About TS > Frequently asked questions
Frequently asked questions
Q. How can I find a consultant who can diagnose or treat Tourette Syndrome?
A. Tourettes Action has details of such consultants in the UK. Contact us to request this free information.
Q. Do consultants accept referrals and patients from outside of their area?
A. Usually consultants are very happy to receive out of area referrals. However. there may be problems with funding, making if difficult for a GP to agree to refer to an out of area consultation.
Q. How do I register as a volunteer for clinical trials of new drugs?
A. Unfortunately, there is currently no registry for such trials in the UK. For the US, there is a good website http://www.clinicaltrials.gov/ with some information on TS. You can sign up to receive a monthly e-newsletter, which features a section on Research News.
Q. What is the youngest age TS has been diagnosed?
A. Conventially tics start at about five, sometimes younger. Although some parents would say there was something different about the child as a baby, in general the diagnosis can't be made at that age.
Q. Is there a link between tics and body temperature?
A.There's no known link, except that having a fever can make the tics worse. In some patients involuntary movements can certainly make them feel hot.
Q. Is there a recent review paper describing current opinion about the pros and cons of the different medication options for TS?
A. Probably the biggest review of treatment is Robertson, 2000 in Brain. There are many reviews of TS which give a standard account of treatment. Treatment responses can be very individual between patients. There is certainly no one answer.
Q. Can nicotine help alleviate tics?
A. There is some evidence that nicotine patches can help tics, but probably mostly when used in combination with certain kinds of medications.
Q. Is it possible that Temporal Lobe Epilepsy is linked to Tourettes?
A. There is no connection between the two, but sometimes misdiagnosis of the symptoms can occur.
Q. Do people with TS tic because they like it?
A. Tics are involuntary. However, performing a tic can give a feeling of relief. Patients also often have a need for things to be "just right".
Q. What is the difference between a psychiatrist and a clinical psychologist?
A. A psychiatrist is a doctor who can prescribe drugs. A psychologist is not necessarily medically qualified but is trained in psychological assessment and treatment. The involvement of a psychiatrist can be helpful to assess the problems associated with TS and to decide on the most appropriate treatment.
Q. How likely is it that a child with motor tics will develop TS?
A. Tics are very common in children, especially in boys. Mostly they do not develop into TS.
However, in TS vocal tics usually start later than muscular tics. Therefore, it is not certain that a child with tics will not develop vocal symptoms. TS itself can be very mild in many cases.
Q. What is the connection between TS and streptococcal infections?
A. This area is still considered controversial. Streptococcal infections might trigger TS in some patients, and infections might be associated with worsening of symptoms. But any infection could do that, not just streptococcal. It is possible to test for anti-basal ganglia antibodies which could be caused by streptococcus but their significance is not yet known. They don’t necessarily cause TS although some researchers have put forward that view and it needs further investigation.
We don’t yet understand this area fully, so there are as yet no implications for treatment. Antibiotics and treatments affecting the immune system have been tried in small numbers of patients but they probably not helpful. It is an area that might progress in future.
Q. What can be done about rage and violent compulsions?
A. The causes of anger/rage/frustration in TS are many and various.The circumstances when this happens and what actually happens need to be looked at. Sometimes people exhibit violent behaviour as part of a tic, or as a frustration about compulsions or thoughts. Sometimes it can be a manifestation of frustration, if a tic prevents a person doing something they want.
There are a variety of treatments for angry outbursts in relation to TS. Some of these involve psychological treatments and can involve the participation of the whole family. If the outbursts are more directly related to tics or OCD, then direct treatment of these things is probably the best way forward. If it is a compulsion, then SSRI medications or cognitive behavioural therapy may help.
Q. What can be done about spitting tics?
A.Spitting in the context of TS is a complex tic. The first thing to do is to make sure that spitting is a tic rather than a "willed action". If it is a tic then the treatment is no different to any other tic. Medications may damp down the behaviour. Psychological interventions such as habit reversal may be helpful.
If it is a tic,try and minimise the environmental effect of spitting to reduce the chance of social exclusion. For a child at school, this may involve working with teachers in school and being inventive about ways of preventing others from being spat on. For an adult, this might involve carrying something that you can spit into.
Q. What if no treatments seem to help?
A.Re-assess the diagnosis or diagnoses and the symptoms that are causing the most disability.
Consider whetherall the treatments been used to maximum therapeutic effect - proper doses for a reasonable time unless adverse effects prevented this. Have anytreatmentsnot been tried? Could anon-medical treatmentsuch as habit reversal be beneficial?
Finally, if all these have been tried, look atways toreduce the impact of tics on daily life.
Q. What is the difference between tics and compulsions?
A. It is not always easy, or helpful, to distinguish tics from compulsions. Usually tics are experienced with a physical sensation of tightness, itching or tension; whereas compulsions are preceded by a pattern of thinking that can go on for a long time before the action itself ("If I don't move my head, something bad will happen to one of my family". In real life, this distinction is not always easy to make.
Q. Should my child take medications for TS?
A.The decision to start medication in children is a difficult. One of the reasons for considering medication is that the tics or behaviours are causing significant distress or disability in your child or preventing their development in some way.
Medicines can also have adverse effects at different doses. Itcan be a balancing act between the pros and cons of treatment versusno treatment at all.
The key to success in this area is to maintain a good dialogue with your child about which tics/behaviours are particularly distressing, to be clear in your own mindabout what you hopemedication might achieveand to have a good dialogue with your treating doctor about any good or bad effects of treatment.
There have beena few treatment trials of habit reversal, a formof psychological therapy, which show that it can be useful for individual troublesome tics. If available, it is worth a try.
Q. How can I access habit reversal training?
A.There is apatchy services in the UK. Sometherapists are willing to try this technique. But no informationon psychologists or others with experience is currently available. If you havebeen offered thistreatment, please let us know so that we can compile this information for others.
Q. Why does my child seem only to tic at home?
A.Many people with TS are able to suppress their tics for a limited time. Some children suppress their tics (or let them out in private) when at school, or in a doctor’s surgery.
This can be tiring. When a child comes home from school, they may be too tired to suppress. Or theysimply feel comfortable enough to express their tics.
In such circumstances, it can be helpful to video the child’s tics. This couldhelp withdiagnosis and explaining to the school what your child is holding in.
Q. Is TS degenerative?
A. No. Degenerative conditions like Parkinson’s disease or Alzheimer’s disease involve brain cells dying over time. There is no evidence for this in TS. Inclinical terms the reverse is true. TSgenerally improves with time. On average, tics are most severe at ages 10 to 11.
Every patient is different. It is not impossible for people with mild tics to experience worse tics, and it is certainly common for them to fluctuate in severity. But a child with mild tics is unlikely to become an adult with more severe TS.
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