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Najah Johnson
Tourette syndrome is an inherited severe
neurological disorder usually occurring before the age of eighteen and is
associated with a degree of facial and body tics sometimes accompanied by
random declarations of phrases or obscenities (2,3). The facial and body tics associated with the
disorder can be painful and even embarrassing.
Involuntary body movements such as jaw snapping, gyrating, hopping, and
obscene gesturing are to name a few (1). Tourette Syndrome was named after a French
neuropsychiatrist named Gilles de la Tourette who successfully assessed the
disorder in the late 1800’s(3). Tourette Syndrome claims no specific race or
ethnicity. The disorder generally can
affect any ethnic group yet it does affect three to four times more males than
it does females (3).
Although
just a mere decade ago Tourette Syndrome was frequently misdiagnosed as
schizophrenia, Sydenham’s chorea, epilepsy, or nervous habits, its symptoms are
now differentiated and specific case related.
Tourette Syndrome is a case sensitive genetic disorder that varies from
generation to generation. However, not
everyone that carries the genetic make up of Tourette Syndrome will express
those symptoms (1). Coined as the term autosomal dominate, when
one parent is a carrier or expresses symptoms of having Tourette syndrome,
there is a 50/50 chance the child will receive the gene from the parent (1,4).
There
are several behavioral and cognitive difficulties associated with the tics that
many with Tourette Syndrome experience.
Although Tourette Syndrome may present itself as a disorder of motor and
vocal tics, it is much more complex.
Commonly linked with Tourette Syndrome is attention deficit disorder
with hyperactivity(ADHD) as well as obsessive compulsive behavior (1,3).
There are other behavioral disorders that Tourette Syndrome patients
display such as depression, anxiety, irritability, argumentativeness,
stubbornness, and impulsivity, that may not be directly linked to Tourette
Syndrome itself, but may be contributed to the patient’s reaction to having to
live with such a chronic illness (3). Associated with the motor tics experienced
by the patient are sometimes more self-destructive behavior such as head
banging, eye poking, and lip biting (1). There have also been cases of various
learning disabilities connected with Tourette Syndrome such as dyslexia (4).
Vocal
tic behavior in patients diagnosed with Tourette Syndrome include outbursts of
meaningless words or phrases. The vocal
tics disrupt the regular flow of speech and cause the patient to stammer or
stutter (1). Inappropriate outbursts called coprolalia
are considered involuntary. Coprolalia
may also take place in this display of vocal tic disorder. However, coprolalia only takes place in a
small number of Tourette Syndrome sufferer’s (1).
Each
individual suffering from Tourette Syndrome should be evaluated as such. Certain manifestations of Tourette Syndrome
may disable one in certain parts of their life such as in their school
performance, while it may affect another’s personality or psyche (3).
It may affect a totally different behavioral dimension in one’s life
than that of another diagnosed with Tourette Syndrome.
Although
research on Tourette Syndrome is ongoing, it is believed that the disorder is
related to an abnormal metabolism of the neurotransmitters; dopamine and
serotonin (4). Evidence for the involvement of dopamine
stems from the response haloperidol and other neuroleptics generate(1). There is currently no cure for each symptom
associated with Tourette Syndrome, but these drugs can offer the patient a much
less aggravated lifestyle. Haloperidol
along with pimozide, flupenazine, and penfluridol have shown reduced levels of
dopamine and have therefore led investigators to believe that Tourette Syndrome
results from a hypersensitivity of postsynaptic dopamine receptors (1).
The
presence of an abnormality in the serotonergic mechanisms in Tourette Syndrome
patients have been suggested due a reduced serotonin metabolites after
medications. Neurotransmitters seem
effective for that part of the brain after medical induction and show to be
effective for the obsessive behavior experienced by patients with Tourette
Syndrome (1).
As
was stated earlier there is no definite cure for Tourette Syndrome as a whole,
but only relief for some symptoms of it in some cases. Many that suffer from Tourette Syndrome may
not require drug therapy (3). These are those that have a great deal of
support and are able to effectively cope with their illness. Drug therapy should be dispensed if Tourette
Syndrome is impairing one’s ability to grow and develop socially, and
emotionally (1). It is also very important that each case be
measured on an individual based scale.
In one patient the major problem may be to suppress tic movement and not
obsessive compulsive disorders (3). Not every patient with Tourette Syndrome
takes a medication, but those that do are usually started off on the smallest
dosage possible so that it can be known what movements are being suppressed (1,3).
A low dosage also helps to pay attention to the side effects that a
patient may develop as a result of the medication.
Tourette
Syndrome has raised some interesting questions about the relationship between
the brain and behavior. In the specific
case of Tourette Syndrome, how meaningful are the tics in determining one’s
behavior? If Tourette Syndrome patients
brains are undergoing an imbalance that is constant, shouldn’t they have tics
or outbursts all of the time? When my
body jerks does that classify me as having a chemical imbalance? Or can my behavior be altered without my
brain being altered? How does
coprolalia play a role in the behavior of someone with Tourette Syndrome? Why do many patients shout profanities
instead of saying ‘the flowers smell nice?'
My thoughts are that brain and behavior are interrelated, but it could
be the case that Tourette Syndrome patient is frustrated with their disorder
and is showing a behavior that is perfectly normal. Instead of a scientific name ‘coprolalia’ I think it is just
frustration and a normal human reaction.
Many of us sometimes say obscenities when we are not satisfied or
aggravated with a circumstance.
Behavior is a result of the brain, but in a much more complex fashion than we sometimes tend to realize. Chemical imbalances in the brain can sometimes cause a whole systematic reaction that our bodies just can’t control. While we think of behavior as a voluntary physical action, Tourette Syndrome reminds us that it is not. Without proper brain function our behavior can become totally involuntary and have a ‘mind’ of its own. Behavior is not a result of a physical bodily movement. Behavior may start in the brain and the type of behavior emitted is thus a result of the manner by which that brain functions. However it is also important to be opened minded and realize that sometimes our bodies can react without direct causation of the brain.
1)htttp://www.mentalhealth.com/book/p40-gtor.html;
Guide to the Diagnosis and Treatment of Tourette Syndrome
2)Dictionary.com/tourette syndrome
3)http://www.tsa-usa.org/;
Tourette Syndrome Association, Inc.
4)http://members.tripod.com/~tourette13/; The Facts About Tourette Syndrome