Understanding Tourette syndrome

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Last summer I worked as a camp nurse. One of the campers was taking medication for Tourette syndrome (TS). What do I need to know about TS in children?—T.K., OHIO
Roxanne Ferguson, EdD, RN, and Bridget Parsh, EdD, CNS, RN, respond: TS typically appears in children around the ages of 5 to 10 years.1 The first sign is often a motor tic affecting the head or neck. A tic is a sudden, brief, intermittent movement in the face, legs, arms, or trunk. Vocal tics usually consist of unusual utterances, such as repeated syllables and phrases, obscene words, or others' words.1-3 A person with TS may have a warning feeling or sensation, which goes away when the tic occurs.2
Tics may be simple or complex. Simple tics take the form of eye blinking, facial grimacing, shoulder shrugging, and head jerking.3 A complex tic, on the other hand, may include bobbing of the head with arm jerking and then jumping.1 Many children exhibit a complex sequence of movements such as a bizarre gait, kicking, jumping, body gyrations, scratching, and seductive or obscene gestures. Although the signs of TS vary from person to person and range from very mild (simple, brief, repetitive movements) to severe (distinct coordinated patterns of movement involving several muscle groups), most cases are considered mild.4 Most people with TS and other hyperkinetic movement disorders lead productive lives with no barriers to achievement in their personal and professional lives.1-4
The diagnosis of TS requires the presence of multiple motor tics and at least one vocal tic that's continued for at least 1 year.5 These tics don't have to occur at the same time or every day, but they need to have started before the age of 18 and not be related to medication administration.5
TS often occurs with other psychiatric disorders and behavioral problems such as attention-deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder (OCD), and learning disabilities.6 Most patients have a family history of tics, TS, ADHD, or OCD. TS occurs in all ethnic groups, but more frequently in non-Hispanic White children than in non-Hispanic Black children.1
TS can't be cured. Patients should understand that the clinical manifestations of TS may decrease during adolescence and early adulthood, or they may increase in intensity.6 Multiple treatment modalities can help them deal with the signs and symptoms.7 Treatment includes medications such as antidopaminergic drugs, alpha-adrenergic agonists, and botulinum toxin injection; behavioral therapy, including habit reversal; and comprehensive behavioral intervention.2 Attending a camp for children with TS may promote overall social self-confidence and a strong sense of community with peers.8
Increasing public awareness and understanding of the disease is of paramount importance so that children won't be subjected to teasing and bullying.9 Nurses can help people with TS to live full, productive lives.
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