Tic chart
The tics listed here are examples only and the list is not exhaustive. A huge variety of tics exist, and tic patterns vary from one individual to another.
Comorbidities, associated symptoms
Although the presence of tics is the only necessary and essential criterion for the diagnosis of GTS, several other symptoms or concomitant disorders are often associated with the clinical picture. Here are the main ones:
- ADHD and impulsivity. What ADHD and GTS have in common is a delay in the maturation of the frontal and prefrontal areas of the brain. These brain regions are responsible for self-control, inhibition and behavior management. SGT is therefore frequently associated (up to 90% comorbidity) with ADHD, especially in its hyperactivity and impulsivity aspects.
- Anxiety. The reasons for this association are less clear, but Tourette's syndrome is very frequently accompanied by anxiety symptoms, and often these are quite severe and pervasive. Anxiety is characterized by irrational thoughts, doomsday scenarios, and fear of novelty and change.
- Obsessive-compulsive behaviors. Around 10-20% of people with Tourette's syndrome also exhibit behaviors such as the need to touch or count things, or to perform actions in a specific order, for example. They may refuse a new route to school, refuse to let food touch each other on their plates, or need to get dressed in a specific sequence in the morning. Obsessive-compulsions are often underpinned by anxiety.
- Rigidity. Both because of the immaturity of the frontal areas and because of their anxiety, people with GTS are often described as very rigid and inflexible. As much in their habits and routines as in their thoughts, opinions and demands. As a result, they can be inordinately insistent on getting things done, and find it extremely difficult to adapt to change and the unexpected.
- Temper tantrums and emotional management difficulties. Because of their impulsiveness, young people with Tourette syndrome are described as prone to quick and easy outbursts of excessive anger. Parents sometimes imagine that their child seems to be transforming and "possessed" by anger. These tantrums also seem to rise suddenly from 0 to 100 in intensity, with no progression of frustration to intervene before the situation degenerates.
Assessment and diagnosis
Diagnosis of Gilles-de-la-Tourette syndrome is based on observation of characteristic tics, which must have been present for at least one year.
However, tics are said to be migratory, i.e. they affect a certain muscle group during one period, then seem to migrate to another muscle group during the next period. At least two motor tics and one sound/verbal tic must be documented to make the diagnosis of GTS.
At CERC, the assessment is carried out by a neuropsychologist and includes the following steps:
- Anamnesis: this is a one-hour meeting during which we take a complete history of the development and current life situation of the child or adult we are assessing. This meeting usually takes place remotely, by videoconference.
- Evaluation:Neuropsychological evaluation assesses the integrity of various brain functions. It takes place in an office, over a full day (5 hours) or two half-days for children under 8.
The person being assessed will be given various tests (adapted to their age) measuring all cognitive functions (IQ, reasoning, logic, memory, attention/concentration, etc.).
Often, a profile of personality traits and emotional / psycho-affective feelings is also drawn up, to help the professional fully grasp the various issues at play in the day-to-day life of the person being assessed.
- Test correction and report writing : This part of the work carried out by the neuropsychologist or psychologist takes place in the weeks following the assessment, without the client being present.
The results of the tests administered are compared with expected averages and used to assign a percentile rank (rank among 100 people in a reference group) to the various cognitive functions of the person being assessed. A detailed, graphically illustrated report is produced to explain the results.
- Debriefing session : Three to four weeks after the assessment, the neuropsychologist (or psychologist) meets with the parents or adult being assessed, to explain the results and provide a copy of the report.
Treatment
Treatment of Tourette syndrome is aimed at reducing the frequency and severity of tics, as well as alleviating associated symptoms such as anxiety, ADHD and compulsive or impulsive behaviors.
Behavioral therapies such as habituation therapy, cognitive-behavioral therapy (CBT) and exposure and response prevention therapy (ERPT) can help people with Tourette syndrome recognize and modify tic-like behaviors and thoughts.
These approaches can help reduce anxiety and improve symptom management.
Medication may also be prescribed to reduce the frequency and severity of tics, as well as to control anxiety and promote better mood regulation (to reduce angry outbursts) in people with Tourette syndrome.
Other useful links