Tourette’s Syndrome: Cause, Onset, Symptoms, and Treatment Options (Part 4)
Because tics change in severity often weekly and are exhibited in differing bouts throughout a single day, it is important initially for the doctor to observe the patterns so that he or she may decide upon the most effective treatment regime. Additionally, it is extremely important to treat Tourette’s syndrome as early as possible to reduce ridicule and rejection by peers, exclusion from activities and prevention from enjoying normal interpersonal relationships due to the perception of those in the child’s immediate environment who may observe the bizarre behavior and become frightened. To avoid such psychological harm, early diagnosis and treatment is key (Tourette Syndrome Association). While many children with Tourette’s syndrome of school age have similar IQs to the majority of the school population, many will have special educational needs which must be addressed to optimize learning. Tape recorders, typewriters, or computers for reading and writing problems, un-timed exams to reduce stress and anxiety which aggravate tics, and permission to leave the classroom when tics become noticeable and embarrassing to the child are affective methods of gaining control of symptoms in the school environment (Tourette Syndrome Association). In terms of professional assistance, habit reversal therapy, or making a patient aware of tics or the urge to tic building up and training and then training him or her to “engage in a response that would be muscularly competing or incompatible with tic” (Packer) as well as the similar exposure response-prevention therapy in which patients are instructed to suppress their tics have mixed results. Relaxation techniques may also be utilized, instructing patients in a simple breathing-based approach to train themselves to relax as a way of decreasing the incidence of tics in stressful situations. Moreover, neurofeedback can be performed using the biofeedback of an EEG machine where “individual receives immediate feedback about a physiological or biological process, with hopes that the immediate feedback and reinforcement will enable the individual to modulate a physiological process that is usually not easily modifiable. ” (Packer). One megahertz of transcranial magnetic stimulation over the prefrontal cortex or motor cortex delivered to the primary motor area have reduced the frequency of tics during stimulation as well (Chae et al. The most dramatic treatments those found in surgical operations when all other treatments have failed. Lesioning of the brain known as stereotactic zona incerta and ventrolatral/lamella medialis thalamotomy may provide a significant long term decrease in motor tics if further developed. A less risky surgery with fewer side effects was recently attempted by a neurosurgical team at University Hospitals of Cleveland where the use of deep brain stimulation, similar to the device used to treat Parkinson’s disease and tremor, was attempted. Electrodes placed around cells inside the thalamus portion of the brain, a structure which forms part of the circuit connecting the basal ganglia to the cerebral cortex, deliver continuous high frequency electrical stimulation, thus producing messages that are rebalanced through movement centers in the brain (News Medical). Within hours of surgery and activation, the patient noticed a disappearance of jerking motions, muscle tics, and grunting symptoms associated with Tourette’s. With the discovery of the streptococcal factor involved in Tourette’s syndrome, clinical researchers have explored experimental methods such as plasmapheresis (plasma exchange, PEX) and intravenous injection of immunoglobin (IVIG) to treat PANDAS related symptoms themselves. However, neither of these treatments have been proven to be effective. Also significant improvement has been documented in the symptoms of Tourette’s patients supposedly affected by PANDAS after undergoing tonsillectomies or adenotonsillectomy for recurrent streptococcal pharyngitis (Packer).
The great majority of people diagnosed with Tourette’s syndrome are not significantly impaired by their symptoms and thus do not re quire medication, but when medication becomes necessary, many options are available. To achieve maximum control of symptoms, dosages of specific drugs vary significantly from patient to patient and must be carefully monitored. In most circumstances, doctors prescribe medications in small doses and gradually increase these doses until a maximum alleviation of symptoms with minimal side effects are achieved. Some undesired side effects incurred during treatment include weight gain, muscle rigidity, fatigue, motor restlessness and social withdrawal. Most drugs administered to treat this disorder are dopamine agonists and antagonists which can often reduce abnormal movements and vocal tics in Tourette’s syndrome (Hershey et al.