Tourette Syndrome Essay Example for Free

Tourette Syndrome EssayTourette syndrome (TS) is a chronic, familial, neurobiological dis aver with itsonset in childhood and is marked by presence of in volunteer take headings and sounds, kn consume as motor and birdsong tics respectively (Bagheri, Kerbeshian Burd, 1999). According to Lingui-Systems (1999, cited in Prestia, 2003), approximately 1 in every 2,500 individuals suffer from TS, with boys being diagnosed to a greater extent frequently than girls. Tourettes syndrome overly known as Gilles de la Tourette syndrome (after its discoverer Georges Gilles de la Tourette, a French neurologist), bed be considered to be the most interlacing and severe manifestation of the spectrum of tic disorders (Kwak Jankovic, 2002). Etiology and PathogenesisThe subscribe to cause of TS is non known. TS is supposed to have a multifactorialetiology with, genetic and environ psychogenic factors playing an important part in its development. Concordance rate of ab out(p) 60% in monozy gotic twins and 10% in dizygotic twins suggest genetic basis behind TS (Bagheri et al, 1999). The mode of transmission of Tourettes syndrome is controversial. Though the exact patho-physiological mechanism rudimentary the disease has yet non been discovered, ab patternities in basal ganglia (shown in figure 1) and facade cortex have been implicated in the pathogenesis of Tourettes syndrome (Bagheri et al). Ab blueprintity in secretion of neuro-transmitters e particular(a)ly dopamine is also thought to be associated with TS (Bagheri et al).Figure1. Brain Structures Involved in Tourette Syndrome reference book John Henkel, J. (2006). Food and Drug Administration. Retrieved on 21 April 2007 from http//en.wikipedia.org/wiki/ImageBrain_structure.gifSymptomsTourettes syndrome follows a fluctuating course in most children. Symptoms usually appear at about 6-7 years of age. Many factors like anxiety, stress, substance abuse etc.can intensify tics. Presence of tics (both motor and vocal) is characteristic of TS. According to American Psychiatric Associations Diagnostic and Statistical manual of psychic disorders, fourth edition- text revision. (DSM-IV-TR, 2000), tics ar defined as sudden, rapid, purposeless, repetitive, non-rhythmic, stereotyped movements or vocalizations.Tics in TS be not constantly present (except in extremely severe cases) and occur on a background of normal motor activity (Kwak Jankovic, 2002). This disorder usually begins with simple tics which progress over time into more decomposable ones. Different types of simple and complex tics as described by Bagheri et al (1999) which can be seen in patients with TS have been enumerated in table 1. Besides TS, tics can be seen associated with other neurologic disorders like (encephalitis, Huntingtons disease etc). These secondary tics, not associated with Tourette syndrome are commonly referred to as tourettism ((Bagheri et al, 1999).Table 1.Common Types of Tics Seen in Patients with Tourette Synd rome.SIMPLE TICS manifold TICSMotor ticsVocal or phonic ticsMotor ticsVocal or phonic ticsEye heartbeatThroat clearingFlapping armsTalking to one selfSticking tongue outSniffingFacial grimacing assume different intonationsHead turningBarkingAdjusting or picking at clothingCoprolalia blurting out obscene or socially inappropriate lyric poem or phrasesJerking of head or shouldersCoughingComplex lamentable movementsEcholalia involuntary repetition of the words of othersMuscle tensingYellingJumpingPalilalia involuntary repetition of ones own wordsFlexing fingersHiccuppingShaking feetKickingBelchingPoking and pinchingProducing animal soundsCopropraxia involuntary executing of obscene gesturesKissing self or othersSpittingSource Bagheri, M.M. Kerbeshian, J., Burd, L. (1999). Recognition and management of Tourettes Syndrome and tic disorders. American Family Physician, 59 (8). Retrieved on 21 April from http//www.aalpha fetoprotein.org/afp/990415ap/2263.htmlMotor ticsMotor tics can be described as brief movements which occur over overdue to involuntary muscle contraction. Motor tics can be simple or complex in character (see table 1). Tics usually occur as an involuntary movement or as a reply to an involuntary urge to perform the movement (Kwak Jankovic, 2002). These involuntary movements are often perceived as voluntary by the patient and he tries to suppress them. Suppression of tics results in building up of an inner latent hostility or a feeling of discomfort. This leads a further burst of tics which is relieved after performance of the movement (Kwak Jankovic, 2002).Vocal tics Vocal or phonic tics represent involuntary sounds produced due to contraction ofnasal or oro-pharyngeal muscles (Kwak Jankovic, 2002). Like somatic motor tics, vocal tics can also be divided into simple and complex tics (shown in table 1). Coprolalia once thought to be characteristic of TS is present in about 8-25% cases (Bagheri et al, 1999). other type of speech disturbance p resent in some patients is engine block tics. They are manifested by every hesitancy in starting the speech or sudden interruption in the flow of normal speech (Kwak Jankovic, 2002) Developmental stuttering is also sometimes seen in patients with TS (Kwak Jankovic, 2002).Tourettes syndrome is often associated with other co-morbid conditions like obsessional compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), behavior problems and learning disabilities (Prestia, 2003).DiagnosisDiagnosis of TS is usually made clinically based on recognition of tics. The Diagnostic criteria for TS as defined by American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders, fourth edition- text revision. (DSM-IV-TR), 2000 is shown in table 1.Table 1. DSM-IV-TR Diagnostic Criteria for Tourettes DisorderAPresence of both motor and vocal tics at some time during the illness, although not necessarily concurrently.BThe tics occur many times a daytime (usu ally in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there is never a tic-free period of more than 3 consecutive months.CThe onset of symptoms is before the age of 18 years.DTS is diagnosed after ruling out the presence of symptoms due to direct effect of drugs of abuse or general medical conditions (e.g., Huntingtons disease or post viral encephalitis). intervention Treatment of TS may require a multi-disciplinary team approach involvingneurologists, psychiatrists, psychologists, social workers, occupational therapists, educators etc. (Kwak Jankovic, 2002).An algorithm for management of TS as described by Bagheri et al (1999) is shown in figure 2.Pharmacological therapy medical examination therapy should aim at the treatment of most disabling symptom. Tics(both vocal and motor) respond best to dopamine blocking drugs (Kwak Jankovic, 2002). These can include conventional neuroleptics like haloperidol and pimozide and t he atypical neuroleptic agents like risperidone. Neuroleptic agents are associated with numerous side effects like sedation, weight gain, impaired academic performance, in children and extra pyramidic movement symptoms (like tardive dyskinesia).Since TS is frequently associated with other co-morbid conditions like OCD, ADHD etc, pharmacotherapy should be tailored to treat these conditions as well (Kwak Jankovic, 2002). For e.g. Central nervous system stimulants (amphetamines and dextroamphetamine) can be used for treatment of ADHD and anti-depressants (selective serotonin reuptake inhibitors) for management of OCD, if present. Injections of botulinum toxin can be used for tics isolated to one body vicinity such as the eyes, neck, or vocal cords.Non-Pharmacologic interventionsSince TS most commonly affects children in the age when they are attendance school, symptoms of TS can affect their academic performance, cause inference with their social-emotional development, and impose l imitations due to corporal disabilities produced as a result of tics (Prestia, 2003).It is the duty of educational providers, school personnel and parents to keep these limitations in mind and to draw out an adequate plan incorporating carefully thought out interventions and adaptations, in order to enhance the success and performance of children suffering with TS, at school (Prestia, 2003). Behavior treatment and counseling can be used to conjure development of social and academic skills in children and to prevent exacerbation of symptoms related to TS, by modifying their behavior (Bagheri et al, 1999).Source Bagheri, M.M. Kerbeshian, J., Burd, L. (1999). Recognition and management of Tourettes Syndrome and tic disorders. American Family Physician, 59 (8). Retrieved on 21 April from http//www.aafp.org/afp/990415ap/2263.htmlPrognosisTS is a lifelong disorder with an unpredictable course (Prestia, K. (2003). Theclinical course of TS as described by Bagheri et al (1999) is shown i n figure 3. As shown in figure 3, symptoms of TS diminish during and after adolescence in about 85% of patients. About 5 to 10 % of patients may show no improvement. Most patients with TS require medication for up to one to two years. About 15 % of patients may require long-term medication for tic control.Figure 3. clinical Course of Tourettes SyndromeSource Bagheri, M.M. Kerbeshian, J., Burd, L. (1999). Recognition and management of Tourettes Syndrome and tic disorders. American Family Physician, 59 (8). Retrieved on 21 April from http//www.aafp.org/afp/990415ap/2263.htmlConclusionTS is not an uncommon problem and can be often encountered in school children. TS is a multifactorial neurological disorder requiring an integrated treatment approach targeting at the other co-morbid conditions associated with TS, as well. Treatment must also incorporate an effective multi-disciplinary team approach aiming at treatment and recognition of underlying complex mechanisms, solving speech and l anguage problems and promoting socio-emotional and academic development to substantially improve the quality of life and performance of individuals with TS.Article ReviewThe member by Prestia, 2003 focuses on need of educators to understand the special academic, social-emotional, and animal(prenominal) needs of the children suffering from TS. Educators need to make use of simple interventions to help these children overcome their illness and touch best possible performance at school. TS can cause significant academic, social-emotional, and physical challenges for the child as described belowAcademic ChallengesTS does not directly affect intelligence, and many students with TS have average or above average IQs. Still approximately 40% of individuals with TS can have learning problems. This is so as many individuals with TS have associated comorbid disorders like learning disabilities, OCD, ADHD, Asperger syndrome etc. Assistance can be provided through special education services or individualized education program (IEP) or a 504 Plan.If the student does not qualify for either, classroom teachers can make use of simple interventions and plans by using available resources and their own knowledge .For e.g. if the child is having trouble with writing, teachers can make use of alternatives like using oral opinion tests instead of written assignments, using multiple-choice questions etc. Since stress can precipitate tics, teachers should take steps to eliminate any source of stress for the student.Social-emotional ChallengesChildren with TS tend to have problems in interacting with and being accepted by their peers due to abnormal behavior produced as a result of motor and vocal tics. Such children may become isolated and depressed and are at risk for developing poor self-esteem and self-confidence. They are also easy targets to bullying. Educators should take steps to encourage acceptance and support of such students by their peers. sensible ChallengesUnderlying physical problems accompanying the disorder often go unaddressed. Educators should properly assess these problems by consulting a multi-disciplinary team (MDT) involving a physical therapist, occupational therapist, and adapted physical education teacher in order to determine the students motor strengths and areas of need. For e.g. Impairments in sensory processing or motor planning may interject with normal day to day non-academic activities like toileting, eating lunch, etc. Simple solutions can be offered by the MDT to facilitate independence and to prevent self-harm during the period of tic release in such children. In my view this article provides helpful suggestions that can be utilized in school settings. In order to achieve optimum development and performance of these students, educators must make use of simple and carefully thought out interventions. They should hap out ways to promote social-emotional development and also help them in coping with learning and physical d isabilities, imposed by the tics.ReferencesAmerican Psychiatric Associations Diagnostic and Statistical manual of mentaldisorders, fourth edition- text revision. (2000). Retrieved on 21 April from http//www.behavenet.com/capsules/disorders/touretteTR.htmBagheri, M.M., Kerbeshian, J., Burd, L. (1999). Recognition and management ofTourettes Syndrome and tic disorders. American Family Physician, 59 (8). Retrieved on 21 April from http//www.aafp.org/afp/990415ap/2263.htmlKwak, C. Jankovic, J. (2002). The Neurology of a Tic From the Point of Viewof the Scientist. Retrieved on 21 April 2007 from http//www.asha.org/about/publications/leader-online/ recital/2002/q3/020806a.htmPrestia, K. (2003).Tourettes syndrome Characteristics and interventions. Interventionin school and clinic, 39(2), 67. Retrieved on 21 April 2007 from http//proquest.umi.com/pqdweb?index=37did=443394391SrchMode=1sid=2Fmt=4VInst=PRODVType=PQDRQT=309VName=PQDTS=1176684625clientId=18091