Tourette’s syndrome A neurologic disorder in
which a person experiences an array of tics (invol-
untary and repetitive movements). Researchers
believe Tourette’s syndrome results from subtle
imbalances of neurotransmitters in the BRAIN. The
imbalances cause disturbances of motor function
that affect the muscles of movement as well as
functions of articulation and vocalization. Most
people who have Tourette’s syndrome experience
simple neuromuscular tics such as involuntary
movements of the eyelids or MOUTH, or even the
head and extremities. Some people also experi-
ence vocal tics, in which they express noises such
as grunts and coughs. And some people experi-
ence articulation tics in which they speak words,
sometimes obscenities, involuntarily and often
loudly, as though the words erupted from them.
Although these tics have the appearance of con-
scious behavior (and some people can temporarily
suppress them through conscious effort), they are
involuntary neurologic disturbances.
There are no clear diagnostic markers for
Tourette’s syndrome. Symptoms typically begin in
childhood, around age seven or eight, and peak
during ADOLESCENCEbefore trailing off. Many peo-
ple who have Tourette’s syndrome have few
episodes of tics after they reach midlife, though
neurologists consider Tourette’s syndrome a
chronic, lifelong condition. When evaluating the
symptoms of Tourette’s syndrome, the neurologist
may conduct numerous tests and procedures to
rule out other potential causes, including psychi-
atric illness, of the symptoms. The neurologist will
generally make the diagnosis of Tourette’s syn-
drome after ruling out such possibilities and when
symptoms persist for a year or longer.
Many people who have Tourette’s syndrome
respond to combinations of medications including
ANTIPSYCHOTIC MEDICATIONS, ANTIDEPRESSANT MEDICA-
TIONS,STIMULANTS, and the BLOOD PRESSUREmedica-
tion clonidine (Catapres). All of these medications
have varied effects on neurotransmitters and the
brain’s biochemical balance. Though it may take a
period of trial and error to find the combination
that is most effective for each individual, nearly
everyone who has Tourette’s syndrome experi-
ences diminished symptoms with appropriate
treatment. Though the tics, especially the vocaliza-
tions and articulations, can be disconcerting,
Tourette’s syndrome does not result from signifi-
cant neurologic damage and does not threaten
health or well-being. SUPPORT GROUPSand thera-
pists can help people develop COPING MECHANISMS
for living with Tourette’s syndrome. Because stress
and anxiety exacerbate symptoms, people who
have Tourette’s syndrome generally benefit from
stress reduction methods and approaches such as
BIOFEEDBACK.
See also ATTENTION DEFICIT HYPERACTIVITY DISORDER
(ADHD); NEUROTRANSMITTER; OBSESSIVE–COMPULSIVE
DISORDER(OCD); STRESS AND STRESS MANAGEMENT; TIC.traumatic brain injury (TBI) Damage, often per-
manent, to the BRAINthat results from trauma,
blunt or open. TBI may be acute (occur suddenly)
or chronic (occur over time as a result of cumula-
tive injuries). Acute TBI most often occurs from a
blow to the head, such as from a significant fall or
collision. Open trauma to the head, such as gun-
shot wound, may also result in acute TBI. Chronic
TBI develops in people who receive repeated
blows to the head, such as athletes who partici-
pate in contact or collision sports. Boxing, soccer,
and American football are the leading causes of
chronic TBI in the United States. The effects of TBI
may range from mild disturbances of thought or
movement to incapacitating loss of cognitive and
motor function or PERSISTENT VEGETATIVE STATE.Shaken baby syndrome, a form of CHILD
ABUSE, is a significant and preventable
cause of TRAUMATIC BRAIN INJURY(TBI)in
young children. Children are especially
vulnerable to brain injury and may
experience permanent damage or die
from events that would not harm an
adult.Symptoms and Diagnostic Path
Symptoms of TBI may be vague and mild or sud-
den and severe. Common symptoms include- significant or persistent HEADACHE
- loss of CONSCIOUSNESS
- unequal dilation of the pupils
- weakness or PARALYSISon one side of the body
- blurred or double vision (DIPLOPIA)
traumatic brain injury (TBI) 287