What is Tourette's?

- [Voiceover] So you may
have heard of Tourette's

or Tourette Syndrome before,

and it's possible that when
you think about Tourette's,

you might picture what's
been kinda popularized

in TV shows and movies,

which is that people with Tourette's

have these kind of verbal outbursts.

And while this is possible
in someone with Tourette's,

this popularized image of Tourette's

is actually not all that common.

So if this isn't exactly what
Tourette's is always like,

then what is Tourette's?

Tourette's is a disorder
that causes the person

to make sudden, really brief,
unwanted movements and sounds.

And just before these unwanted
movements or sounds occur,

the person actually feels
this urge to make them.

Kinda like that feeling you get

when you have an itch that
you really wanna scratch.

Or like that feeling we get

just before we're about to sneeze.

And just like itching and sneezing,

right after doing these things,

the person feels a sense of relief.

So an example of an unusual
or unwanted movement

could be something like
unnecessary blinking

or facial expressions, or
maybe shrugging the shoulders

or kicking.

And an unusual unwanted sound

could be something like grunting

or repeating words, or maybe swearing.

And there's actually a word to describe

these movements and sounds.

They're called "tics."

So Tourette's is actually
a particular type

of tic disorders.

There are a few different
types of tic disorders,

and what makes Tourette's
different from the other types

is that someone with Tourette's

has both of these types of tics.

So the movements and the sounds.

They might not occur together

at exactly the same time,

but the person does occasionally have

both movement and sound tics.

And something that's
really unique to Tourette's

and helps set it apart from
other movement disorders

is that many people are able to find ways

to suppress their tics.

So in other words, with effort,

they're able to kind
of push away that urge

to engage in a tic behavior.

But often they'll need to release the urge

in another way,

maybe by performing a
different movement or sound

that is more appropriate
while they're in public,

maybe like blinking or
shrugging the shoulders.

Or, maybe they'll need to
release the urge later on

by actually engaging in the tic,

but this time in privacy.

So you might have been able to guess

from the examples that we put down here,

these examples of possible tics,

that Tourette's can look pretty different

between different people.

And that's definitely the case.

Tourette's is actually
a spectrum disorder,

which means that someone with Tourette's

can fall anywhere along a spectrum

that ranges from mild to severe,

where mild would mean
that the person's tics,

the unwanted movements
and sounds that they make,

aren't really noticeable and
don't really impact their life.

So maybe every so often
they blink unnecessarily

or clear their throat,

something that you might not even notice.

And on the severe end of the spectrum,

the tics that the person has would be

really debilitating.

So maybe their tics involve
really noticeable head-jerking

or saying obscene words.

These sorts of tics could really impact

the person's day to day life,

especially if they occur frequently.

So Tourette's is a disorder
that crops up in childhood,

usually around the age of
about six to seven years old.

And while we haven't
completely figured out

what causes Tourette's,

we do have some clues about the cause.

So, for example, we know that

a lot of people with Tourette's

have parents who also have Tourette's.

And we also know that boys are about

three times more likely
to be affected than girls.

So both of these things suggest

that there's probably a
genetic cause involved,

something going on in the genes

that are being passed
down from the parents

to their kids.

And we also have a clue
about where in the brain

we think things might be going awry.

So we know that in the brains
of people with Tourette's,

there's a particular neural circuit

that doesn't quite function properly.

So bear with me here,

this is a bit of a complex name,

but we'll go through it in a sec.

So the cortico-striatal-thalamic-cortico
circuit

is what's not quite functioning properly.

So "cortico" here stands
for the cortex of the brain,

and "striatal" stands for striatum,

which is part of the basal ganglia here.

And "thalamic" stands for thalamus.

So these structures
normally chat to each other

to coordinate our movements.

So in someone with Tourette's

where this circuit isn't
able to function properly,

that might explain why movements

can't really be prevented
like they normally would be

and the person ends up with tics.

So even though we think we might know

what's going on in the brains

of people with Tourette's,

we don't currently have a
way to actually see this.

We don't have a brain scan or a blood test

to look for and diagnose Tourette's.

So instead, Tourette's is diagnosed

by looking for the movement and vocal tics

in children that we suspect
might have the disorder.

Now, once we determine that someone

does indeed have Tourette's,

what do we do to treat it?

Well, it turns out that for a
lot of people with Tourette's,

the disorder is on the mild
end of the spectrum here

and the tics often actually disappear

or at least improve significantly

once the child reaches adulthood.

So for these people,

we don't usually really
need any medications

to manage the Tourette's,

and instead one of the main things

that we usually do is something called

Habit Reversal Therapy.

Remember how we mentioned

that people with Tourette's
can often find a way

to suppress their tics?

With Habit Reversal
Training, the idea here

is to help the child learn to recognize

those urges that happen

just before a tic is about to occur,

and then try to help them find

a new habit that they can use

to help relieve that urge

without performing the tic.

So maybe their tic is kicking.

And when they start to feel that urge

that would normally be
relieved by kicking,

we get them to itch their nose instead,

and try to relieve the
urge through this movement.

So even though we're kinda trading

one example of a tic for another,

itching the nose is much more subtle

and something that the person
can probably do in public

to relieve the urge they
feel before a tic comes on.

Now, for some people,

they're on the far end of the spectrum.

So their Tourette's is more severe,

and it does impact their daily living.

So when this is the case,

we might need something more

than Habit Reversal
Training to manage the tics.

Now when someone has an
involuntary sound that they make,

or maybe a movement
that just happens to be

in a really specific part of the body,

one way that we might be
able to deal with this

is by going directly to
the problematic body part.

So maybe if it's a movement,

let's say that it's a hand jerk,

we could try to stop that from occurring

by preventing the
messages that neurons send

to that particular muscle
to tell it to move.

And funny enough,

we can actually do this with Botox.

So when we inject Botox into the hand here

that jerks during a tic,

that blocks some of the
signals coming from the neurons

that send messages to the hand

to make it active.

So after the injection of Botox,

the hand can't really be as active anymore

for a few months until
the Botox wears off.

So the tic may not be as noticeable,

or it may not even occur.

Now, sometimes the tics
may not be so localized.

They might be more widespread.

So we might need something that acts

in a little bit more of a
widespread way than Botox does.

So when this is the case,

rather than going to the
muscles involved in the tics,

we might need to head
back up to the source,

the brain,

and try something that
will reduce these movements

in a more global way.

And it turns out that we have

these particular medications

called antidopaminergic
medications that we can use.

So dopaminergic here is
referring to dopamine,

a chemical that neurons can use

to initiate movements in muscles.

So these antidopaminergic medications

they prevent dopamine in the brain

from activating the muscles so much.

So all these extra movements

don't really get initiated,

and the person's tics
hopefully get decreased

or go away.

And it turns out that quite
a few kids with Tourette's

also have other disorders that co-occur

with their Tourette's.

Disorders like attention
deficit hyperactivity disorder,

or also known as ADHD,

and obsessive compulsive disorder,

also known as OCD.

So for kids with Tourette's that also have

one of these other disorders,

they may need to go on a medication

or have some sort of therapy

to help them manage these disorders

as well as their Tourette's.