Neurology:
Tourette's is a neurological disorder in which one experiences both motor and verbal tics. There are a myriad of tic disorders, but the defining aspect of Tourette's is the presence of at least one motor and one vocal tic each. These are caused, it's believed, by malfunctions in the dopamine system, dopamine being a neurotransmitter. What happens, essentially, is that excess dopamine rushes through the system at uneven intervals, causing parts of the body to move on their own, and on occasion a scarcity of dopamine can cause body parts to become stiff and immobile. This dis-regulation is the heart of the disorder.
Cases vary greatly in severity. Tics can be as small as a grimace and a cough, or as wild as full-body thrashing and ear-splitting screams. Sometimes tics can be immobilizing, or they can look like seizures or seem purposeful, though they are most certainly not. I'll provide a thorough list of tics at a later date for your perusal (though to call any list of tics "complete" would be utter hokum), but for now keep these generalities in mind.
Interestingly enough, the nervous system is not all that's affected by Tourette's Syndrome. In the brain, we have four motor cortices, and in a typical human being, only two are active at a time. However, in an individual with Tourette's all four cortices are active at once, which can make it more difficult to multi-task, but can also cause the individual to feel a need to multitask; in my case, I need to always have something to do with my hands. If I don't have anything to do with my hands, I end up ticking more frequently, and I'll wind up chewing my nails and fingers.
The four cortices being active at once mean that the individual is trying to both watch and do, listen and speak. Overactive mirror neurons in the supplementary motor cortex are believed to be partially to blame for some tics, echolalic and echopraxic tics in particular, and are likely the reason that it can be so easy to set someone off.
Research and Statistics:
Now you may have noticed that I've been speaking in uncertainties. The reason for this is simple: there aren't many certainties. Tourette's being a relatively rare disorder, which isn't deadly or, in and of itself, harmful, it's pretty low on the radar of the public. There isn't much research being done, and what is being done isn't getting big-money funding or huge pushes from a large and concerned populous. "Tourette's" isn't in the common vocabulary as anything other than a joke; most people don't believe it's real, even if they've heard of it at all, and most kids who have it don't realize that they do.
The statistics are about one in every three-to-eight hundred children, but as our understanding of the disorder becomes more prevalent and parents become a little more understanding of the honesty of their children, we find that the disorder may be more common still--perhaps as many as one in every hundred children afflicted, the ration male: female being 3:1. Most children have only small tics--coughs, trills, finger-snapping, grimaces, blinks, etc.--which can be seen as nothing more than annoying habits by adults and lead to the absence of diagnosis.
Children typically begin to show signs of tics between the ages of seven and twelve, but I've heard of children showing their first signs as young as two and as old as thirteen. A childhood disorder, the onset cannot begin in adulthood, as that would be an entirely different type of tic disorder. It's commonly said that tics start to decline around the age of eighteen and may disappear altogether in adulthood, likely due to the adult's ability to control their own environment, craft their own schedule, and better regulate their moods. However, Tourette's does not stop when you get older; even if symptoms decrease, in times of stress tics are likely to return, no matter how infrequent, and the more research I do, the less true the myth of "never after eighteen" seems to be.
Diagnosis:
Diagnosis is a very simple process. Once my tics became more violent and noticeable, we went to our family doctor. He knew nothing about Tourette's, but tested my blood, found nothing, gave us a tentative diagnosis and sent us to a neurologist. Our neurologist interviewed me, performed a series of tests to check for a brain tumor, and handed me a slip to give to the school nurse. It's a simple process because, like I said, there hasn't been too much research done.
Medications and Co-Morbid Disorders:
Now when the family doctor first saw me, he prescribed fifty mg Clonidine twice a day, which did nothing and may have worsened the symptoms. When I saw the neurologist, he upped the dosage and told me that if after a certain amount of time it continued to be ineffective, I should wean myself off the meds. That's what I wound up doing, and come to find out, Clonidine is a drug used to treat ADHD and high blood pressure, which doesn't actually surprise me. Due to history of heart problems and a desire to keep my mental functions intact, we chose not to medicate further and simply deal with the severe case I was dealt.
The truth is, there are no medications for Tourette's Syndrome, due again to rarity and poor amounts of research. There are seizure medications, which can either help to plug up parts of the brain that might cause tics, or can do absolutely nothing for the syndrome. The drugs can be very harmful to the heart and can cause your mind to become foggy and dull; to some people, it's worth it, but personally I couldn't stand feeling like I was running at only sixty percent just to keep myself from spasming. Tourette's can have my body, but it sure as fuck can't have my mind.
Since you can't treat the Tourette's itself (not effectively, at least), what most people do is treat the co-morbid disorders. Very rarely does Tourette's occur all on its lonesome--probably due to the neurological nature of the disorder, most people have something co-morbid, usually OCD or ADHD, but it can also be anxiety disorders, poor impulse control, neurological disorders, mood disorders, behavioral disorders, developmental disorders, etc.. Recently, DD officials have been opening their eyes to the possibility of certain "behaviors" in their populations being not "behaviors" at all, but tics. Often we find that if you treat the co-morbid disorder, the tics decrease, largely because stress is a huge source and instigator of tics. The less stress a child feels, the less apt they are to tic, and the more likely their tics are to be harmless.
Pet Peeve: People who call it Tourette or Tourettes Syndrome. It's called Tourette's Syndrome because it's named for Georges Albert Édouard Brutus Gilles de la Tourette, a French physician and neurologist who documented nine cases in his lifetime.
Part Two will be about the more personal aspects of Tourette's Syndrome, so be on the lookout! If anyone out there has anything to add about the neurology of Tourette's, feel free to comment!
