Tourette syndrome (TS) is a neurological disorder characterised by repetitive, stereotyped, involuntary movements and vocalisations called tics.
Although the cause of TS is unknown, current research points to abnormalities in certain brain regions (including the basal ganglia, frontal lobes, and cortex), the circuits that interconnect these regions and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells. Given the often-complex presentation of TS, the cause of the disorder is likely to be equally complex.
What are the symptoms?
Tics are classified as either simple or complex. Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. Some of the more common simple tics include:
- Eye blinking and other vision irregularities
- Facial grimacing
- Shoulder shrugging and head or shoulder jerking
Simple vocalisations might include repetitive throat-clearing, sniffing or grunting sounds. Complex tics are distinct, coordinated patterns of movements involving several muscle groups. Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug.
Other complex motor tics may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending or twisting.
Simple vocal tics may include throat-clearing, sniffing/snorting, grunting or barking. More complex vocal tics include words or phrases. Perhaps the most dramatic and disabling tics include motor movements that result in self-harm such as punching oneself in the face or vocal tics including coprolalia (uttering swear words) or echolalia (repeating the words or phrases of others).
Some tics are preceded by an urge or sensation in the affected muscle group, commonly called a premonitory urge. Some with TS will describe a need to complete a tic in a certain way or a certain number of times in order to relieve the urge or decrease the sensation.
Tics may become worse with, excitement or anxiety and are better during calm, focused activities certain physical experiences can trigger or worsen tics, for example tight collars may trigger neck tics, or hearing another person sniff or throat-clear may trigger similar sounds. Tics do not go away during sleep but are often significantly diminished.
All students with TS need a tolerant and compassionate setting that both encourages them to work to their full potential, and is flexible enough to accommodate their special needs.
This setting may include:
- A private study area
- Exams outside the regular classroom
- Oral exams when the students symptoms interfere with his or her ability to write
- Additional time in exams