Clinical features

The symptoms of Tourette's syndrome usually begin at around 7 years of age and become most pronounced at 10-11 years (1).

TS is characterized by the chronic presence of at least two motor tics and one vocal tic since childhood (2).

• tics are sudden, rapid, recurrent, non-rhythmic motor movements or vocalizations (3)
  • it has a waxing and waning course and may vary in frequency, severity, and distribution during the lifetime
    
    
• severity of tics may range from mild symptoms (often go unnoticed) to loud noises and forceful movements that can result in self injury (2)
  • is increased during early teenage years while most cases improve or stabilise after puberty (2)
    
    
• tics can be
  • simple tics
    • motor tics includes, simple tics such as: twitching, eye blinking, facial grimacing, shoulder shrugging, neck stretching abdominal contractions
    • vocal tics or phonic tics include : sniffing, grunting, and throat clearing (1,3)
  • complex tics
    • echolalia - repeating other people's words
    • coprolalia - swearing as a tic
    • copropraxia - involuntary rude gestures (1)
      
      
• motor tics generally precede the development of vocal tics - usually after 1 or 2 years, with <5% of patients developing phonic tics (3)
• complex tics generally appear later than the simple tics (3)

Patients may give a history of preceeding premonitory urges or uncomfortable sensations that are usually localized at the site of the tic. These sensation are often relieved by occurrence of tics (4)

Patients have the ability to suppress their tics for a short period of time (seconds to minutes) This is particulary seen in socially sensitive places such as school or church where children tend to suppress tics (sometimes subconsciously) (2,4)

Anxiety and stress may exacerbate tics while mental and physical tasks that require concentration (sports and music) tend to alleviate tics (2)

Reference:

• (1) NHS 2013. Tourette's syndrome
• (2) Cavanna AE, Seri S.Tourette's syndrome. BMJ. 2013;347:4964
• (3) Cath DC et al.European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment. Eur Child Adolesc Psychiatry. 2011;20(4):155-71
• (4) Kurlan R.Clinical practice. Tourette's Syndrome. N Engl J Med. 2010;363(24):2332-8