Instruct: Given a question, retrieve passages that can help answer the question.
Query: Will therapy help Tourettes?
Habit reversal training (HRT), massed negative practice, biofeedback, relaxation, hypnosis and other behavioral approaches are proposed as alternative treatments of tics, but few have been well assessed.[19] Relaxation techniques, such as exercise, yoga or meditation, may be useful in relieving stress that may aggravate tics, but the majority of behavioral interventions (such as relaxation training and biofeedback, with the exception of habit reversal) have not been systematically evaluated and are not proven therapies for Tourette's.[20]
Findings reported in published studies of Tourette syndrome since 1999 have advanced TS science in the areas of genetics, neuroimaging, neurophysiology, and neuropathology. The TAA supports a clinical database that may help identify genes involved in Tourette syndrome, and the TSA International Genetic Consortium has collected a database on large extended families for future studies. Novel neuroimaging studies are being employed to study tic expression and functional or cognitive deficits in TS patients. Studies of Tourette's neurophysiology and neuropathology are attempting to link deficits in Tourette's to specific brain mechanisms, and have taken advantage of a brain bank sponsored by the TSA. Clinical trials have focused on understanding tic suppression, comorbid conditions, novel treatment approaches such as botulinum toxin, and targeted behavioral therapies. Controversy remains in the areas of deep brain stimulation and PANDAS.
The exact cause of Tourette's is unknown, but it is well established that both genetic and environmental factors are involved. Genetic epidemiology studies have shown that the overwhelming majority of cases of Tourette's are inherited, although the exact mode of inheritance is not yet known and no gene has been identified. In other cases, tics are associated with disorders other than Tourette's, a phenomenon known as "tourettism".
There is no cure for Tourette's and no medication which works universally for all individuals without significant adverse effects;[3] knowledge and understanding are the best treatments available for tics.[2][4] Management of the symptoms of Tourette's may include pharmacological, behavioral and psychological therapies. While pharmacological treatment is reserved for more severe symptoms, other types of treatments may help avoid or improve symptoms of depression or social isolation, and improve supportive family functioning. Educating the patient, family, and surrounding community (school, church, friends, etc.) is a key part of treatment.[1]
The Shapiros, working with the patient families who founded in 1972 the Tourette Syndrome Association (TSA, renamed to Tourette Association of America in 2015), advanced the argument that Tourette's is a neurological, rather than psychological, disorder, and worked to persuade the media to promote information about Tourette's. Although the original case reports of TS were by French neurologists, the "focus moved to New York in the 1970s" and "the centre for the most committed progress in TS continued to be the USA, facilitated by the success of the Tourette Syndrome Association".
Cognitive Behavioral Therapy (CBT) is a useful treatment when OCD is present.[23]
Causes and origins of tinnys Tourette syndrome have not been fully elucidated. Tourette syndrome (also called "Tourette's syndrome", "Tourette's disorder", "Gilles de la Tourette syndrome", "GTS" or "TS") is an inherited neurological disorder with onset in childhood, characterized by the presence of multiple motor tics and at least one phonic tic, which characteristically wax and wane. Tourette's syndrome occurs along a spectrum of tic disorders, which includes transient tics and chronic tics.
The exact cause of Tourette's is unknown, but it is well established that both genetic and environmental factors are involved. The overwhelming majority of cases of Tourette's are inherited, although the exact mode of inheritance is not yet known, and no gene has been identified. Tics are believed to result from dysfunction in the thalamus, basal ganglia, and frontal cortex of the brain, involving abnormal activity of the brain chemical, or neurotransmitter, dopamine. In addition to dopamine, multiple neurotransmitters, like serotonin, GABA, glutamate, and histamine (H3-receptor), are involved.
Tourettism refers to the presence of Tourette-like symptoms in the absence of Tourette syndrome, as the result of other diseases or conditions, known as "secondary causes".
Television shows that are credited with helping to advance accurate information about TS include "Quincy, M.E.", "The Practice" and "7th Heaven". A March 1981 episode of "Quincy" was devoted to Tourette's and orphan drugs; it "not only educated the American public about Tourette's as an organic disorder, but also helped get the then stalled 'Orphan Drug Bill' passed ... into legislation".
Other television and film productions depicting persons with TS, or using coprolalia as a plot device, include an episode of "Ally McBeal", in which Anne Heche portrays a woman with Tourette's whose leg tic causes her to run over and kill her boyfriend; "An Angel on my Tree", an episode of "Touched by an Angel" in which a father commits manslaughter in reaction to an event that involved his son who had Tourette's; an episode of "The Simpsons", in which Bart Simpson is mentioned to claimed to have Tourette's to excuse himself from a test; and an episode of "South Park", "Le Petit Tourette", in which Eric Cartman pretends to have Tourette's to get away with saying offensive things. The episode received a mixed reaction from the Tourette Syndrome Association, which commented that it provided useful information while at the same time perpetuating outright myths about coprolalia and Tourette syndrome.
Complementary and alternative medicine approaches, such as dietary modification, allergy testing and allergen control, and neurofeedback, have popular appeal, but no role has been proven for any of these in the treatment of Tourette syndrome.[5][24] While a balanced diet may aid in overall health, and avoidance of caffeine may help minimize tics for some children,[25] no particular diet or alternative therapy (vitamin or diet) is supported by scientific evidence.[25][19] Regular exercise can help reduce stress and improve a child's sense of accomplishment and self-esteem, but the effect of exercise on symptoms remains unstudied.[25]
Relaxation techniques, such as exercise, yoga or meditation, may be useful in relieving the stress that may aggravate tics, but the majority of behavioral interventions (such as relaxation training and biofeedback, with the exception of habit reversal) have not been systematically evaluated and are not empirically supported therapies for Tourette's. Deep brain stimulation has been used to treat adults with severe Tourette's that does not respond to conventional treatment, but it is regarded as an invasive, experimental procedure that is unlikely to become widespread.
I Have Tourette's but Tourette's Doesn't Have Me is a 2005 documentary film featuring children between the ages of six and thirteen with Tourette syndrome. The film examines the lives of more than a dozen children who have Tourette's, and explores the challenges they face.
Prognosis differs from person to person, and the ideal treatment is not completely understood. Treatment for this disorder gains the best results when tailored specifically for each individual. To date, the mainline pharmacological treatments have been pimozide (a typical antipsychotic which was also approved for treating Tourette's Syndrome), and atypical anti-psychotics like risperidone and clozapine. Non-pharmacologic treatments that have shown some degree of efficacy are electroconvulsive therapy (ECT), supportive psychotherapy, family and environment therapy, rehousing, risk management and treating underlying disorders in cases of secondary erotomania. ECT may provide temporary remission of delusional beliefs; anti-psychotics help attenuate delusions and reduce agitation or associated dangerous behaviors, and SSRIs may be used to treat secondary depression. In delusional disorder there is some evidence that pimozide has superior efficacy compared with other antipsychotics. Psychosocial psychiatric interventions can enhance the quality of life through allowing some social functioning, and treating comorbid disorders is a priority for secondary erotomania. Family therapy, adjustment of socio-environmental factors, and replacing delusions with something positive may be beneficial to all. In most cases, harsh confrontation should be avoided. Structured risk assessment helps to manage risky behaviors in those individuals more likely to engage in actions that include violence, stalking, and crime. For particularly troublesome cases, neuroleptics and enforced separation may be moderately effective.
During 1873 Tourette began medical studies at Poitiers. He later relocated to Paris where he became a student, amanuensis, and house physician of his mentor, the influential contemporary neurologist Jean-Martin Charcot, director of the Salpêtrière Hospital. Charcot also helped him to advance in his academic career. Tourette studied and lectured in psychotherapy, hysteria and medical and legal ramifications of mesmerism (modern-day hypnosis).
Tourette Canada (formerly Tourette Syndrome Foundation of Canada) is a Canadian voluntary organization based in Mississauga, Ontario. It was formed in 1976, and is dedicated to improving the quality of life for those with or affected by Tourette Syndrome through programs of education, advocacy, self-help and support. It has affiliates in eight Canadian provinces.
The show was accused by some of exploiting Bennett's Tourette's syndrome. The Tourette Syndrome Association (TSA) initially expressed concern that others with the condition would be mocked, though they later softened their stance, a TSA spokesperson said: "What it has done is put Tourette's on the map". A Channel 4 spokesperson said "Pete's attitude to his condition is a really positive one and that's helped to educate and inspire people [...] "He's a very positive role model and he's been a great housemate."
Administration of nicotine via transdermal patches was found beneficial,[26] in preliminary case studies, but these effects were not reproduced in well-controlled trials several years later.[5] Studies of nicotine derivatives (mecamylamine, inversine) also showed that they were not effective as a single therapy for the symptoms of Tourette's.[27] Two small, controlled studies have found that capsules of tetrahydrocannabinol (THC), the main psychoactive ingredient of cannabis, helped reduce tics. More research is needed to confirm this low-quality evidence for the effects of THC.[28]
Tourette's is a heterogeneous condition, with waxing and waning symptoms. The inherently changing nature of its core symptoms complicates research design, resulting in questions about medications in clinical practice. Results from case studies may not be borne out by controlled or prospective, longitudinal studies, stimulants may be underused, and behavioral therapies are understudied. High-profile media coverage focuses on treatments that do not have established safety or efficacy e.g., deep brain stimulation, and alternative therapies involving unstudied efficacy and side effects are pursued by many parents.
There is no cure for Tourette's and no medication that works universally for all individuals without significant adverse effects. Knowledge, education and understanding are uppermost in management plans for tic disorders. The management of the symptoms of Tourette's may include pharmacological, behavioral and psychological therapies. While pharmacological intervention is reserved for more severe symptoms, other treatments (such as supportive psychotherapy or cognitive behavioral therapy) may help to avoid or ameliorate depression and social isolation, and to improve family support. Educating a patient, family, and surrounding community (such as friends, school, and church) is a key treatment strategy, and may be all that is required in mild cases.
Medication is available to help when symptoms interfere with functioning. The classes of medication with the most proven efficacy in treating tics—typical and atypical neuroleptics including risperidone (trade name Risperdal), ziprasidone (Geodon), haloperidol (Haldol), pimozide (Orap) and fluphenazine (Prolixin)—can have long-term and short-term adverse effects. The antihypertensive agents clonidine (trade name Catapres) and guanfacine (Tenex) are also used to treat tics; studies show variable efficacy, but a lower side effect profile than the neuroleptics. Stimulants and other medications may be useful in treating ADHD when it co-occurs with tic disorders. Drugs from several other classes of medications can be used when stimulant trials fail, including guanfacine (trade name Tenex), atomoxetine (Strattera) and tricyclic antidepressants. Clomipramine (Anafranil), a tricyclic, and SSRIs—a class of antidepressants including fluoxetine (Prozac), sertraline (Zoloft), and fluvoxamine (Luvox)—may be prescribed when a Tourette's patient also has symptoms of obsessive–compulsive disorder. Several other medications have been tried, but evidence to support their use is unconvincing.
Tourettes: I Swear I Can't Help It is a "QED" documentary made by the BBC in 2009.
There are many individuals with Tourette's, living and deceased, recognized in their fields, or for whom obsessive-compulsive tendencies associated with Tourette's may have helped fuel their success.
Children with Tourette's Syndrome discuss the challenges of living with Tourette's, a misunderstood and often stigmatizing condition. They demonstrate some of their tics, and talk about their lives with tics including embarrassing and isolating situations at school and among friends. Professionals and experts offer further information about Tourette's on the DVD.
Tourettes Action's services include a Helpline, information packs, conferences and workshops, support groups, camps for teenagers, help finding specialists, networks among professionals, ID cards for people with a diagnosis of TS, free monthly email newsletters and an online forum.
In 2015, the Tourette Syndrome Association changed its name to the Tourette Association of America. As of 2006, the Tourette Syndrome Association had contacts in more than 50 countries. The Tourette syndrome International database Consortium (TIC) brought together data on clinical samples of patients with Tourette syndrome from twenty-two countries (Argentina, Australia, Austria, Belgium, Brazil, Canada, Denmark, Germany, Hungary, Iceland, Israel, Italy, Japan, The Netherlands, Norway, People's Republic of China, Poland, South Africa, Sweden, Turkey, the US and the UK); Tourette's has also been studied in Chile, Colombia, Costa Rica, India, Indonesia, Korea, and Spain.