Gilles de la Tourette syndrome (or tic disorder)

The present PsychologyOnline article has intended to provide a definition, as complete as possible, of what is understood today by Gilles de la Tourette syndrome (or tic disorder), its medical treatments and behavioral therapies, which help to cope with this disorder.
This contribution serves, in some way, to face the greatest difficulty that an individual who suffers from this condition has to face, which is ignorance.

This ignorance of its existence, even though it is relatively frequent (5 and 10 per 10,000 inhabitants), and in most cases, failure to diagnose this disease leads to, unfailingly to those who suffer from it and their families, to wander over the years looking for a answer.

Index

1. Definition of Tourette Syndrome
2. Tics: Definition
3. epidemiology
4. Historical aspect of the disease
5. The case of Mozart
6. Ethiopathogenesis
7. Clinical manifestations

Gilles de la Tourette syndrome (TS) is a

This disease has also had different names o synonyms What:

• Multiple Chronic Tics.
• Gilles de la Tourette, Syndrome
• Habitual Spasm Syndrome.
• Paulitis.
• Chronic Motor Tic.
• Tourette Syndrome

In general, the symptoms of Gilles de la Tourette Syndrome are manifested in the individual before 18 years old old. (TS) can affect people of any ethnic group: men are affected 3 or 4 times more than women.

The natural course of this disease varies between patients, ranging from mild to very severe but in most cases they are moderate.

However, it is necessary to take into account certain features of the syndrome that recur among patients, they are:

• Usually has an early onset in childhood
• Is hereditary
• It is neurological, and not psychological
• It affects more males than females
• Does not get progressively worse

But before defining and determining the characteristics of the disease, we must specify and explain what a tics is.

An early definition of tics was given by Meige and Feindel in 1907, who define them as follows:

"A tic is an intentional coordinated act, caused in the first instance by some external cause or by an idea; repetition leads to its becoming habitual and eventually to its involuntary reproduction without cause and without any purpose, at the same time that its shape, intensity and frequency; thus it assumes the character of a convulsive, inopportune and excessive movement; its execution is usually preceded by an irresistible impulse, its suppression is associated with discomfort. The effect of distraction or volitional effort is to decrease your activity; disappears during sleep. It occurs in predisposed individuals, who usually have other indications of mental instability."(Ollendick, 1993, p. 322).

A tic is a problem where a part of the body moves repeatedly, quickly, suddenly, and without control. In other words, they are involuntary, sudden, rapid, recurrent, arrhythmic, and stereotyped movements or vocalizations.

This disorder occurs more in children than adults and more in boys than in girls, considering the appearance of tic before the age of 18 as a criterion (Ollendick, 1993; DSM-IV, 1995).

Tics etiology

For Azrin and Nunn (Bados, 1991, Ollendick, 1993), a tic begins as a normal reaction to psychological trauma or physical harm, or as normal but infrequent behavior. The movement integrates with normal movements and activities in such a gradual way that it escapes personal and social awareness. Then, for unspecified reasons, the movement especially increases in frequency and becomes a strong habit that again escapes personal consciousness due to its automatic nature.

In some special cases of tics, it may happen that some muscles are more required, while its antagonistic muscles are left unused, thus making inhibition of the tics. Tolerance of tics by other people, especially relatives and close people, and even the social reinforcement of them in the form of attention or sympathy strengthens the occurrence of the tics.

The Tics. Generalities

Tics can occur anywhere on the body, such as the face, hands, or legs. They can be stopped voluntarily for short periods. Sounds that are made involuntarily are called vocal tics.

The most common tic seen in children is the "transient tic disorder", which can affect up to 10% (percent) of children in the first years of school. Teachers and others notice your tic and think you must be stressed or "nervous." These transient tics go away on their own over time.

Most of the tics are mild and hardly noticeable. However, in some cases they are very frequent and severe and can affect many areas of the child's life.

Children who suffer from these tics, suppressing them causes an effort very similar to suppressing a sneeze. Eventually, the stress of skipping a short-term tick builds until the tick escapes.

That is, these Tics can be suppressed voluntarily, for minutes or hours, but most experience them as irresistible.
Tics get worse under certain circumstances such as stress, hours of tension or pressure; and they improve when the person is relaxed, focused, or absorbed in an absorbing activity or work. In most cases the tics decrease markedly while the child falls asleep.

It is very characteristic that people with these Tics often look for a secluded place where unleash your symptoms after you have been holding them during school or work hours.

The tic can appear at any time of day, apparently, unrelated to anything else you are doing in that same period. Also the tics unexpectedly after months or years of frustrated attempt to "stop doing them", systematically disappear and are replaced by other tics.

Some tics never go awayIn other words, tics that last for more than a year are called "chronic tics." These chronic tics affect less than 1% (one percent) of children and may be related to a rare and special tic called "Tourette's disorder."

These kids with Tourette's disorder have body and vocal tics. Some usually disappear after adolescence and others continue. Children with Tourette's disorder may have problems with concentration and attention, they may also act impulsively, or develop obsessions and compulsions.

Classification of Tics

The two categories of tics in Gilles de la Tourette syndrome and some common examples are:

1- Simple:

They are brief repetitive movements that involve a limited number of muscle groups, these occur in a singular or isolated way and are often repeated.

• Engines: Simple motor tics are those characterized by repetitive and rapid contractions of functionally muscle groups similar, for example: continuous blinking of the eyes, shaking of the head, shrug of the shoulders, and grimaces or gestures facials.
• Vowels: Simple vocal tics include coughing, clearing, grunting, barking noises, breathing heavily through the nose, blowing, sniffing, tongue flicking, and more.

2- Complexes:

They are successive coordinated movements involving several muscle groups.

• Engines; jumping, touching other people or things, sniffing, spinning, echopraxia, coproparxia, and rarely acts of self-harm, including hitting or biting.
• Vowels; the expression of vocabulary or phrases out of context, coprolalia, (the use of obscene words in public), palilalia and echolalia.

Simple tics are considered less severe than complex ones.

3- Some others are:

Jumps in the eye; eat nails; cough; whistle; buzz; stutter; sudden change in tone of voice, speed, or volume.

The variety of tics or tic-like symptoms that can be found in Gilles de la Tourette Syndrome is enormous. The complexity of some symptoms often confuses family members, friends, teachers, and entrepreneurs, who may find it hard to believe that the actions or words uttered are involuntary.

It is perceived that saying bad words is often the most painful and dramatic aspect of the Gilles de la Tourette syndrome This has received the medical term of coprolalia. (Latin: lips of feces).

According to the classification of Tics proposed by the DSM - IV:

Bados (1995), in his book "Tics and their disorders" presents a table with examples of different kinds of tics and their percentage of frequency.

The classification made by Shapiro in his study considers two other types of tics that Bados (1995) also mentions. Sensory tics which are recurring involuntary sensations in the joints, bones, muscles or other parts of the body; These sensations include heaviness, lightness, emptiness, tingling, cold, heat, and strangeness. They occur in at least 10% of patients with TS. On the other hand, the cognitive tics which are defined as repetitive thoughts with aggressive content that do not provoke fear or neutralizing actions. According to preliminary data, they can occur in 66% of patients with TS.

The prevalence of Gilles de la Tourette's disorder is between 5 and 30 per 10,000 children. It happens three times more frequently in men than in women.

The average age of onset is seven years, but it can occur as young as two years. In general, symptoms are more severe during the first decade of illness, then gradually improve; It should be remembered that the onset of the disease occurs in most cases before the age of 21.

According to the articles in the Course on Tic Severity in Tourette Syndrome: The First Two Decades, Pediatrics, July 1998 by James F. Leckman; Heping Zhang; Amy Vitale; Fatima Lahnin; Kimberly Lynch; Colin Bondi; Kim YoungShin; and Bradley S. Peterson. According to these studies, the prevalence indicates a ten-fold higher rate of Tourette syndrome (TS) among children compared to adults; 42 patients with (TS) were taken at the Yale child's study center, yielding Sig. Result: Tic onset at 2.3 years of age was followed by a progressive pattern of tic worsening. On average, the most severe period of tic severity occurred at 2.4 years of age.

The official estimate, according to the National Institutes of Health, is that 100,000 Americans have TS. The most recent genetic studies suggest that this figure could be in the proportion of one in each two hundred people, if the account includes those with multiple chronic tics and / or transient tics of the childhood.

It is that winks, sighs, throat clearing, and, in general, all those sudden, repetitive and involuntary movements that some people make, involve many more than everyone imagines. Studies carried out in the United States estimate that 1% of the population would suffer from them, a figure that may be short considering that a third of those affected do not realize their disorder.

There are historical information scales, direct observation scales, or scales that combine history and direct observation.

Between the historical information surveysSelf-report instruments are included, for parents and patients.

These scales are useful in massive epidemiological studies, in family genetic studies, in longitudinal evaluations of the natural course of the disease and of the response to therapy. The most widely used scales are the "Tourette Syndrome Questionnaire"(TSQ) and the"Tourette Syndrome Symptom List"(TSSL).

The direct observation scales they can be applied in the classroom, home, or clinic. The evaluation can be done by the teacher, the parents or the doctor. These scales have been used to document changes in treatment studies.

The disorder is named after the doctor Dr. Georges Gilles de la Tourette, who was one of Charcot's favorite students, he worked at Salpêtrière in the studies of new therapeutic techniques such as suspension, vibration and hypnotherapy.

Gilles de la Tourette's most substantial achievements were in the study of hysteria and the medico-legal ramifications of hypnotism. He was a dynamic man, open passionate, he reflected his own obligations, as well as the interests of his bosses, his dear to him Brouardel and Charcot.

Georges Gilles de la Tourette paradoxically by his disturbed behavior of him in 1902 necessitated his retirement from the professional sphere, and the internment of her, dying in a mental hospital in Lausanne in June 1904.

Leon Daudet (1867-1942)

This pioneering French neurologist who described in the Medical Literature, and in the annals of psychiatry, the The first case in the year 1875 in this describes an 86-year-old French noblewoman named, La Marchioness of Dampierre (known for her exquisite manners), whose symptoms included the involuntary tics in many parts of her body and several vocalizations including coprolalia and echolalia; "... he abruptly changed her civic behavior; In front of the guests and her servants she began to bark like a dog, to meow, to insult her companions or to say obscenities. The noble lady seemed possessed by the devil... ".

Dr. Georges Gilles de la Tourette.

"... The Marquise de Dampierre, hostess of a literary salon where they frequently met, used to incur in sudden movements and bruises, accompanied by profanity "unfit for hers high rank",..."

Dr. de la Tourette

The Marchioness of Dampierre only lived to be 86 years old, and the writings of Dr. G. Gilles where he talks about his patient:

The Marchioness of Dampierre:

"... at the age of 7 she was afflicted by convulsive movements of her hands and arms... She felt like she was suffering from overexcitement and mischief, and... she was the object of reprimands and punishments. It soon became clear that these movements were truly involuntary... it involved the shoulders, neck, and face, and resulted in extraordinary contortions and grimaces. "

Sixty years later, this French neurologist and disciple of Charcot, reviewed this case and added that of other patients. In her original description of her syndrome, she highlights the triad which includes:

• Multiple tics
• Echolalia (repetition of words or phrases of others).
• Coprolalia.

Conscious or not, the concrete thing is that such famous figures as Napoleon, Moliere, Peter the Great, Samuel Johnson, Mozart (who, in addition to her motor tics, she wrote scribbles, which is known as coprography) and the French writer André Malraux had to live with his tics.

In the publication Neurologics Clinics of North America, published in May 1997 and devoted entirely to Tourette syndrome, it is mentioned that historical figureslike Dr. Samuel Johnson, Napoleon and Mozart suffered from neurological disorders characterized by the presence of tics.

From the careful review, carried out by Dr. Benjamin Simkin, of the letters written by Mozart to family and friends, obtained data indicating that the musician suffered from Gilles de la syndrome. Tourette.

In his article "Mozart's scatological disorder", published in the British Medical Journal in 1992, Simkin points out that 39 of the 371 letters written by Mozart have eschatological references. Many of these letters are peculiar for their obvious puns, for the repetition of words heard or written by someone else. (echolalia) and by repeating his own words (palilalia).

The evidence for tics arises from material contributed by his earliest biographers. Among them, Schlichtegroll writes about Mozart: "His body exhibited a perpetual wiggle; he played incessantly with his hands, or continually kicked the floor. "

A direct quote is that of a person who was in daily contact with him: his sister-in-law, Sophie Haibel, who He describes it as follows: "Even when he washed his hands in the morning, he walked from one side of the quarter…he never stood still... She often made weird grimaces with her mouth... She was always playing with something, with her hat, her pockets, with the table or chairs, as if they were a keyboard. "

Joseph Lange, a famous actor, recalled in his memoirs: "On many occasions, Mozart not only spoke confusedly, but often made gestures one did not expect of him and always deliberately disregarded his behavior. There were great contrasts between the divine ideas of his music and his sudden outbursts of vulgar trivia. "

According to Simkin, the accumulation of evidence that he gathers in his article supports the idea that the phenomenal composer met the general criteria for Tourette syndrome. But he argues, in the case of Mozart and many others, that the fact of greatest interest is establishing the relationship between genius and such disorders.

Dr. Gloria I. Menendez.

In the first decades of this century, psychoanalysts focused on symptoms, as a hidden assault and its analogues. Since 1980 and to the present day, there has been a marked increase in TS research and it is again recognized that Tourette Syndrome is not a psychological disorder or neurosis, but it has bases, both biological and neurological.

Obey a malfunction of certain brain structures such as the basal ganglia, in charge of controlling the movement. Current research suggests that there are abnormalities in genes affecting metabolism and producing an imbalance in brain neurotransmitters such as dopamine, serotonin, and norepinephrine.

The influence of testosterone to explain the predominance in males.

But a biological reason that explains the etiology of this disease "Gilles de la Tourette's disorder", is the compromise in the dopamine system. This theory is based on the fact that pharmacological agents that are dopamine antagonists, such as haloperidol, suppress tics. and those that increase central dopaminergic activity, such as methylphenidate, amphetamines, and cocaine, tend to exacerbate tics.

It has been postulated that there are abnormalities in dopamine receptor function, perhaps in specific regions, derived from an excessive postsynaptic sensitivity of the receptor.

There are low levels of the dopamine metabolite homovanillic acid (HVA) in cerebrospinal fluid and tissues. These low levels of HVA may arise from a decreased dopamine transaction, which would result from postsynaptic hypersensitivity. However, autopsy and positron emission tomography studies have not found an elevation in the density of dopamine D1 or D2 receptors that indicates hypersensitivity. It has been observed that in monozygotic twins with severe discordant disorder, there are differences in the binding of the dopamine D2 receptor at the head of the caudate nucleus.

Anomalies have been implicated in the noradrenergic system, due to the reduction of tics by clonidine in some cases. This drug is believed to directly decrease the firing rates of noradrenergic neurons and indirectly modulate the activity of dopamine neurons. Adults with Gilles de la Tourette's disorder have elevated levels of norepinephrine in the cerebrospinal fluid, a response blunted growth hormone to clonidine and abnormally high urinary norepinephrine secretion in response to stress. However, studies of the norepinephrine metabolite 3-methoxy-4-hydroxyphenylethylene glycol (MHPG) have been inconclusive.

Postmortem studies have shown that 5-hydroxytryptamine (5-HT) and its metabolite 5-hydroxyindoleacetic acid (5-HIAA) can be decreased in the basal ganglia and other brain regions of patients with Gilles de la Tourette. Studies in cerebrospinal fluid have reported decreased levels of 5-HIAA. The levels of 5-HT and tryptophan in the blood have also been found to be reduced. It was hypothesized that there may be alterations in serotonin receptors or tryptophan oxygenase.
Furthermore, specific serotonin reuptake inhibitors have been shown to have little efficacy against tics.

Endogenous opioids have also been implicated in tic disorders, because pharmacological agents that are antagonists of These, for example naltrexone, reduce tics and attention deficit in patients with Gilles de la's disorder. Tourette.

No gross structural lesions have been demonstrated by computed tomography or necropsy in patients with Gilles de la Tourette's disorder. However, studies with volumetric magnetic resonance techniques have suggested a reduction in the volume of the left lenticular region (putamen and globus pallidus).

When discordant monozygotic twins were compared by degree of severity of the disorder, it was found that who was more severely affected had a smaller right anterior caudate and a lateral ventricle left.

Finally, functional imaging studies with positron emission tomography have shown a decreased use of glucose in the basal ganglia.

Genetic investigations of the syndrome

Exists, a hereditary correlation, between monozygotic twins if one of them has tics, there is 90% that the other brother suffers from tics; if it is a dizygote twin, there is still 30% to have it (Chandler, 1997).

As a psychological cause, we could attribute it to the product of environmental factors and learning, especially within the family; it is also associated with mental retardation, hyperactivity, and other developmental disorders.

Genetic research evidence suggests that ST is hereditary in a dominant way and that the gene (or genes) involved can cause a variable range of symptoms in different members of the family. A person with (TS) has a 50-50 chance of passing the gene (s) to one of their children. However, this genetic predisposition does not necessarily result in the full syndrome. Instead, the syndrome is expressed in milder tic disorder, obsessive-compulsive behavior, or attention deficit disorder with little or no tic.

It is currently known that there is a higher than normal incidence of mild tic disorders and obsessive-compulsive behaviors in families of patients with TS.

It is also possible that the offspring that carry the gene do not develop any symptoms of TS. A higher than normal incidence of mild tic disorders and obsessive-compulsive behaviors has been found in the families of individuals with TS.

Gender plays an important role in the genetic expression of (ST). If the offspring of a patient with (TS) that carry the gene is male, the risk of developing symptoms is 3 to 4 times higher.

In other words, the chances of a child suffering from a disorder characteristic of people with TS is at least three times higher in males than in females. Still, only about 10 percent of children who inherit the gene would have symptoms severe enough to receive medical treatment.

However, most people who inherit the genes do not develop symptoms severe enough to warrant medical treatment. In some cases inheritance cannot be established. These cases are called sporadic and their cause is unknown.
Researchers are currently conducting genetic linkage studies in families. large multigenerational patients affected with (TS) in an effort to find the chromosomal location of the gene or (ST) genes. Finding a genetic marker (a biochemical abnormality that all TS patients share) would be an important step in understanding the genetic risk factors for TS.

Anamnesis of the patient with Gilles de la Tourette syndrome

The evaluation should consider the following variables:

• First: How many types of tics does the patient show?
• Second: What is the frequency of presentation?
• Third: What intensity does the patient report?
• Quarter: How complex are they?
• Fifth: What is the distribution in the body segments?
• Sixth: What capacity does the patient have to suppress them?
• Seventh: What capacity does it have to interfere with daily activities?

The normal and desirable thing is that the doctor begins the exploration of the problem with an interview with the child and his parents, guardians or other significant others. The following aspects should be obtained from it.

• Data personal and family.
• Characteristics of tics: specific description of each tic, number, frequency, intensity and complexity of the tics, the degree to which can be suppressed, presence of preliminary sensations, possible existence of sensory tics and cognitive
• Influencing factors: variables associated with the improvement or worsening of tics, be it stress, fatigue, drugs, drugs, etc.
• Repercussions of the problem: impact on relationships with different people, at school or at work, on the emotional area and self-esteem, on the experience of pain and on the risk of physical harm.
• History of the problem: age of onset, circumstances associated with onset, improvements and deteriorations, and possible factors responsible for both, identification of the different tics had and duration of these until their disappearance or replacement for another tick.
• Previous and current treatments: specialists visited, treatments received, duration, results and side effects thereof, degree to which the treatment prescription was complied with, etc.
• Motivation, objectives and expectations: whose initiative has been to seek treatment, the extent to which the parents and the child are interested in solving the problem problem and willing to actively participate in treatment, what is to be achieved, what type of treatment is desired receive.
• Resources and limitations: who are willing to help and in what way, who can interfere, positive and negative aspects of the child that can work for or against solving the problem.
• Exploration of possible associated problems:
  1. Inattention, impulsivity, hyperactivity.
  2. Obsessive-compulsive symptoms
  3. Drives
  4. Learning difficulties
  5. Emotional instability
  6. Irritability, aggression
  7. Elevated anxiety, phobias, separation anxiety
  8. Depression

When these problems are more disturbing than the tics themselves, they should take priority in treatment.

• Family background: presence of tics and other possible associated problems in first and second degree relatives.
• Evolutionary history, medical and psychiatric: adverse prenatal and perinatal events, difficulties in the part, developmental delays, taking CNS medications, previous and current illnesses, operations and accidents, psychological or psychiatric problems and disorders previous.
• Family situation, social and school (or work): relationship with family and colleagues, achievements and difficulties at school and, where appropriate, at work.

The interview provides a qualitative information on the problemHowever, there are scales and questionnaires that provide a more precise, systematic and quantified evaluation of Certain aspects of the disorder and the results of the intervention can be achieved with the use of scales and questionnaires.

As already mentioned, the clinical manifestations are characterized by the appearance of multiple motor tics and one or more vocal tics.
These Tics previously described affect different parts of the child's body; In order of Frequency they would affect:

• Head.
• Arm and hands.
• Trunk and Lower Extremities.
• Respiratory and Digestive System.
• Tics most commonly described are those that affect the head and neck, such as: gestures, wrinkling the neck, closing the eyes, raising the eyebrows, winking one eye, wrinkling the nose, shaking the nostrils, contracting the mouth, showing the teeth, bite the lips or other parts, stick out the tongue, protrude the lower jaw, nod, move the head, twist the neck, look to the sides and rotate the head.
• They are followed by those who affect arms and handsExamples of these are: shaking your hands or arms, stretching your fingers, twisting your fingers, and clenching your fists.
• Those that affect the trunk and lower extremities are also observed, such as: shrugging the shoulders, shaking feet, knees or a joint, gait peculiarities, twisting the body and jumping.
• There are other tics that affect the respiratory and digestive systems, such as: hiccups, sighing, yawning, sniffing, exaggerated breathing, burping, sucking, or making tasting, clearing sounds.
• The most common initiating symptom is tic of flicker, followed by shaking the head or making a facial gesture.
• Most of the complex motor or vocal symptoms appear several years after the initial symptoms. Coprolalia usually begins in early adolescence and occurs in one third of all cases, the so-called mental coprolalia, in the who thinks a word or has an obscene or socially unacceptable idea, these people often shout obscenities or rudeness unwittingly.
• Repeating the words of others constantly (echolalia) or the urge to repeat someone else's words, sometimes in conversations, insignificant words or the end of sentences, which somehow capture the patient's attention and he feels obliged to repeat them.
• Sometimes they touch other people excessively or repeat actions obsessively and unnecessarily. Some patients with severe TS show behavior self-mutilating like biting your lips or cheek and hitting your head against hard objects.
• Symptoms vary spontaneously, decreasing in the morning in 40% of patients, in the months summer in 19% and when the patient is with strangers, with the doctor, at school or in the job. Instead they increase with anxiety or when the patient is with the family.
• The urge to imitate the actions of other people (Ecopraxia); This patient finds himself repeating each foot drag, or else he walks behind someone and imitates her gait.
• The urge to repeat your own words or thoughts Palilalia, "The patient finds that those people around him often think that he is speaking to them; but it is only that the patient maintains and external his thoughts aloud "
• Other repetitions: Many of these patients report that they sometimes find themselves in a repeating cycle of actions or thoughts. Often they feel that the only way to end these repetitions is with a tic.

When my friends and I drive somewhere, I often find myself repeating words I read out loud. The conversation is something like:

"Laundromat."
"What?"
"Oh nothing."

But if something characterizes Gilles de la Tourette syndrome in History, it is Coprolalia, or saying bad words
This is in my opinion the best known, dramatic and in some way sensational characteristic of this syndrome. Flashy titles like "Damn Disease" or "The foul-mouthed syndrome" They were used. Sadly, it is often the only aspect of Gilles de la Tourette Syndrome (TS) that is commonly known (and made fun of.)

The truth is that swearing is not a universal symptom of TS. Coprolalia (Latin: stool lips) occurs in about 8 to 30 percent of cases, and often remains in only one phase of a person's life.
Coprolalia can be one of the most distressing and yet fascinating aspects of TS.

Many of those who show coprolalia live in environments where speaking obscene words was not allowed or forgiven. Many do not forgive themselves for being insulting. Coprolalia can also cause social problems, creating the false impression that this person is offending others.

Likewise, it is for this reason that tournetics many times and erroneously have been thinking that they suffer from a moral deficiency, and that TS is a psychological disorder.

This peculiarity of saying obscene words has its rational explanation that's why saying obscene words is considered reprehensible, or if you insult yourself, bad words often carry emotionally strong value - that's their purpose, after all.

Although it is specified that the way in which profanity is determined is through cultural and not biological analysis, it is possible that, when the individual grows and learns its meaning, these are "stored" in relation to certain specific emotional systems of the brain.

There are bad words that are more preferred than others. It seems as if the most common offensive words have a certain sound quality that gives them a certain sharpness; such as explosive consonants or repetition of phonemes (examples of phonemes: mata and bata, sal and sol, etc). These same aspects make them ideal for tic. In fact, other vocal tics often seem to carry a certain rhythmic quality.

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

If you want to read more articles similar to Gilles de la Tourette syndrome (or tic disorder), we recommend that you enter our category of Neuropsychology.