Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

1436 Torticollis Tourette Syndrome

■Surgery: pallidotomy or deep brain stimulation to globus pallidus or

thalamus may be helpful

follow-up

■Depends on cause & severity

complications and prognosis

■May resolve w/o therapy in 10–15%

■Symptoms may slowly progress in untreated pts

TOURETTE SYNDROME

CHAD CHRISTINE, MD

history & physical

■Syndrome of involuntary motor & vocal tics

■First motor tic often involves face (sniffing, blinking, etc.)

■Vocal tics usually follow (eg, grunts, barks, hisses, coughing, copro-

lalia or echolalia)

■Obsessive-compulsive disorder & attention deficit/hyperactivity

disorder common

■Onset between 2 & 21 yr

■Hereditary

■Males > females 3:1

■Poor impulse control is common

■Multiple motor & vocal tics

tests

■Diagnosis made clinically

■Lab tests & brain imaging normal

differential diagnosis

■Wilson’s disease, Sydenham’s chorea, bobble-head syndrome exclu-

ded clinically

management

■What to do first: education of pt, family & teachers

■General measures: extra break periods at school, extra time on tests

■Counseling, behavior modification may be sufficient

specific therapy

■Many will not require treatment

Tics

■Fluphenazine or pimozide increased every 5–7 d