetitive, stereotyped motor movement or phonic production that involve discrete muscle group (Leckman & Cohen, 1998). They are classified on motor ones, which are based on specific movements, and phonic, which include some vocal problems.
Stereotypical approach mistakenly considers that inappropriate utterance of obscene words actually is the main symptom of Tourette’s syndrome. In fact, such disorder considers very rare cases, and belongs merely to one of kinds of such disorder, being called coprolalia. Another kind – palilalia – is expressed in repeating of one’s words.
It is easily to understand that any display of Tourette’s syndrome at first glance may look like asocial and unattractive behavior, hence, narrow-minded people may easily mistreat those, who suffer from such disorder. Even if social environment is comparatively friendly, it is always a subject of an ill person’s fears and doubts, as it is rather difficult to control flashes of tics (often – impossible), which may display in any moment. Consequently, people suffering from severe forms of Tourette’s syndrome are likely to become social aliens, who would be discriminated for their allegedly inappropriate behavior, which in fact does not depend on their conscious will.
In most cases, Tourette’s syndrome expresses itself in a child age, with gradual weakening of symptoms. However, aforementioned symptoms may have looked as absolutely horrible and insuperably asocial, but in fact people with such diagnosis are usually accommodated and socially integrated, special treatment frequently allows minimizing negative displays.
On the other hand, tics are rather often supplemented by various disorders of different origin. For instance, children with Tourette’s syndrome often have a variety of comorbid psychopathologies, including attention deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder (OCD), learning difficulties, sleep abnormalities, anxiety, and other behaviors with a possible significant impact on the individual’s prognosis (Felling & Singer, 2011). It does not automatically mean that such people will have problems with analytical thinking etc, they usually are just prone to be more slow and uncertain, hence just their devoted work is empowered to change the situation in their favour.
Considering treatment strategies, it is necessary to understand that there is no panacea for all patients, everyone’s case is unique and demands special approach. The dose or set of medications, suitable for ones, may cause unpredictable side effects for others. At the same time some common approaches of treatment are ones of paramount importance to the universal welfare, as science needs general principles and algorithms, which will be able to be modified in any time.
The most general division of treatment directions’ is on medical, or pharmaceutical and behavioral, or psychological. The first category is more radical, as it prescribes actual influence on the organism, hence part of people without impairment do not use any drugs at all. Those, who decided to minimize adverse effects, frequently use neuroleptics, to side effects of which belongs wide spectrum of symptoms – from cognitive dulling to more serious and even hazardous, like parkinsonian-like symptoms. Any unexpected side effected is usually possible to uproot by reducing the dose of medicine.
The second approach of treatment is the behavioral one, key sense of which is in regular practicing (at first – under professional supervision, and then – by personal power). Such method is efficient not also for suppressing of tics, but also is proper for coping with emotional and social disturbances. The complexity of this approach is in its dependence on one’s power of will and desire to change and work hard. In addition, this method may be used as a supplementary for previously considered one, whereas sole application of behavioral concept is not a guarantee of success. As a result, the most recommended solution, which still cannot be regarded as the one and only way out, is the combination of two approaches, without any attempt to offend.
Researching on different aspects of Tourette’s syndrome includes getting acquainted with accomplishments of scientific thought in this very field. Actually, this issue is researched all over the world, when great neuroscientists, psychiatrists join their efforts in order to both formulate a generally recognized theoretical basis for Tourette’s syndrome and critically estimate every single hypothesis in order to verify its scientific credibility.
If take a closer look on contemporary scientific accomplishments in this sphere, current scientific articles turn out to be the most informative sources. For instance, article titled “Neurobiology of Tourette Syndrome: Current Status and Need for Further Investigation”, apart from brief description of symptoms, gives characteristic of clinical solutions – from behavioral to pharmacological approaches. Another considered aspect is the hypothesis of inherited character of disease, which is transmitted in genetic level.
The great scientific meaning of this article is gained due to specific investigation of Tourette’s syndrome on the basis of face and construct validity. Groundbreaking importance of considered article is in detailed description of structural and functional changes, which happen to the organism, affected by Tourette’s syndrome. To the first group belong changes that influence such brain regions as thalamus, basal ganglia and cortex white matter, whereas researching on functional changes has proven that biochemical defect may be recognized as underlying one.
Despite obvious importance of aforementioned data, as far as I am concerned, its main value is in its prognostic function. Authors do not ignore vitally important questions by hiding in somebody’s shadow. In contrary, they sincerely and fairly ask acute questions, answers to which are still unknown.
For instance, they frankly aver that that it is essential to further characterize variations in phenotype, understand the relationship between tics and associated comorbidities, clarify factors that modify tic behavior, and continue the search for new and improved behavioral and pharmacologic therapies (Felling & Singer, 2011).
The next considered article by Gilbert and Jankovic distinguishes various ways of available treatment, especially stressing on the one, connected with drug use, which is understandable from the title – “Pharmacological treatment of Tourette syndrome”. Authors highlight complexities, with which clinicians, pharmacologists and scientists are to face. Among ones of the most sophisticated – impossibility to observe direct impact of specific way of treatment, as due to waxing and waning character of Tourette’s syndrome, natural temporary weakening of symptoms may be easily misinterpreted as effectiveness of chosen way of treatment.
This very article presents a three-tier system of oral medications: 1) alpha 2 adrenergic agonists guanfacine and clonidine; 2) a plethora of medications which appear, usually in small or open label studies, to have modest benefit; 3) neuroleptics or antipsychotics (dopamine depletors) (Gilbert & Jankovic, 2014).
As for me, special value of this article is in its critical and broad-minded approach, as it simultaneously describes experimental treatment approaches. It is also useful for the estimation of advantages and disadvantages of placebo practice. Furthermore, authors do not limit themselves just with the scope of own research, they take a broad and complex look on the special features of Tourette’s syndrome, and admit that apart from any kind of treatment, collaborative work with family and closest social environment plays an irreplaceable role.
Last but not least of considered articles with an intriguing title “When Things Go Wrong- Diseases and Disorders of the Human Brain” by Lavoie and Kieron introduces broad characteristic and argumentative prognosis for the future of researching and treatment of Tourette’s Syndrome. Authors bitterly remark that unidisciplinary approach has not proven its efficiency, hence exclusively joined efforts of specialists from different fields of knowledge (neuroscience, psychology, neurology) are able to make a scientific turnover of significant importance. Majority of proposed recommendations, given for clinical perspective, as well as specialized interventions attract me comprehensively. The statement psychophysiological technology may be easily used as an instrument of treatment leads me to important conclusion that self-controlled strategies belong to irreplaceable supplements to any way of treatment (Lavoie & Kieron, 2012).
All in all, synthesis of aforementioned facts is the following: such neuropsychiatric disorder as Tourette’s syndrome is still not studied as comprehensively as it could be, as there are many vital questions without answers. However, known data allows facilitate lives of people with such syndrome make the negative impact almost unnoticeable.
Having analyzed considerable amount of facts and hypotheses , it is possible to make a conclusion that Tourette’s Syndrome, even caused epigenetically, is possible to be supported in comparatively solid way.
1. Felling, R. J., Singer, H. S. (2011). Neurobiology of Tourette Syndrome: Current Status and Need for Further Investigation. The Journal of Neuroscience, 31(35), 12387-12395.
2. Gilbert, D. L., Jankovic, J. (2014). Pharmacological treatment of Tourette syndrome. Journal of Obsessive-Compulsive and Related Disorders, 3(4), 407-414.
3. Lavoie, M. E., Kieron P. O’C. (2012). Neurocognitive Aspects of Tourette Syndrome and Related Disorders. When Things Go Wrong - Diseases and Disorders of the Human Brain, 27-50.
4. Leckman, J. F., Cohen, D. J. (1998). Tourette's Syndrome -- Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care. New York: John Wiley & Sons.
5. Olive, M. F., Levitt, P. (2010). Tourette Syndrome. New York: Infobase Publishing.
6. Woods, D. W., Piacentini, J., Walkup, J. T. (2011). Treating Tourette Syndrome and Tic Disorders: A Guide for Practitioners. New York: Cambridge University Press.