Deep brain stimulation for Tourette syndrome

Abstract

To discuss Tourette syndrome, one has to know what doctors mean by “tics.” A tic is a brief, unwanted movement or noise that someone performs repeatedly, usually many times a day. Tics can be held back for a period of time, but this often brings a sense of building pressure to repeat the tic. Blinking, head shaking, and loud sniffing are common simple tics. More complex actions such as touching the floor or saying words can also be tics. Tics are very common: about a quarter of young children will have a tic for a short period of time, and about 1 child in each elementary school classroom has tics that last for a year or more. If a patient has both motor and vocal tics that started in childhood or teens, have lasted for at least a year, and do not have an identifiable specific cause, the patient receives a diagnosis of Tourette syndrome (TS). By this accepted definition, TS is relatively common. Studies in which a large number of children are examined carefully for tics find that about 1 in 200 (0.5%) have TS. However, only about half that number (0.3%) have ever received the TS diagnosis. Only about a quarter of patients with TS describe their symptoms as moderate or severe.1 Thus most people with TS have fairly mild symptoms and are best managed with education and nonspecific supportive treatment.2 For others, however, TS is a daily battle. The problems can be many. There may be social problems like bullying in school or unfair treatment in job interviews. Children may have trouble concentrating in school because of tics or from focusing on holding tics back. Some patients have tics that are violent enough to cause injuries. It is appropriate to provide treatment for patients with …