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Rady Children's Specialists

Tic/Tourette Clinic

Overview

The Tic/Tourette Center at Rady Children’s Hospital-San Diego provides compassionate care for pediatric and adult patients with tics or Tourette syndrome. In correlation with our Neurology department, our clinic takes a multidisciplinary approach to treating patients with these symptoms and conditions.

We also provide a setting to train fellows, residents, and medical students in caring for our patients, thereby increasing awareness of these conditions among future clinicians.

Treatment

Many patients do not require treatment for their tics. For those that do, behavioral therapy is a popular choice. Behavioral therapy is not a cure but it can help to reduce the number, severity, or impact of tics. It is important to note that even though behavioral therapy can help, this does not imply that tics are completely under voluntary control. Tic disorders are a neuro-biologic condition. Though individuals may have some voluntary control – tics are not produced purposefully.

Behavioral Therapy/CBIT Clinic

In Comprehensive Behavioral Intervention for Tics (CBIT) sessions, a therapist works with a child (and his/her parents) or an adult to better understand the patients’ tics and the situations in which they occur. Changes to surroundings will be made if possible and the individual with tics will also learn a new behavior (competing response) to do instead of the tic. Practice and support for the individual with tics is an important part of the success of this technique. A typical course of CBIT consists of 11-hour-long sessions spread over several months, though some patients may require far fewer. Occasionally, there are additional sessions.

Follow-Up Care

Follow-up care varies depending on the needs of children and adults we evaluate. Milder cases may need education at the first visit and follow-up only as needed if symptoms worsen. Other individuals with more impairing symptoms may opt for medical or behavioral treatments at the first visit, in which case follow-up appointments will be recommended to monitor treatment benefits and possible side effects. Follow-up may also be needed to discuss the results of recommended tests or referrals.

Frequently Asked Questions

Q. What is Tourette syndrome (TS)?
A. A neurobiological disorder characterized by tics (involuntary), rapid, sudden movements and/or vocal outbursts that occur repeatedly.

Q. What are the most common symptoms?
A. Symptoms change periodically in number, frequency, type, and severity, even disappearing for weeks or months at a time. Commonly, motor tics may be eye blinking, head jerking, shoulder shrugging and facial grimacing. Vocal symptoms include throat clearing, sniffing and tongue clicking.

Q. What is the cause of the syndrome?
A. No definite cause has yet been established, but considerable evidence points to abnormal metabolism of at least one brain chemical called dopamine.

Q. How many people are affected?
A. As TS often goes undiagnosed, no exact figure can be given. Authoritative estimates indicate that 200,000 people in the United States may have the disorder. All races and ethnic groups are affected.

Q. Is it inherited?
A. Genetic studies indicate that TS is inherited as a dominant gene, with about a 50 percent chance of passing the gene from parent to child. Sons are three to four times more likely than daughters to exhibit TS.

Q. Is obscene language (coprolalia) a typical symptom of TS?
A. Definitely not. A small minority of individuals with TS have this symptom. The fact that cursing, uttering obscenities, and ethnic slurs stems from an uncontrollable urge to voice the forbidden even when it is directly opposite to the actual beliefs of the person voicing it.

Q. How is TS diagnosed?
A. Diagnosis is made by observing symptoms and evaluating the history of their onset. No blood analysis, X-ray or other type of medical test can identify this condition. The TS symptoms usually emerge between 5 and 18 years of age.

Q. How is it treated?
A. While there is no cure, medications are available to help control TS symptoms. These drugs range from atypical neuroleptics, to neuroleptics, to anti-hyperactive drugs, to antidepressants. Individuals react differently to various medications, and frequently it takes some time until the right substance and dosage for each person are achieved. Almost all of the medications prescribed for TS treatment do not have specific FDA indication for the disorder. CBIT is a behavioral therapy that can be as effective as medication treatment.

Q. Is there a remission?
A. Many people with TS get better, not worse, as they mature. In a small minority of cases symptoms remit completely in adulthood.

Q. Do TS children have special educational needs?
A. As a group, children with TS have the same IQ range as the population at large. But problems in dealing with tics, often combined with attention deficits and other learning difficulties, may call for special education assistance. Examples of teaching strategies include: technical help such as tape recorders, typewriters or computers to assist reading and writing and access to tutoring in a resource room. Under federal law, an identification (“child with a disability”) under other health-impaired category may entitle the student to an Individual Education Plan.

Q. What future faces people with TS?
A. In general people with TS lead productive lives and can anticipate a normal life span. Despite problems of varying severity, many reach high levels of achievement and number in their ranks as surgeons, psychiatrists, teachers, executives, and professional musicians and athletes..

Resources

View our resources page below for helpful documentation and links related to Tic/Tourettes:

Resources

Location

Rady Children’s Hospital-San Diego (Map it)
Tic/Tourette Center
Nelson Pavilion, 3rd Floor
8001 Frost Street
San Diego, CA 92123
Phone: 858-966-5819 (Appointments)
Fax Records to: 858-966-4930