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Tourette's Disorder (Factors (Genetic (May be transmitted in an…
Tourette's Disorder
Clinical Findings
Presence of multiple motor tics, and 1+ vocal tics that may interfere with normal functioning
Can appear as early as 2yo but more often in 6-7yos. Symptoms can diminish with age
Occurs in boys more than girls
Factors
Genetic
May be transmitted in an autosomal pattern intermediate btwn dom/rec
Environmental
Pregnancy complications, low birth weight, head trauma, carbon monoxide poisoning, encephalitis, strep
Biochemical
Abnormal levels of dopamine, serotonin, GABA, dynorphin, ACH, and norepinephrine
Structural
Basal ganglia dysfunction. Smaller corpus callosum, larger hippocampus and amygdala
Treatment
Pharmacotherapy is often
not recommended
unless the disorder is causing significant impairment/discomfort. Works best when combined with a psychosocial therapy.
Antipsychotics
Haloperidol
- NOT recommended for children under 3yo
#
Pimozide
- NOT recommended for children under 12yo
#
AE: extrapyramidal symptoms, neuroleptic malignant syndrome, tardive dyskinesia, ECG changes
Alpha Agonists
First line choice for treatment of Tourette's. CI w/ Hx of cardiac or vascular diseases. Do not D/C abruptly.
Clonidine
#
SE: dry mouth, sedation, headaches, fatigue, dizziness, postural HTN
Guanfacine
- longer lasting and less sedating
#
Diagnostics
Onset before age 18. Cannot be attributed to substance abuse or other conditions. Disturbances have persisted for 1+ years.
Multiple Motor tics
eye blinking, neck jerking, shrugging, grimacing, squatting, hopping, skipping, tapping, retracing steps
One or more Vocal tics
squeaks, grunts, barks, sniffs, snorts, coughs, uttering obscenities. May use phrases out of context, repeat own sounds/words(
palilalia
), or repeat words of others(
echolalia
)
Disturbances are compulsive and irresistible. They are exacerbated by stress, and attenuated when absorbed by an activity. Typically diminished during sleep.